Cabozantinib (Cometriq)

About This Drug

Cabozantinib is used to treat cancer. It is given orally (by mouth).

Possible Side Effects 

  • Bone marrow suppression. This is a decrease in the number of white blood cells, and platelets. This may raise your risk of infection and raise your risk of bleeding.
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • Nausea
  • Constipation (not able to move bowels)
  • Diarrhea (loose bowel movements)
  • Pain in your abdomen
  • Tiredness
  • Changes in your liver function
  • Electrolyte changes
  • Decreased appetite (decreased hunger)
  • Changes in the way food and drinks taste
  • Weight loss
  • Changes to the color of your hair
  • Hand- foot syndrome. The palms of your hands or soles of your feet may tingle, become numb, painful, swollen, or red.
  • High blood pressure

Note:Each of the side effects above was reported in 25% or greater of patients treated with cabozantinib. Not all possible side effects are included above.

Warnings and Precautions 

  • Abnormal bleeding – symptoms may be coughing up blood, throwing up blood (may look like coffee grounds), red or black tarry bowel movements, abnormally heavy menstrual flow, nosebleeds or any other unusual bleeding.
  • Abnormal opening in stomach, intestine or esophagus (fistula). Symptoms of a fistula may be: severe abdominal pain or difficulty swallowing.
  • Blood clots and events such as stroke and heart attack. A blood clot in your leg may cause your leg to swell, appear red and warm, and/or cause pain. A blood clot in your lungs may cause trouble breathing, pain when breathing, and/or chest pain.
  • Osteonecrosis of the jaw. This is a breakdown of the jaw bone. This is a bad but rare health problem.
  • Slow wound healing
  • Increased protein in your urine
  • Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel extreme tiredness, agitation, confusion, hallucinations (see or hear things that are not there), trouble understanding or speaking, loss of control of your bowels or bladder, eyesight changes, numbness or lack of strength to your arms, legs, face, or body, and coma. If you start to have any of these symptoms let your doctor know right away.

Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team.

Important Information 

  • Do not substitute the capsules for the tablets.
  • Cabozantinib may cause slow wound healing. It should not be given within 28 days of surgery If you must have emergency surgery or have an accident that results in a wound, tell the doctor that you are on cabozantinib.

How to Take Your Medication 

  • Swallow the medicine whole with a full glass of water (8 ounces). Do not open the capsules.
  • Take this drug on an empty stomach. No food should be eaten for at least two hours before cabozantinib is taken and for at least one hour after cabozantinib is taken.
  • Missed dose: If you miss a dose, and it is less than 12 hours until your next dose, then skip the missed dose and go back to your normal schedule. If you miss a dose, and it is more than 12 hours until your next dose, take it as soon as you think about it. Do not take 2 doses at the same time or extra doses.
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • Storage: Store this medicine in the original container at room temperature.
  • Disposal of unused medicine: Do not flush any expired and/or unused medicine down the toilet or drain unless you are specifically instructed to do so on the medication label. Some facilities have take-back programs and/or other options. If you do not have a take-back program in your area, then please discuss with your nurse or your doctor how to dispose of unused medicine.

Treating Side Effects 

  • To decrease the risk of infection, wash your hands regularly.
  • Avoid close contact with people who have a cold, the flu, or other infections. Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.
  • To help decrease the risk of bleeding, use a soft toothbrush. Check with your nurse before using dental floss.
  • Be very careful when using knives or tools.
  • Use an electric shaver instead of a razor.
  • Avoid sun exposure and apply sunscreen routinely when outdoors.
  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • Drink fluids that contribute calories (whole milk, juice, soft drinks, sweetened beverages, milkshakes, and nutritional supplements) instead of water.
  • Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or 1/2 teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
  • If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
  • Taking good care of your mouth may help food taste better and improve your appetite
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help stop or lessen these symptoms.
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack of water in the body from losing too much fluid).
  • If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping.
  • Ask your doctor or nurse about medicines that are available to help stop or lessen constipation, diarrhea and/or nausea.
  • To help with decreased appetite, eat small, frequent meals. Eat foods high in calories and protein, such as meat, poultry, fish, dry beans, tofu, eggs, nuts, milk, yogurt, cheese, ice cream, pudding, and nutritional supplements.
  • Consider using sauces and spices to increase taste. Daily exercise, with your doctor’s approval, may increase your appetite.
  • Manage tiredness by pacing your activities for the day. Be sure to include periods of rest between energy-draining activities.
  • Keeping your pain under control is important to your wellbeing. Please tell your doctor or nurse if you are experiencing pain.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
  • Tell your cancer doctor if you have any problems with your teeth or jaw before you start this drug. It is important that your dentist knows that you are on this drug. Give your dentist and your cancer doctor each other’s name and phone number so they may call each other if they have any questions.

