Cabozantinib (Cometriq, Cabometyx)

Cabozantinib is a type of targeted cancer drug. It is a treatment for kidney cancer and medullary thyroid cancer that has spread to other parts of the body. 

What is cabozantinib?

Cabozantinib is a type of targeted cancer drug and is also known as Cometriq and Cabometyx. It is a treatment for:

• kidney cancer that has spread to other parts of the body (advanced kidney cancer)

• a type of thyroid cancer called medullary thyroid cancer that has spread to other parts of the body

You might have cabozantinib with other cancer drugs.

How does cabozantinib work?

 Cabozantinib works in 2 ways. It: 

• stops cancers from growing their own blood vessels which supplies it with food and oxygen to grow
• blocks the messages that tells the cancer cells to grow

How do you take cabozantinib?

Cabozantinib comes in tablets and capsules. 

You take it as tablets if you are taking it for kidney or liver cancer. Cabometyx is the other name of the tablet form of cabozantinib.

You take it as capsules if you have medullary thyroid cancer. Cometriq is the other name of the capsule form of cabozantinib.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. When taking cabozantinib you swallow it whole. You should not eat anything for at least 2 hours before taking them, and through to 1 hour after taking them.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

How often do you take cabozantinib?

You usually take cabozantinib once a day for as long as it helps you and the side effects aren’t too bad.

Your doctor or pharmacist will tell you how many tablets or capsules you need to take as it depends on your individual needs.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of cabozantinib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Breathlessness, difficulty breathing and a cough

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Less often you may find it difficult to breathe or have a cough due to bleeding in the airways or a lung infection such as pneumonia. Other rarer problems include part of your lung not inflating (atelectasis), or you might have inflammation of the lungs (pneumonitis). 

Call your advice line immediately if you become breathless or find it difficult to breathe.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Cabozantinib can cause heavy bleeding in some people. Contact your health care team straight away if you have any unexpected bleeding, such as blood in your poo, vaginal bleeding, or coughing up blood. Or if you have any other unusual bleeding.

Changes in the levels of thyroid hormones

The level of your thyroid hormones may drop, or they might increase. With lower levels, your symptoms might include feeling tired or cold or you may gain weight. You might also feel sad. Some people notice their voice sounds deeper when their thyroid levels are low. 

Symptoms for increased thyroid hormone levels can include feeling nervous, having mood swings, or weight loss. Your neck might look swollen. This is because the thyroid gland in your neck is bigger.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Changes in the levels of minerals, protein and fat in your body

Your blood contains different levels of minerals, fat and protein. Cabozantinib can change the levels of calcium, albumin, magnesium, and potassium in your blood. It may also change the levels of phosphate and cholesterol. It might raise or lower blood sugar levels but this is less common.

Taste changes

Taste changes may make you go off certain foods and drinks or less commonly you might lose your taste completely. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.

Headaches 

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Dizziness

This drug might make you feel dizzy. Don’t drive or operate machinery if you have this.

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Sore mouth, tongue, and ulcers

Mouth sores and ulcers can be painful. Your tongue might feel like it is burning. Tell your doctor or nurse if you're in pain or have ulcers. They can give you medicines to help.

Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges and lemons. Chewing gum can help to keep the mouth moist.

Pain in different parts of your body

It’s common to feel pain in different parts of your body such as your tummy (abdomen), joints, muscles, and limbs.

You might also get pain in other areas of the body for example pain in your ear, mouth, throat, face and bones. But these are less common.

Tell a member of the team treating you if you have any pain. They can check the cause and give you medicine to help.

Indigestion, heartburn, or reflux

Symptoms include bloating, feeling full, a burning feeling in your chest, burping or passing wind. Less common symptoms include hiccups that keep coming back and bad breath.

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Skin changes

You might notice your skin is dry or red and that you have a rash. Less commonly some rashes have small raised bumps similar to acne. You may see these on your face, neck and over your chest and back. There may be blistering, itching, and lightening of the skin. It may also be flaky and there may be areas of skin that are thicker than others.

Rarely you might notice broken blood vessels or ulcers near the surface of the skin.

Tell your doctor if you have any rashes or itching. Don’t go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Hair loss and changes to the colour of your hair

You might lose all your hair with this treatment. This includes your eyelashes, eyebrows, underarm hair, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. This treatment may lighten your hair, it may grow back a different colour, or be curlier than before. Some people may have hair growth elsewhere on the body, but this is less common. 

