Cabozantinib tablets (Cabometyx)

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

It is a treatment for some people with advanced:

• kidney cancer (renal cell carcinoma)
• liver cancer (hepatocellular carcinoma)
• a type of thyroid cancer called medullary thyroid cancer that has spread to other parts of the body

How does cabozantinib work?

Cabozantinib is a type of cancer growth blocker called a tyrosine kinase inhibitor. It 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 tablets?

You take cabozantinib as tablets. 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:

Breathlessness

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

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 to thyroid hormones

Your thyroid hormone levels may change. Your symptoms might include feeling tired or cold or you may gain weight. You might also have dry skin and feel constipated.

Your doctor checks your thyroid hormone levels regularly during treatment.

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 albumin, magnesium and potassium in your blood. It may also change the levels of phosphate, sodium and calcium. It might increase levels of fats (cholesterol and triglycerides). It might also increase a protein called lipase and amylase but this is less common.

You have regular blood tests during treatment to check these levels.

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 

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Dizziness

This drug might make you feel dizzy. You might also feel dizzy when standing or moving around. Or it might feel like the world is spinning.

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. Your nurse checks your blood pressure regularly. 

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

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.

Cough or shortness of breath

You might develop a cough or breathing problems. This could be due to an infection, such as pneumonia. Or less commonly due to a blood clot on the lung (pulmonary embolism). It could also be caused by a collapsed lung (pneumothorax) but this is rare.

Feeling or being sick

You might feel sick or be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

• Avoid eating or preparing food when you feel sick.
• Avoid hot fried foods, fatty foods or foods with a strong smell.
• Eat several small meals and snacks each day.
• Relaxation techniques help control sickness for some people.
• Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
• Try fizzy drinks.
• Sip high calorie drinks if you can’t eat.

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.

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.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Pain in different parts of your body

You may feel pain in different parts of your body such as your tummy (abdomen) or limbs.

You might get joint pain and pain in your mouth 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 (heartburn), 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.

Rash or other skin changes

You might notice skin changes such as a rash. Less commonly you might have dry, itchy or red skin. You might develop small, raised bumps similar to acne. You usually see these on your face, neck and over your chest and back. Or you may get thickening of some areas of the skin or nails.

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.

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.

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

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment stops or you have a break. You have regular blood tests to check for any changes in the way your liver is working.

Less commonly you may develop changes in the brain if your liver is not working properly. This is called hepatic encephalopathy. Symptoms include confusion, personality or mood changes, worsening handwriting, anxiety, sleepiness, slurred speech and seizures (fits).

Rarely, you may develop liver damage and a decreased bile flow in the liver. Tell your doctor straight away if your urine looks much darker than usual or your skin or eyes look yellow.

These serious liver changes are more likely to happen if you are having Cabometyx as a treatment for liver cancer.

Fluid build up in your hands and legs

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

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

• tinnitus

• inflammation of the pancreas (pancreatitis) – symptoms include severe tummy (abdominal) pain, sickness and a high temperature. Contact your advice line straight away if you have these symptoms

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

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

• damage to the nerves (peripheral neuropathy) – symptoms include an unusual feeling around your skin such as prickling, pins and needles, a burning or stabbing pain, numbness and tingling in your hands or feet

• an abnormal connection of tissue creating a tunnel that has developed between different organs in the body (fistula)

• a tear or hole in your stomach or bowel

• difficulty swallowing

• muscle spasms

• dry mouth

• hair loss or thinning

• hair colour may grow a different colour

• having protein in your wee – this can be a sign of changes to how well your kidneys are working

• changes in blood sugar levels

• severe bleeding such as vomiting blood, blood in stools or urine or coughing up blood

• a collection of pus with swelling and inflammation (abscess) - can develop in any part of the body, including the mouth and tummy (abdomen)

• having abnormal kidney test results because of increased amounts of creatinine in your blood

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)

• 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

• 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 call 999 immediately if you have these symptoms

• unusual dreams, feeling disorientated, and unable to concentrate

• a rare disorder of the nerves causing headaches, fits, feeling confused and changes in your eyesight

• a burning feeling in your tongue

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

• problems with wound healing

Other side effects

There isn’t enough information at the moment to work out how often the following side effect happens:

• a weakness or tear in the walls of blood vessels called arteries (aneurysm or artery dissection)

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.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed for 4 months after your last treatment.

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 information 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.