Cabozantinib(Cometriq )

Cabozantinib(Cometriq®)

Pronounced: [cabo-ZAN-ti-nib]

About Your Medication

Cabozantinib (Cometriq®) is an oral medicine that your doctor prescribed for the treatment of your cancer. Please take Cabozantinib as directed by your prescriber.

How to Take Your Medication

Take your cabozantinib at approximately the same time each day
Do not eat for at least 2 hours before and at least 1 hour after taking your Cabozantinib. Take the tablets whole – do not crush or break them.
If you miss a dose of cabozantinib, take your next dose at the usual scheduled time.
Do not take two doses on the same day to make up for a missed dose.
Contact your cancer clinic if you are unable to take cabozantinib as prescribed, including if you are unable to swallow the tablet.

Tell Your Healthcare Provider if you have any trouble taking your cabozantinib, including:

Trouble swallowing pills
Forgetting to take doses
Trouble affording your medications
Throwing up pills
Side effects

Important Precautions

Cabozantinib may be harmful to an unborn child. If sexually active with a partner that is pregnant or who may become pregnant during and for several weeks after treatment, two forms of contraception must be used (a condom and another effective form of birth control).
It is not known whether cabozantinib passes into breast milk. Nursing mothers should discuss with their healthcare providers whether to discontinue nursing or to discontinue cabozantinib.
Gastrointestinal perforations have occurred in a small number of patients taking this medication
Severe, sometimes fatal bleeding events have occurred in patients taking cabozantinib. Monitor signs and symptoms of bleeding while on this medication.
Wound healing may be impaired while on cabozantinib. It is recommended that this medication be stopped at least 28 days prior to a scheduled surgery.
Damage to the jaw bone called osteonecrosis of the jaw (ONJ) has been observed with cabozantinib. This risk may be increased if other medicines to support your bones are used. Notify your cancer clinic if you have jaw pain immediately.

What foods and drugs may interact with my cabozantinib?

Please talk to your healthcare provider at your cancer clinic before starting or stopping any medications, vitamins, or herbal supplements, because some of these may interact with your cabozantinib. Some examples of products that interact withcabozantinib include:

Grapefruit or grapefruit juice
Certain anti-infectives such as rifampin (Rifadin®)
Anti-seizure medicines, including carbamazepine (Tegretol®), phenobarbital (Luminal®), and phenytoin (Dilantin®)
Antivirals like ritonavir (Norvir®), nelfinavir (Viracept®), and saquinavir (Invirase®)
Some medications for mood, like St. John’s Wort and nefazodone (Serzone®)
Certain antifungals, such as itraconazole (Sporanox®), ketoconazole (Nizoral®), posaconazole (Noxafil®), and voriconazole (Vfend®)
Antibiotics like ciprofloxacin (Cipro®) and levofloxacin (Levaquin®)
Heart rhythm medications like quinidine, verapamil (Calan®) and amiodarone (Cordarone®) or dronedarone (Multaq®)
Blood thinning medicines such as warfarin (Coumadin®) and dabigatran (Pradaxa®)

Storage, Handling, and Disposal

It is important to keep these safeguards in mind when storing and handling oral anticancer therapy to keep you and your caregivers safe.

Keep your cabozantinib in a safe place, away from other family members’ medications and away from any food or drinks.
Store the medication at room temperature in a dry location – avoid storing your medication in the bathroom.
Store cabozantinib in its original container.
Keep the medication out of reach from children and pets.
Return expired, damaged, or unused cabozantinib to a pharmacy or hospital for disposal. Do not discard into the garbage or toilet, or anywhere that children or pets may have access.

MOQC makes no representations or warranties and explicitly disclaims the appropriateness or applicability of the MOQC Content to any specific patient's care or treatment. Any clinician seeking to treat a patient using the MOQC Content is expected to use independent medical judgment in the context of individual clinical circumstances of a specific patient's care or treatment.

Cabozantinib (Cometriq®) Side Effect Summary

This list does not include all possible side effects of cabozantinib. If you have an unusual symptom, call the clinic. Below are the most common side effects:

Diarrhea – frequent and/or watery bowel movements

What are your symptoms? / What can you do…
Mild diarrhea – stools are more loose/watery or you are having 1-3 more stools per day than usual /

Stay well hydrated
Avoid fatty, greasy, spicy foods that may increase your risk for diarrhea
Avoid caffeine and alcohol
Eat small, frequent meals; foods that are easy on the stomach include bananas, rice, applesauce, and toast
Use your antidiarrheal medicine, loperamide (Imodium®) 4 mg at the onset of diarrhea, then 2 mg every 2 hours until diarrhea-free for 12 hours
If diarrhea is not improving after 48 hours of treatment with your antidiarrheal medicine, or you are having trouble staying hydrated, call the clinic

Moderate diarrhea - you are having 4-6 more stools per day than usual; you are still able to perform your normal daily activities /