Food and Drug Interactions 

  • Avoid grapefruit or grapefruit juice while taking this medicine as it may raise the levels of cabozantinib in your body which could make side effects worse.
  • Check with your doctor or pharmacist about all other prescription medicines and over-the-counter medicines and dietary supplements (vitamins, minerals, herbs and others) you are taking before starting this medicine as there are known drug interactions with cabozantinib. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions.
  • Avoid the use of St. John’s Wort while taking cabozantinib as this may lower the levels of the drug in your body, which can make it less effective

When to Call the Doctor

Call your doctor or nurse if you have any of the following symptoms and/or any new or unusual symptoms: 

  • Fever of 100.4° F (38° C) or higher
  • Chills
  • Tiredness that interferes with your daily activities
  • Headache that does not go away
  • Seizure. Symptoms of a seizure such as confusion, blacking out, passing out, loss of hearing or vision, blurred vision, unusual smells or tastes (such as burning rubber), trouble talking, tremors or shaking in parts or all of the body, repeated body movements, tense muscles that do not relax, and loss of control of urine and bowels. If you or your family member suspects you are having a seizure, call 911 right away.
  • Trouble understanding or speaking
  • Easy bleeding or bruising
  • Feeling dizzy or lightheaded
  • Blurry vision or other changes in eyesight
  • Confusion or agitation
  • Coughing up blood
  • Wheezing and/or trouble breathing
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause. If you have any of these symptoms for 2 minutes, call 911.
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Difficulty swallowing
  • No bowel movement for 3 days or you feel uncomfortable
  • Diarrhea, 4 times in one day or diarrhea with weakness or lightheadedness
  • Bad abdominal pain, especially in upper right area
  • Blood in your urine, vomit (bright red or coffee-ground) and/or stools (bright red, or black/tarry)
  • Heavy menstrual period that lasts longer than normal
  • Painful, red, or swollen areas on your hands or feet
  • Numbness and/or tingling of your hands and/or feet
  • Extreme weakness that interferes with normal activities
  • Pain between shoulder blades, or in right shoulder
  • Your leg or arm is swollen, red, warm and/or painful
  • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skinSigns of osteonecrosis of the jaw such as pain, swelling or infection of the gums, loose teeth, poor healing of the gums, numbness or the feeling that your jaw is heavy
  • Foamy or bubbly-looking urine
  • Rash or itching that is not relieved by prescribed medicine
  • If you think you may be pregnant

Reproduction Warnings 

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of childbearing potential should use effective methods of birth control during your cancer treatment and for at least 4 months after treatment. Let your doctor know right away if you think you may be pregnant.
  • Breast feeding warning: Women should not breastfeed during treatment and for 4 months after treatment because this drug could enter the breast milk and cause harm to a breastfeeding baby.
  • Fertility warning: In men and women both, this drug may affect your ability to have children in the future. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.

Revised June 2019

This patient information was developed by Via Oncology, LLC © 2019. This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.

CLIENT acknowledges that the Via Pathways and Via Portal are information management tools only, and that Via Oncology, LLC has not represented the Via Pathways or Via Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The clinical information contained in the Via Pathways and Via Portal are intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.