Antineoplastic biologic response modifiersUS FDA Database Verified

cabozantinib

Brand: Cometriq

(ka'boe- zan'ti- nib)

Pregnancy Category: D

Pharmacological Action

Inhibits abnormal tyrosine kinase associated with growth and development of metastatic medullary thyroid cancer

Therapeutic outcome: Decrease in size, spread of tumor

Uses

Treatment of progressive metastatic medullary thyroid cancer

Contraindications

Pregnancy (D), hypersensitivity

Precautions: Breastfeeding, children, geriatric patients, cardiac/renal/hepatic/dental disease, bone marrow suppression, wound dehiscence, skin disease, MI, hypertension, proteinuria, infertility, surgery, thrombocytopenia, neutropenia, immunosuppression

BLACK BOX WARNING: Bleeding, fistula, GI bleeding/perforations

Dosage & Routes

Renal dosage

Adult: PO 140 mg/day until disease progression or unacceptable toxicity

Available forms: Tabs 60, 100, 140 mg

Implementation - Take on an empty stomach; do not eat for 2 hr before and 1 hr after use; swallow whole; do not open or crush caps - Do not take with grapefruit juice - Do not take a missed dose within 12 hr of the next dose; if the next dose is in ≥ 12 hr, take the missed dose; if the next dose is in < 12 hr, skip the missed dose and take the next dose at the scheduled time - Store at room temperature

Adverse Effects

CNS: Headache, dizziness

GI: Nausea, vomiting, dyspepsia, anorexia, abdominal pain, diarrhea, GI bleeding/fistula/perforation

HEMA: Neutropenia, thrombocytopenia, bleeding

INTEG: Rash

META: Hypokalemia

MISC: Fatigue, hypothyroidism, elevated liver enzymes

MS: Arthralgia, myalgia

Pharmacokinetics

Distribution: Protein binding 99%

Metabolism: metabolized by CYP3 A4

Interactions

Individual drugs

Increase: cabozantinib concentrations- CYP3 A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin)

Increase: plasma concentrations of simvastatin, calcium channel blockers, ergots

Decrease: cabozantinib concentrations- CYP3 A4 inducers (dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital)

Drug/food

Increase: cabozantinib effect- grapefruit juice; avoid use while taking product

Drug/herb Cabozantinib concentration- St. John's wort

Nursing Considerations

Assessment -

Proteinuria: monitor urine protein regularity; discontinue if nephritic syndrome occurs - GI bleeding/fistula/perforation: can be fatal - Wound dehiscence: discontinue product 20 days before surgery

Patient/family education - Teach patient to report adverse reactions immediately: bleeding - Explain reason for treatment, expected results - Teach that effect on male infertility is unknown

Evaluation

Positive therapeutic outcome: Decrease in size, spread of tumor

Reference

Mosby's Drug Guide; Davis Drug Guide

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