Cabozantinib

Cabozantinib is an oral multi-target tyrosine kinase inhibitor.

1. Indications

Cabozantinib is a multi-target tyrosine kinase inhibitor, suitable for:

1. Renal cell carcinoma (RCC) : Treatment of advanced renal cell carcinoma for patients with HCC; or combined with nivolumab as first-line treatment for advanced RCC

2. Hepatocellular carcinoma (HCC) :Treatment of patients with HCC who have received sorafenib

< p>3. Differentiated thyroid cancer (DTC) :Treatment of locally advanced or metastatic DTC patients 12 years old and above who are refractory to radioactive iodine or are not suitable for radioactive iodine therapy, and who have previously received VEGFR targets After progression to treatment

4. Neuroendocrine tumors (NETs) :Treatment of previously treated patients 12 years of age and older with unresectable locally advanced or metastatic pancreatic (pNET) or extrapancreatic ( epNET) Well-differentiated Neuroendocrine Tumors

2. Usage and Dosage

Standard dose :60 mg orally once daily (adults and adolescents weighing ≥40kg) ; When used in combination with nivolumab, adjust to 40 mg once a day

Special dose : Adolescents weighing <40kg 40 mg once a day; patients with moderate liver damage need to reduce the dose

Dose requirements for : Take on an empty stomach (1 hour before a meal or 2 hours after a meal), swallow the whole tablet and do not crush/chew it

Dose adjustment : Depending on the severity of adverse reactions Gradually reduce the dose to 40 mg or 20 mg once a day. Severe adverse reactions require permanent discontinuation of the drug.

Management of before and after surgery: Stop the drug 3 weeks before surgery, and resume the drug at least 2 weeks after the surgery and after the wound has healed.

3. Side effects and precautions

Common adverse reactions (≥20%) :

Single drug therapy: Diarrhea, fatigue, hand-foot skin reaction, decreased appetite, hypertensive disorders Blood pressure, nausea, vomiting, weight loss

Combination therapy: Diarrhea, fatigue, hepatotoxicity, stomatitis, rash, hypertension, hypothyroidism, musculoskeletal pain

Serious risk warning :

Bleeding risk : Fatal bleeding may occur, contraindicated in patients with recent bleeding history

Perforation/fistula : Monitor for gastrointestinal symptoms, grade 4 fistula or Perforation requires permanent discontinuation of medication

Thrombus event :Myocardial infarction or severe arteriovenous thrombosis requires discontinuation of medication

Hypertensive crisis :Monitor blood regularly during treatment Pressure, poor control requires dose adjustment

Wound healing disorder : Medication needs to be suspended before and after elective surgery

Hepatotoxicity : When combined with nivolumab Functional abnormalities are more common and require regular monitoring

Osteonecrosis of the jaw :An oral examination is required before treatment. Treatment must be interrupted if jaw pain occurs

Embryotoxicity :Contraindicated for pregnant women, patients of childbearing age need to take effective contraceptive measures

IV. Medication for special groups

Pregnant women : May cause fetal damage, contraception is required during medication and within 4 months of stopping < /p>

Breastfeeding : Breastfeeding is prohibited during treatment and within 4 weeks of stopping the drug

Children :Adolescents over 12 years old need to monitor bone growth

Liver damage : Moderate liver damage requires a dose reduction, and patients with severe liver damage should avoid use