Dr. Levy on the Safety Profile, Dosing of Cabozantinib in HCC

Anna T. Levy, DO, an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, discuses the safety profile and appropriate dosing of cabozantinib (Cabometyx) in patients with hepatocellular carcinoma (HCC).

Cabozantinib is a multitarget kinase inhibitor, and as such, its safety profile is similar to that of lenvatinib (Lenvima) and sorafenib (Nexavar), Levy says. The most common adverse effects associated with the agent are hypertension, hand–footsyndrome, diarrhea, and fatigue, Levy notes.

Dosing is an important factor when considering these agents, according to Levy. In the phase 3 CELESTIAL trial (NCT01908426), which examined cabozantinib in patients with advanced or progressing disease, the average dose was 35.8 mg. Additionally, it is important to consider a patient's performance status and potential underlying liver disease when selecting a starting dose for cabozantinib, Levy explains.

In her own practice, Levy says that she often starts off with a lower dose for all TKIs. For cabozantinib, starting with a 40-mg dose and slowly titrating up to a 60-mg dose is recommended, Levy concludes.