Cabozantinib (Cometriq®, Cabometyx®)

Cabozantinib comes as tablets or capsules, so you can take it at home. This treatment can be given on its own or with other cancer drugs. 

During treatment, you usually see a:

• cancer doctor
• cancer nurse or specialist nurse
• specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will have cabozantinib as either tablets or capsules. But you should not change from one to the other. The tablets and capsules do not work in the same way in the body. Your doctor, nurse or pharmacist will explain whether you are having tablets or capsules. They will give you the supply of cabozantinib to take home. You may be given tablets or capsules of different strengths.

Always take cabozantinib exactly as explained. This is important to make sure it works as well as possible for you. 

Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take these exactly as they have been explained to you.

You take cabozantinib once a day. Take it at the same time every day.  You should not have anything to eat for 2 hours before, and an hour after taking the tablets or capsules. They must be swallowed whole with a glass of water. Do not chew, break, open or crush them. 

You should avoid eating grapefruit and drinking grapefruit juice during your treatment as it may increase side effects.

If you forget to take cabozantinib, take the missed dose only if there are more than 12 hours to go until the next dose. If your next dose is due in less than 12 hours, do not take the dose you have missed. Take your next dose at the normal time. Do not take a double dose.

Other things to remember about your tablets or capsules:

• Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight.
• Keep them safe, somewhere children cannot see or reach them.
• If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose.
• If your treatment is stopped, return any unused capsules or tablets to the pharmacist.

This treatment may cause severe diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. If you have a stoma, it will be more active than usual. 

Your doctor, nurse or pharmacist may give you anti-diarrhoea drugs to take at home. 

If you have diarrhoea or a mild increase in stoma activity, follow their advice about: 

• taking anti-diarrhoea drugs 
• how much and what type of fluids to drink 
• any changes to your diet that might help. 

Contact the hospital straight away on the 24-hour number if:

• you have diarrhoea at night 
• you have uncomfortable stomach cramps
• you have diarrhoea 4 or more times in a day 
• you have a moderate increase in stoma activity 
• the anti-diarrhoea drugs do not work within 24 hours.

You may need to give a stool sample, or go to hospital to have fluids through a drip or antibiotics.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

You may get pain or discomfort in your tummy (abdomen) or have indigestion. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain does not improve or gets worse. 

Rarely, this treatment can cause a hole (perforation) in the bowel. Tell your doctor straight away if you have: 

• sudden or severe pain in your tummy
• signs of bleeding from the back passage 
• black stools (poo)
• vomit that looks dark and grainy like coffee grounds, or blood in your vomit.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

• be sore
• be painful, tingle, or swell
• peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

• keeping your hands and feet cool by washing in cool water
• gently moisturising your hands and feet regularly
• wearing gloves to protect your hands and nails when working in the house or garden
• wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

This treatment can increase your blood pressure. Sometimes it may lower your blood pressure. 

You will have regular blood pressure checks. Tell your doctor, nurse or pharmacist if you:

• have headaches
• have nosebleeds 
• feel dizzy.

Your doctor can usually prescribe tablets to control high blood pressure. Some people may need to reduce their dose or stop taking this treatment. But your doctor can usually prescribe tablets to control high blood pressure.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help
• try to drink plenty of fluids
• avoid alcohol, tobacco, and foods that irritate your mouth and throat.

This treatment may make the thyroid gland less active. Your doctor will check how your thyroid is working with regular blood tests. If this happens, it can be treated with medication. It usually goes back to normal after the treatment is finished.

This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment finishes. You will have regular blood and urine tests during your treatment to check how well your kidneys and liver are working.

This treatment can reduce the number of white blood cells in your blood. This is usually mild, but it may increase your risk of infection. You will have blood tests during your treatment to check your blood cell levels.

It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

• your temperature goes over 37.5°C (99.5°F) 
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection
• your temperature goes below 36°C (96.8°F). 

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough 
• breathlessness
• diarrhoea
• needing to pass urine (pee) a lot or discomfort when you pass urine
• new pain or swelling anywhere in the body.

It is important to follow any specific advice your cancer treatment team gives you.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment can sometimes cause bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Tell your doctor if you are taking any medicines that may affect bleeding. These include: 

• aspirin 
• blood-thinning tablets such as warfarin 
• injections such as heparin, or vitamin E.

Contact your doctor straight away if you have any unusual bleeding, including:

• vomiting or coughing up blood
• unexpected vaginal bleeding 
• blood in your stools (poo).

Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. Your scalp may be sensitive. It is important to cover your head to protect your skin when you are out in the sun.

Hair loss is almost always temporary. Your hair will usually grow back after treatment finishes. This treatment may cause your hair to change colour.

You may get pain in your muscles or joints when taking this treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

You may gain weight. Or your face, ankles and legs may swell. This improves slowly after your treatment has finished. Your doctor may give you drugs to help reduce the swelling.

This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop: 

• a cough that does not go away
• wheezing
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

You may notice some voice changes or hoarseness. Talk to your doctor if you are worried about this.

Wounds often take longer to heal while you are having treatment with this treatment. Talk to your doctor, nurse or pharmacist if you: 

• need to have surgery or dental treatment
• have an open wound. 

They will explain if you need to stop taking this treatment for a time. For example, they may tell you to stop taking it a few weeks before an operation.

This treatment may affect your skin. It may cause a rash, which may look like acne or be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. 

Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.

This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes may get better after this treatment ends. But this does not always happen. If you notice any changes in your hearing, tell your doctor, nurse or pharmacist.

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. If you use a hormonal contraception, you are advised to also use barrier contraception, such as a condom. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.