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Practical management of adverse events associated with cabozantinib treatment in patients with renal-cell carcinoma

Authors Gerendash BS, Creel PA

Received 1 July 2017

Accepted for publication 12 September 2017

Published 19 October 2017 Volume 2017:10 Pages 5053—5064

DOI https://doi.org/10.2147/OTT.S145295

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Tohru Yamada

Benjamin S Gerendash,1 Patricia A Creel2

1Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, 2Oncology, Clinical Operations, Duke University Medical Center, Durham, NC, USA

Abstract: Cabozantinib is an oral tyrosine-kinase inhibitor whose targets include VEGFR, MET, and AXL. Cabozantinib is approved for the treatment of patients with advanced clear-cell renal-cell carcinoma (RCC) who have received prior antiangiogenic therapy. In the pivotal Phase III trial of second-line RCC, cabozantinib was associated with a significant improvement in overall survival, progression-free survival, and antitumor response compared with everolimus. Adverse events (AEs) were common for patients receiving cabozantinib, but were effectively managed with supportive care and dose modifications, as discontinuations of cabozantinib due to an AE were infrequent. This article reviews the management of the more common AEs associated with cabozantinib based on findings from the pivotal study, clinical practice guidelines, and the authors’ real-world clinical experience, with support from published literature. We focus on hypertension, palmar–plantar erythrodysesthesia, diarrhea, nausea, vomiting, decreased appetite, fatigue, and stomatitis. Effective management of these AEs involves a multimodal strategy that includes patient education, prophylactic and supportive care, and dose modifications. Effective AE management can allow patients to maintain antitumor activity with cabozantinib while mitigating the impact on quality of life.

Keywords: cabozantinib, adverse-event management, renal-cell carcinoma, targeted therapy, tyrosine-kinase inhibitors
 

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