Cazar 60

Indications

Cabozantinib is a cancer medicine used for:

• Advanced kidney cancer (renal cell carcinoma), alone or together with Nivolumab.
• Liver cancer (hepatocellular carcinoma) in people already treated with Sorafenib.
• Differentiated thyroid cancer that has kept growing after earlier treatment.
• Medullary thyroid cancer (capsule form).

It is started and monitored only by a cancer specialist (oncologist).

How It Works

Cabozantinib is a tyrosine kinase inhibitor, which means it blocks several proteins (including MET, VEGF receptors and AXL) that cancer cells use to grow, spread and build new blood vessels. This can slow or stop tumour growth.

Dosage and Administration

Take exactly as prescribed by your oncologist. The dose depends on the cancer type, other medicines and how well it is tolerated, and the doctor may lower or pause it if side effects occur.

• Usually taken once a day by mouth on an empty stomach: no food for at least 2 hours before and 1 hour after the dose.
• Swallow whole with a full glass of water; do not crush or chew.
• Tablets and capsules are not interchangeable, so do not switch between them.
• Do not eat grapefruit or drink grapefruit juice during treatment.
• If a dose is missed and the next one is due in less than 12 hours, skip it.

Interactions

• Strong CYP3A4 blockers such as Ketoconazole, Itraconazole, Clarithromycin and Ritonavir can raise its level and side effects.
• Rifampicin, Carbamazepine, Phenytoin, Phenobarbital and St John's wort can lower its level and effect.
• Grapefruit raises its level.
• Tell your doctor if you take blood thinners, as bleeding risk is higher.

Always tell the doctor and pharmacist about every medicine, herbal product and supplement you use.

Contraindications

• Allergy to cabozantinib or any ingredient of the product.
• Pregnancy and breastfeeding.

Side Effects

Common: diarrhoea, tiredness, nausea, poor appetite, weight loss, mouth sores, change in taste or voice, high blood pressure, low thyroid activity, and hand-foot skin reaction (redness, pain, swelling or peeling of the palms and soles).

Get urgent medical help if you have:

• Vomiting or coughing up blood, black or bloody stools, or other serious bleeding.
• Severe stomach pain, which can be a sign of a tear in the bowel.
• Chest pain, shortness of breath, or sudden weakness on one side, trouble speaking or vision loss.
• Severe headache with confusion, vision changes or seizures.
• Severe diarrhoea with signs of dehydration.
• Jaw pain, loose teeth or a wound in the mouth that will not heal.

Pregnancy and Lactation

Cabozantinib can harm an unborn baby. Women who can become pregnant should use effective contraception during treatment and for at least 4 months after the last dose. Do not breastfeed during treatment and for 4 months after the last dose.

Precautions and Warnings

• Blood pressure, liver tests, urine protein and thyroid function are checked regularly.
• It can delay wound healing; it is usually stopped at least 3 weeks before planned surgery, including dental surgery.
• Have a dental check before starting, as rare jaw bone damage (osteonecrosis) can occur.
• Tell the doctor about liver disease, bleeding problems, recent surgery or heart disease.

Overdose

There is no specific antidote. If too much is taken, go to the nearest hospital emergency department straight away and take the pack with you.

Therapeutic Class

Anticancer medicine; tyrosine kinase inhibitor.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep in the original pack.