Detailed explanation of the side effects of cabozantinib and their treatment methods

Cabozantinib is an oral multi-target tyrosine kinase inhibitor that has been widely used in advanced renal cancer, medullary thyroid cancer and hepatocellular carcinoma. It affects the growth, angiogenesis and metastasis ability of tumor cells by inhibiting the activities of multiple kinases including MET, VEGFR, and AXL. However, due to its broad range of targets, it has also led to the occurrence of a variety of systemic adverse reactions. Especially during long-term use, more attention needs to be paid to tolerance and toxicity management issues.

One of the most common side effects of cabozantinib is gastrointestinal effects, specifically diarrhea, stomatitis, and decreased appetite. This type of reaction is more common in the early stages of treatment and is mainly related to the effect of the drug on the renewal of gastrointestinal mucosal cells. In order to alleviate these symptoms, patients are advised to avoid irritating foods, maintain good oral hygiene, and use antidiarrheal drugs or mucosal protectants under the guidance of a doctor. If diarrhea persists or worsens, temporary discontinuation or dose reduction should be considered to prevent dehydration and electrolyte imbalance.

Another type of side effect to be wary of is skin toxicity, including hand-foot syndrome, rash, and dry skin. Hand-foot syndrome presents with erythema, swelling, even pain, and peeling of the palms and soles of the feet, usually within a few weeks of treatment. Mild cases can be treated with moisturizers, avoiding friction, and wearing loose shoes and socks. For moderate and above symptoms, medication needs to be suspended and topical steroids or analgesics can be used in combination. The incidence of skin reactions is closely related to the patient's constitution and dosage. Regular observation of skin changes is the key to improving treatment compliance.

In addition, cabozantinib can also cause hypertension, proteinuria, and abnormal liver function. The mechanism of hypertension is mainly related to the suppression of vascular endothelial function, which may occur in the early stages of treatment. Blood pressure needs to be monitored weekly and controlled with antihypertensive drugs in a timely manner. Changes in renal function require close monitoring of urinary protein, and dose adjustment should be considered in patients with persistent proteinuria. For mild liver enzyme elevations, no special treatment is usually required. However, if AST or ALT levels are significantly elevated, dose reduction or temporary discontinuation of the drug should be considered, and other hepatotoxic factors should be investigated.

Reference:https://en.wikipedia.org/wiki/Cabozantinib