Cabozantinib (Cometriq®, Cabometyx®)
Cabozantinib (Cometriq®, Cabometyx®) is a targeted therapy drug. It is used to treat thyroid cancer, kidney cancer and primary liver cancer.
Cabozantinib belongs to two groups targeted therapy drugs. It is known as a cancer growth inhibitor, and also an angiogenesis inhibitor.
Cabozantinib is used to treat medullary thyroid cancer, kidney cancer and liver cancer.
Cabozantinib (Cometriq®) capsules may be used to treat medullary thyroid cancer that cannot be removed with an operation or that has spread to other parts of the body (advanced cancer).
Cabozantinib (Cabometyx®) tablets may be used to treat a type of kidney cancer called renal cell cancer that has spread to other parts of the body (advanced cancer). It is sometimes given with another cancer drug called Nivolumab.
Cabozantinib (Cabometyx®) tablets are sometimes used to treat a type of cancer that starts in the liver called hepatocellular cancer. Your cancer doctor can tell you if it is appropriate for you. Some people may have it as part of a clinical trial.
Cabozantinib may not be available on the NHS. We have further information on what to do if a treatment is not available.
It is best to read this information with our general information about the type of cancer you have.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Cabozantinib comes as tablets or capsules, so you can take them at home. During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Taking cabozantinib tablets
You take cabozantinib tablets or capsules once a day. Take them at the same time every day. You should not have anything to eat two hours before, or an hour after taking the tablets. They must be swallowed whole with a glass of water. They should not be chewed, opened or crushed.
Always take cabozantinib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you. Your doctor will talk to you about how long to take cabozantinib for.
If you forget to take the tablets or capsules, the missed dose should be taken only if it is more than 12 hours before the next dose. If your next dose is due in less than 12 hours, do not take the dose you have missed. Take your next dose at the normal time. Do not take a double dose.
Other things to remember when taking your capsules or tablets:
- Wash your hands after taking your tablets and capsules.
- Other people should avoid direct contact with your capsules/tablets.
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose.
- If your treatment is stopped return any unused capsules/ tablets to the pharmacist.
- Avoid eating grapefruit and drinking grapefruit juice during your treatment as it may increase side effects.
About side effects
We explain the main side effects of this treatment here. We also include some other possible side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
You may get pain or discomfort in your tummy (abdomen) or have indigestion. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.
Rarely, cabozantinib can cause a hole (perforation) in the bowel. Tell your doctor straight away if you have:
- sudden or severe pain in your tummy
- signs of bleeding from the back passage
- black stools (poo)
- vomit up blood, or have vomit that looks like coffee grounds.
Your doctor will give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.
If you feel sleepy, do not drive or use machinery.
Sore and red palms of hands and soles of feet
You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.
Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:
- keep your hands and feet cool
- moisturise your hands and feet regularly
- avoid tight-fitting socks, shoes and gloves.
High blood pressure
Cabozantinib can increase your blood pressure. A nurse will check your blood pressure regularly during treatment. If you have headaches, nosebleeds or feel dizzy, let your doctor know. Your doctor can usually prescribe tablets to control high blood pressure. Some people may need to reduce their dose of cabozantinib or stop taking it. Sometimes, cabozantinib may lower your blood pressure.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco and foods that irritate your mouth and throat.
You may notice that food tastes different while you are taking this treatment. Your nurse can give advice on coping with this.
Effects on the thyroid gland
Pazopanib can affect the way thyroid gland works. It will go back to normal after treatment.
You will have regular blood tests to check your levels of hormones that are made by the thyroid. This side effect is usually mild and may not cause symptoms. Your doctor may give you drugs to take if your hormone levels are low.
Effects on the kidneys and liver
This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have regular blood and urine tests during your treatment to check how well your kidneys and liver are working.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. This is usually mild, but it may increase your risk of infection. You will have blood tests during your treatment to check your blood cell levels.
It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot or discomfort when you pass urine
- new pain or swelling anywhere in the body.
It is important to follow any specific advice your cancer treatment team gives you.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
This treatment can sometimes cause bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Tell your doctor if you are taking any medicines that may affect bleeding. These include:
- blood-thinning tablets such as warfarin
- injections such as heparin, or vitamin E.
Contact your doctor straight away if you have any unusual bleeding including vomiting or coughing up blood, unexpected vaginal bleeding or blood in your stools (bowel movements).
Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair.
Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. Your scalp may be sensitive. It is important to cover your head to protect your skin when you are out in the sun.
Hair loss is almost always temporary. Your hair will usually grow back after treatment finishes. Cabozantinib may cause your hair to change colour.
Muscle and joint pains
You may have joint or muscle pains, especially in your back. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
You may gain weight, or your face, ankles and legs may swell. This improves slowly after your treatment has finished. Your doctor may give you drugs to help reduce the swelling.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
You may notice some voice changes or hoarseness. Talk to your doctor if you are worried about this.
Cabozantinib may make you feel dry (dehydrated). It can also affect the levels of minerals and salts in your body. Your doctor will take regular blood tests to check these. It is important to drink plenty of fluids while having treatment with cabozantinib – around 2 litres (3½ pints) a day. Let your doctor or nurse know if you have any signs of dehydration, such as:
- feeling dizzy or tired
- passing small amounts of urine
- having a dry mouth and eyes.
Wounds often take longer to heal while you are having treatment with this treatment. If you need an operation, your doctor will tell you to stop taking this treatment at least four weeks before you have it.
This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.
This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes usually get better after this treatment ends. But some can be permanent. Tell your doctor if you notice any changes in your hearing.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes. But for some people they may never go away. Talk to your doctor if you are worried about this.
Jaw problems (osteonecrosis)
Rarely, this treatment may cause a condition called osteonecrosis of the jaw. This is when healthy bone tissue in the jaw becomes damaged and dies. Some dental treatments, such as having a tooth removed, can increase the risk. Before you start taking this treatment, you will be advised to have a full dental check-up. Your doctor will advise you to stop taking this treatment for a short time before dental treatments like this. Always tell your dentist that you are taking this treatment.
Effects on the heart
This treatment can affect the way your heart works. Your doctor may do tests to see how well your heart is working.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms. But it is important to get them checked by a doctor.
Effects on the nervous system
This treatment can affect the nervous system. You may feel confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice this.
Changes in eyesight
Cabozantinib can cause blurry eyesight. Tell your doctor if you have this side effect. Do not drive or operate machinery if you have blurred vision.
You may have some mood changes during this treatment. You may feel anxious, low or depressed. Tell your doctor or nurse if you notice any changes.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. If you use a hormonal contraception, you are advised to also use barrier contraception, such as a condom. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
We understand that people are worried about coronavirus (COVID-19). You may have questions about the different vaccines, or you may be worried about how the pandemic will affect your cancer treatment. We have detailed information about coronavirus and cancer treatment here.
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This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
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