Cabozantinib

How it works

It inhibits multiple receptor tyrosine kinases involved in tumour growth and angiogenesis, including VEGFR, MET and AXL, thereby reducing tumour proliferation and blood supply.

Prescribing in practice

• Can cause serious haemorrhage, gastrointestinal perforation and fistula, so it should be stopped before planned surgery and in patients with severe bleeding.
• Hypertension, palmar-plantar erythrodysaesthesia, diarrhoea and wound-healing complications are common and may need dose modification.
• Avoid taking with food and separate from strong CYP3A4 inducers or inhibitors as advised.

Monitoring

Monitor blood pressure, liver function, thyroid function and for proteinuria and gastrointestinal or bleeding complications during treatment.

Counselling the patient

• Take on an empty stomach and avoid grapefruit.
• Report severe diarrhoea, painful hands or feet, bleeding or uncontrolled high blood pressure, and tell your team before any surgery or dental procedure.

Evidence & guidelines

Use in advanced renal cell carcinoma is supported by randomised trial evidence and NICE technology appraisal guidance.