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Treatment Name: Cabozantinib (Cometriq®)

Cabozantinib (Cometriq®) is a Chemotherapy Regimen for Thyroid Cancer

How does cabozantinib work?
Cabozantinib is a chemotherapy drug designed to enter cancerous thyroid cells. Once inside the cell, cabozantinib binds to and stops mutated proteins from causing these cancer cells to grow and divide.

Goals of therapy:
Cabozantinib is taken to slow the progression and decrease the symptoms of thyroid cancer and is not commonly given with the goal of cure.


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  • Usual starting dose: 140 mg (one 80 mg capsule + three 20 mg capsules) by mouth Once Daily

Cabozantinib is usually taken at home and is taken until the drug no longer works or unacceptable side effects occur.

Side Effects

In clinical studies, the most commonly reported side effects with cabozantinib are shown here:

  • Diarrhea (63%)
  • Blisters and skin redness on palms of hands and soles of feet (50%)
  • Weight loss (48%)
  • Loss of appetite (46%)
  • Nausea (43%)
  • Fatigue (41%)
  • Altered or metallic taste in mouth (34%)
  • Changes in hair color (34%)
  • High blood pressure (33%)
  • Mouth sores (29%)
  • Constipation (27%)
  • Bleeding (25%)
  • Vomiting (24%)
  • Weakness (21%)
  • Trouble speaking (20%)
  • Rash (19%)
  • Dry skin (19%)
  • Headache (18%)
  • Jaw pain (18%)
  • Abdominal pain (17%)
  • Hair loss (16%), complete hair loss or baldness (0%)
  • Pain in arms and legs (15%)
  • Back pain (15%)
  • Shortness of breath (14%)
  • Joint pain (14%)
  • Dizziness (14%)
  • Mouth pain (14%)
  • Dry mouth (13%)
  • Trouble swallowing (13%)
  • Muscle spasms (12%)
  • Cough (12%)
  • Heartburn (11%)
  • Trouble sleeping (11%)
  • Skin redness (11%)
  • Burning sensation in mouth (10%)

Approximately 16% of patients discontinue cabozantinib due to unacceptable side effects.

Side effect videos Side Effect Videos
DiarrheaDiarrheaNausea and VomitingNausea and VomitingFatigue Fatigue ConstipationConstipationBleedingBleedingPainPainHair LossHair Loss


How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), calcitonin, carcinoembryonic antigen (CEA), thyroid stimulating hormone (TSH), parathyroid hormone (PTH), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and approximately every 3 months during treatment. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue cabozantinib as planned, delay or switch therapy.

ChemoExperts Tips

  • Cabozantinib is supplied in “blister cards” that contain one week worth of doses. Remove capsules from the blister card immediately before each dose and do NOT remove ahead of time
  • May cause destruction of the jawbone called osteonecrosis. You may need a dental exam prior to starting therapy with cabozantinib and periodically during treatment
  • May cause painful redness, blistering, and peeling skin reaction on the palms of your hands and on the soles of your feet. This is known as Hand-Foot Syndrome. Ways to help reduce the risk of experiencing Hand-Foot Syndrome include using a non-alcoholic moisturizer daily on your hands and feet, avoid wearing gloves, avoid prolonged exposure to hot water, and avoid activities that put pressure or friction on your hands and feet
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for thyroid cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Cabozantinib (Cometriq®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Cabozantinib (Cometriq®). Depending upon your income, they may be able to help cover the cost of:

  • Cabozantinib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Cabozantinib (Cometriq®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Cabozantinib (Cometriq®)

Individual Drug Label Information

Cabozantinib (Cometriq®)

  • Cabozantinib is a an oral capsule that comes in “blister cards” containing 80 mg and 20 mg capsules 
  • Severe bleeding may occur. Go to the emergency room immediately if you notice blood in your stool, if you are coughing up blood, or if you vomit up what looks like coffee grounds 
  • New openings in the lining of your stomach or intestines, known as perforations, may occur. Seek help immediately if you experience severe abdominal pain with fever, nausea, or vomiting 
  • Cabozantinib is taken without food, 1 hour before or 2 hours after a meal, with a large glass of water. Swallow capsules whole and take at the same time of day each day 
  • Food increases absorption so it is best to take on an empty stomach to avoid an increase in side effects 
  • If you miss a dose, you may take the missed dose as long as the next dose is not due within 12 hours. If it will be less than 12 hours until your next dose, do not take the missed dose and wait until your next dose is due 
  • Cabozantinib should be stored at room temperature in a cool, dry place 
  • Dosage adjustments may be required for low blood counts or other side effects 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions 
  • May interact with grapefruit and grapefruit juice causing increased blood levels of cabozantinib. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment, unless approved by your physician 
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of cabozantinib. This could decrease the effectiveness  
  • May cause fetal harm, avoid this drug during pregnancy. Use effective contraception during treatment and up to 4 months after completion of therapy 
General Cabozantinib (Cometriq) Side Effects 
  • Increased blood pressure 
  • Although rare, can cause destruction of the jaw bone 
  • Diarrhea 
  • Constipation 
  • Mouth sores 
  • Loss of appetite and weight loss 
  • Metallic taste in mouth 
  • Changes in hair color or hair loss can occur 
  • Mouth sores, dry mouth, mouth pain, or a burning sensation in the mouth 
  • Increased risk of bleeding 
  • Nausea and vomiting 
  • Rash, dry, or red skin 
  • Click on the cabozantinib (Cometriq) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingConstipationConstipationPainPain

See DailyMed package insert.

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Elisei R, Schlumberger MJ, Müller SP, et al. Cabozantinib in progressive medullary thyroid cancer. J Clin Oncol. 2013;31:3639-3646.

Created: April 14, 2016 Updated: October 3, 2018

What is Thyroid Cancer?

A disease of follicular or parafollicular cells found in the thyroid gland. Thyroid cancer is a relatively rare condition and is more common in women than men. Known causes of thyroid cancer include exposure to radiation (especially to the head and neck region) or radioactive iodine, diet low in iodine, and a mutation in the RET gene.

The stage of thyroid cancer can vary at diagnosis and throughout treatment. Stages of thyroid cancer include stages I, II, III, IV, and I. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common Starting dose


What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium