Cabozantinib: Brands, Price & Uses in Bangladesh

Cabozantinib is an orally administered multi-kinase (tyrosine kinase) inhibitor used in the treatment of several advanced cancers. Its approved and evidence-supported uses vary by strength of evidence:

FDA-approved / established indications

• Advanced renal cell carcinoma (RCC): as a single agent, and in combination with nivolumab (immunotherapy) as first-line treatment for advanced RCC.
• Hepatocellular carcinoma (HCC): in patients who have previously been treated with sorafenib.
• Differentiated thyroid cancer (DTC): locally recurrent or metastatic, progressive disease that is refractory to radioactive iodine and has progressed on or after a prior VEGFR-targeted therapy, in adults and pediatric patients 12 years and older.
• Medullary thyroid cancer (MTC): progressive, metastatic disease (capsule formulation).
• Neuroendocrine tumors (pancreatic and extra-pancreatic, pNET/epNET): previously treated, unresectable, locally advanced or metastatic disease, in adults and pediatric patients 12 years and older.

Combination therapy requirement

For first-line advanced RCC, Cabozantinib must be given in combination with nivolumab; it is not used alone in this specific setting.

Cabozantinib should only be prescribed and monitored by a physician experienced in the use of anticancer therapy.

The dose of Cabozantinib depends on the indication and the specific formulation (tablet vs. capsule) being used; the two formulations are not interchangeable.

Dose adjustment in organ impairment

• Hepatic impairment: Mild impairment — no dose adjustment required. Moderate impairment — reduce the starting dose (e.g. from 60 mg to 40 mg, or 40 mg to 20 mg). Severe hepatic impairment — use of Cabozantinib is not recommended.
• Renal impairment: No specific dose adjustment is established for mild-to-moderate renal impairment; Cabozantinib has not been studied in severe renal impairment or end-stage renal disease, so use with caution and close monitoring in these patients.

Treatment with Cabozantinib should continue as long as clinical benefit is observed and the drug is tolerated, until disease progression or unacceptable toxicity occurs. Dose reductions or temporary interruptions may be required to manage adverse reactions; see Precautions and Warnings.

Serious warnings (boxed warnings)

• Hemorrhage: Severe and sometimes fatal bleeding events have occurred with Cabozantinib. Permanently discontinue Cabozantinib in patients with severe hemorrhage.
• Gastrointestinal perforation and fistula: Perforations and fistulas, including fatal cases, have occurred with Cabozantinib. Permanently discontinue Cabozantinib if these occur.

Very common side effects (≥20%)

Diarrhea, fatigue, hand-foot skin reaction (palmar-plantar erythrodysesthesia), decreased appetite, hypertension, nausea, vomiting, weight loss, constipation, stomatitis, rash, dysgeusia (taste changes), abdominal pain.

Other important side effects

• Thromboembolic events (blood clots in arteries or veins)
• Hepatotoxicity (liver enzyme elevation, liver injury)
• Proteinuria (protein in urine)
• Reversible posterior leukoencephalopathy syndrome (rare, presents with headache, seizures, confusion, vision changes)
• Osteonecrosis of the jaw (rare)
• Wound healing complications
• Hypothyroidism

Patients should seek prompt medical attention for severe abdominal pain, black/bloody stools, vomiting blood, sudden severe headache, seizures, or signs of a blood clot (leg swelling/pain, chest pain, shortness of breath) while taking Cabozantinib.