Cabozantinib capsules (Cometriq)

Cabozantinib is a type of targeted cancer drug. You pronounce it as ka-boe-zan-tih-nib. It is also known as Cometriq.

It is a treatment for a type of thyroid cancer called medullary thyroid cancer that has spread to other parts of the body. Or can’t be removed with surgery.

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 capsules?

You take cabozantinib as capsules. You swallow the tablet whole with a glass of water. You should not eat anything for at least 2 hours before taking it and for 1 hour afterwards.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

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.

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. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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:

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).

Less commonly, you may have heavy bleeding. 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.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

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.

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. 

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.

Less commonly you may throw up blood which may look bright red or like coffee grounds.

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.

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.

Hair changes

Your hair may thin or you may lose all your hair. This can include your eyelashes, eyebrows and other body hair. It usually grows back once your treatment has finished. But your hair may have a different texture or be curlier than before.

This treatment may change the colour of your hair (greying of hair).

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.

Less commonly your blood pressure may drop – you have feel dizzy, light headed, faint or feel tired and confused.

Rarely your blood pressure may suddenly go very high. This may cause damage to blood vessels or other parts of the body.

Sore mouth

You may have redness, swelling or pain in your mouth and throat. You may also have sores in your mouth. This can cause difficulty in swallowing. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Tell your healthcare team if you have pain. They can give you medicines to help.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Changes in your voice

Sometimes you may notice problems when you speak. For example, it may sound hoarse or you might have difficulty speaking.

Changes in blood test results

You may have changes in the levels of different minerals in your blood, including calcium, magnesium and potassium.

Blood tests may also pick up changes to your liver, kidneys, thyroid gland and pancreas.

These changes are usually mild and go back to normal after 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.

Pain in different parts of your body

You may feel pain in your tummy (abdomen), joints or limbs.

You might get pain in other parts of your body, including your ear or chest wall. But this is less common

Tell your healthcare team if you have any pain. They can check the cause and give you medicine to help.

Indigestion

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.

Rash and other skin changes

You might notice your skin is dry or red and that you have a rash. Less commonly you may develop flaky skin, blisters or acne. Or your skin may become thicker in places or lighter in colour. Rarely you may develop fine red lines on your skin (sometimes called spider veins) or ulcers.

Tell your doctor if you have a rash or other skin changes. 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.

Muscle spasms

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

Swollen lymph glands

Cabozantinib can cause lymph nodes to feel swollen when you touch them. The ones near the surface of the skin are the ones that people notice most. They include the nodes in the neck, armpit and groin.

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 – contact your advice line immediately if you have any signs of infection
• 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
• a cough or breathing problems. This could be due to different reasons such as infection or rarely a collapsed lung or inflammation of the lung (pneumonitis)
• reduced thyroid activity (hypothyroidism) which can cause tiredness, weight gain, constipation, dry skin and make you feel cold
• not enough fluid in your body (dehydration) - your skin may feel dry, and you may pass small amounts of urine. Drinking more can help
• feeling very low or sad, confused or anxious
• a stroke - symptoms include drooping of one side of the face, being unable to smile, numbness or weakness on one side of the body or being unable to talk – call 999 immediately if you have these symptoms
• 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
• being unable to control shaking or trembling that can happen to different parts of the body, usually your hands – let your healthcare team know if you notice this
• eye problems such as blurred vision. Rarely you may develop clouding of the lens of the eye (cataracts) or inflammation of the eye making it red, watery, feel gritty, and sticky from pus (conjunctivitis)
• hearing problems such as ringing in your ear (tinnitus). Loss of hearing is rare.
• heart problems such as an irregular and often fast heart rate (atrial fibrillation). Rarely you may develop chest pain (angina) or a sudden very fast heart rate which may last a few minutes or hours - let your healthcare team know straight away if this happens to you
• an abnormal connection of tissue creating a tunnel that has developed between different organs in the body (fistula) – this is mainly in your digestive system which can cause a severe stomach ache, or your food pipe (oesophagus), airway (trachea) and lungs
• a tear or hole in your stomach or bowel
• inflammation of the pancreas which can cause tummy (abdominal) pain, a high temperature, and feeling or being sick
• piles (haemorrhoids) which can cause pain when you open your bowels. Or you may develop a painful tear in your anus small stones that form in the gallbladder (gallstones) - usually you have no symptoms but sometimes it can cause a sudden, intense pain in your abdomen
• bone damage in the jaw (osteonecrosis) – symptoms include swelling of your gums, loose teeth or a feeling of heaviness, numbness or pain in your jaw
• kidney problems such as passing protein or blood when you wee. Rarely your kidneys may stop working (kidney failure). You have regular urine and blood tests to check for any changes
• pain when going for a wee
• problems with wound healing
• shivering (chills)
• swelling in the face or other parts of your body

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:

• unusual dreams, feeling disorientated, unable to concentrate, or seeing or hearing things that aren’t real (delirium)
• changes to the brain due to problems with the liver (hepatic encephalopathy) – symptoms include confusion, mood or personality changes, slurred speech, unusual movements or shaking of hands or arms, or in severe cases, loss of consciousness (coma)
• a condition that causes your muscles to breakdown (rhabdomyolysis) - this can be serious if not treated quickly. Symptoms include muscle pain or weakness, dark urine, tiredness, dehydration and confusion
• a rare disorder of the nerves causing headaches, fits, feeling confused and changes in your eyesight. With treatment, this condition usually goes away within a few weeks
• periods (menstrual cycle) stopping
• forming of fluid filled sacs (cysts)

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

• inflammation of your blood vessels which can cause a skin rash of purple or brown spots all over the body

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 medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

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 get someone pregnant while you are having treatment with this drug and for at least 4 months afterwards.

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.