Try to manage using the measures listed above.
If diarrhea is not improving within 24 hours, or you are having trouble staying hydrated, call the clinic

Severe diarrhea – you are having 7 or more stools per day than usual, or you are having trouble staying hydrated or performing normal daily activities, or you are not making it to the bathroom in time /

Stop taking the cabozantinib and call the clinic

Nausea/Vomiting

What are your symptoms? / What can you do…
Mild nausea – loss of appetite without alteration of eating habits
Mild vomiting - you experience 1-2 episodes in 24 hours /

Stay well-hydrated
Use anti-nausea medication prescribed by the clinic
Eat smaller, more frequent meals/snacks
avoid empty stomach
Eat bland foods

Moderate nausea –decreased oral intake without significant weight loss, dehydration, or malnutrition
Moderate vomiting – you experience 3-5 episodes in 24 hours /

Try to manage using the measures listed above.
If nausea/vomiting is not improving within 24 hours, or you are having trouble staying hydrated, call the clinic

Severe nausea – you have inadequate oral intake of calories or fluids
Severe vomiting – you experience 6 or more episodes in 24 hours /

Unable to stay hydrated or hold down fluid (not able to drink 8-10 cups of liquid per day) – contact the clinic IMMEDIATELY
The anti-nausea medication prescribed is not working
Stop taking cabozantinib and call the clinic

Anorexia – decreased appetite/inability to eat

What Can I Do? / When to Call the Clinic?

Stay well-hydrated
Eat smaller, more frequent meals/snacks that are high in calories

Unable to stay hydrated-CONTACT IMMEDIATELY
Unable to eat
If you have had a rapid increase in weight (i.e. 5 pounds or more in one week)

Skin Conditions – hand-foot syndrome (swelling and redness of the skin on the palms of the hands and soles of the feet

What are your symptoms? / What can you do…
Mild hand-foot syndrome –
Minimal skin changes (e.g., redness or swelling) without pain /

Apply non-scented lotion to affected areas to avoid dryness
Use moisturizing products with lactic acid
Use gloves/socks at night

Moderate hand-foot syndrome –
Skin changes (e.g., peeling, blisters, bleeding, edema, or abnormal thickening of the outer skin layer) with pain or which limit your ability to perform some activities /

If symptoms do not improve with above measures call the clinic.

Severe hand-foot syndrome –
Severe skin changes (e.g., peeling, blisters, bleeding, edema, or abnormal thickening of the outer skin layer) with pain or which limit your ability to perform daily activities /

Stop taking the axitinib and call the clinic

Hair color changes – No self-care measures are recommended as this change is temporary and not harmful.

High blood pressure (onset within 3 weeks)

What Can I Do? /

When to Call the Clinic?

Depending on your specific treatment plan, you may be instructed by your clinic to monitor your blood pressure daily at home, especially during the first 6 weeks of therapy

Blood pressure over 150/90 or less than 100/60 or as instructed by your clinic provider

Mouth sores (mucositis) - Sores in the mouth and throat or on the lips which may be painful

What are your symptoms? / What can you do…
Mild mucositis – None or mild
symptoms; Pain treatments not needed. /

Gently use a soft toothbrush
Rinse 3-4 times daily with a solution of 1/8 tsp baking soda + 1/4 tsp salt in 1 cup warm water
Use pain medications as prescribed

Moderate mucositis – Moderate pain; but not interfering with eating or drinking significantly (may include modifications in diet) /

If symptoms do not improve with above measures call the clinic

Severe mucositis - Severe pain; interfering with eating or drinking (not able to drink 8-10 cups of liquid per day) /

Stop taking the cabozantinib and call the clinic

Below are some less common side effects of cabozantinib.

Less Common Side Effects / What Can I Do? /

When to Call the Clinic?

Gastrointestinal Perforations/ Fistulas
(tears or holes in the intestine) /

There are no self-care measures that can be taken

If you have sudden, severe general abdominal or intestinal pain – contact the clinic IMMEDIATELY

Bleeding /

Be careful with sharp objects
Wear shoes
Use a soft toothbrush
Blow your nose gently

Large unexplained bruises
Bleeding that doesn’t stop after a few minutes
Coughing up blood
Blood in your urine or stools
If you are planning to have surgery, call with the date

Blood Clots
(Deep Vein Thrombosis/Pulmonary Embolism; Formation of a blood clot that plugs the blood vessel) /

Your doctor may prescribe a medication to help decrease your risk of blood clots

Shortness of breath
Chest pain
Swelling/tenderness/redness in the leg or arm

Osteonecrosis of the Jaw /

Notify the clinic of upcoming dental appointments/ procedures

If you have pain in your jaw while at rest, during the night or caused by chewing.

Liver Dysfunction /

The clinic will monitor your labs to assess

Yellowing of eyes or skin

Who to Call With Questions?

If you are having an emergency, call 911

Who to Call With Questions?

If you are having an emergency, call 911