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Inflammation of the digestive system 

You might get inflammation of your digestive system, this can cause symptoms such as pain, weakness, feeling sick, bloating, diarrhoea, high temperature, loss of appetite and blood in your poo. You may also have pale coloured poo and your wee might look darker but this is not as common. 

Speak to your doctor or nurse if you have these symptoms.

Liver changes

You might have liver changes that are usually mild. Less commonly the liver does not work properly. Symptoms can include confusion, slurred speech, feeling anxious, difficulty thinking and concentrating, personality changes and forgetfulness. You might also get symptoms such as yellowing of the skin and whites of your eyes. This usually goes back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Changes in your voice

Sometimes you may notice problems when you speak for example, it may sound different such as rough, raspy or croaky and you might be straining to talk. This is caused by irritation, swelling and spasms of the voice box.

Difficulty swallowing and swelling of the throat

You might have difficulty swallowing (dysphagia) rarely it might be due to swelling in the throat.

Let your nurse or doctor know straight away if this happens.

Fluid build up in your hands and legs or face

You may have swelling of your hands and legs or face due to a build up of fluid (oedema). 

Muscle spasms

Let your doctor or nurse know if you have muscle spasms during or after having treatment. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• increased risk of infection due to a low number of white blood cells in the body

• hearing problems such as tinnitus, rarely you may have partial or complete hearing loss

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• inflammation of the pancreas which can cause tummy pain and feeling or being sick

• piles which can cause pain when you open your bowels or a painful tear in your anus

• problems with the healing of wounds

• kidney changes such as passing protein when you wee or weeing more often. You may have changes picked up on blood tests, you have regular urine and blood tests to check for any changes. Rarely your kidneys may stop working properly

• not enough fluid in your body (dehydration), your skin may feel dry and you may pass small amounts of urine, drinking more can help

• an unusual feeling around your skin such as tingling, prickling or pins and needles. You might also have numbness and tingling in your fingers and toes

• an abnormal connection of tissue creating a tunnel that has developed between different organs in the body (fistula), this can affect areas such as, your airways, food pipe, lungs, and parts of the bowel

• a tear or hole in your stomach and intestines

• feeling very low or sad, anxious and feeling confused. Rarely you might also have unusual dreams, feel disorientated, and be unable to concentrate

• blurred vision

• damage to the jawbone, you might have pain or swelling in the mouth, loose teeth, numbness or the feeling of heaviness in the jaw

• shivering (chills)

• being unable to control shaking or trembling that can happen to different parts of the body (tremor)

• feeling cold, particularly in your hands and feet

• small stones that form in the gallbladder (gallstones), usually you have no symptoms but sometimes it can cause a sudden, severe intense pain in your tummy (abdomen)

• looking pale

• a stroke -symptoms can include drooping of one side of the face, being unable to smile, having numbness or weakness on one side of the body or being unable to talk - you should contact the emergency services immediately if you have these symptoms

• dry mouth

• heart problems such as chest pain, irregular and very fast heartbeat - let your healthcare team know straight away if this happens to you

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• seizures (fits)

• difficulty with balance and walking

• a condition called rhabdomyolysis that causes loss of coordination in your muscles, and damage to skeletal muscles

• a rare disorder of the nerves causing headaches, fits, feeling confused and changes in your eyesight- this condition is reversible

• periods (mensrual cycle) stopping

• eye problems such as clouding of the lens of the eye (cataracts) or inflammation of the eye making it red, watery, feel gritty and itchy and it may form pus

• forming of fluid filled sacs (cysts)

• fainting

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• heart attack- symptoms might include chest pain, shortness of breath, pain that radiates from your chest to your jaw, arms, neck and back, feeling weak and lightheaded - you should contact the emergency services immediately if you have these symptoms

• an aneurysm, this is when the blood vessel wall develops has an area that is weak or has torn

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Many medicines can react with cabozantinib.

Grapefruit and grapefruit juice

Don’t eat grapefruit or drink grapefruit juice while having treatment with cabozantinib. It can change the amount of cabozantinib you absorb and make the side effects worse.

Lactose intolerance

This drug contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before taking this medication.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 4 months afterwards.

You need to use 2 effective methods of contraception during treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment and for at least 4 months afterwards. The drug may come through in the breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.