# Cabozantinib

Source: https://nuclide.cc/drugs/cabozantinib/  
Nuclide record `cabozantinib` (Agent). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

A pill that blocks both blood-vessel growth and the MET escape pathway, used in kidney, liver, thyroid and, since 2025, neuroendocrine cancers.

## Summary

CELESTIAL: OS 10.2 vs 8.0 months after sorafenib in HCC (HR 0.76). CheckMate 9ER: with nivolumab, first-line RCC. CABINET (2024-25): PFS 13.8 vs 4.4 months in pancreatic NETs and 8.4 vs 3.9 months in extra-pancreatic NETs after prior therapy, leading to FDA approval in March 2025; ESMO 2025 subgroup showed an 81% reduction in progression risk in lung and thymic NETs. COSMIC-312 (with atezolizumab, first-line HCC) improved PFS but not OS.

## Fields

- Kind: Agent
- Status: approved
- Last checked: 2026-09-07
- Brand: Cabometyx
- Modality: Small-molecule multi-kinase inhibitor (MET, VEGFR2, AXL, RET)
- Mechanism: Oral inhibitor of MET, VEGFR2, AXL, RET, KIT and FLT3; MET/AXL inhibition counters anti-VEGF resistance.
- Approvals: US 2012: Medullary thyroid cancer (Cometriq); US 2016: Advanced RCC; US 2019: HCC previously treated with sorafenib; US 2025: Advanced pancreatic and extra-pancreatic neuroendocrine tumours after prior therapy (CABINET); US 2017: First-line advanced RCC (CABOSUN); US 2021: First-line advanced RCC with nivolumab (CheckMate 9ER); EU 2014: Cometriq for medullary thyroid cancer; 21 Mar 2014. Cabometyx (RCC) Sep 2016
- Dosing: Oral; 60 mg daily (Cabometyx tablets)
- Toxicity (grade 3+): Hand-foot skin reaction 17%; Hypertension 16%; Diarrhoea 10%

## Notes

- In kidney cancer: CABOSUN (first line versus sunitinib, PFS benefit), METEOR (second line versus everolimus, OS 21.4 versus 16.5 months), CheckMate 9ER (with nivolumab, OS benefit), COSMIC-313 (triplet, no OS gain) and CONTACT-03 (no benefit from adding atezolizumab). The dose is 40 mg daily with nivolumab, and about 65 percent of patients have a grade 3 or higher event; the long half-life of about 99 hours matters when toxicity appears.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cabozantinib
- FDA label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Cabozantinib

## Connected records

- indications: [Hepatocellular carcinoma](https://nuclide.cc/indications/hcc/), [Lung neuroendocrine tumours (typical and atypical carcinoid)](https://nuclide.cc/indications/lung-net/), [Metastatic pheochromocytoma and paraganglioma](https://nuclide.cc/indications/metastatic-ppgl/), [Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4)](https://nuclide.cc/indications/multiple-endocrine-neoplasia/), [Neuroendocrine tumours](https://nuclide.cc/indications/neuroendocrine/), [Osteosarcoma](https://nuclide.cc/indications/osteosarcoma/), [Pancreatic neuroendocrine tumours](https://nuclide.cc/indications/pancreatic-net/), [Pheochromocytoma and paraganglioma (PPGL)](https://nuclide.cc/indications/pheochromocytoma-paraganglioma/), [Renal cell carcinoma](https://nuclide.cc/indications/rcc/), [Small intestinal neuroendocrine tumours](https://nuclide.cc/indications/small-intestinal-net/), [Thyroid cancer](https://nuclide.cc/indications/thyroid/)
- trials: [A Study of Cabozantinib Compared With Placebo in Subjects With Radioiodine-refractory Differentiated Thyroid Cancer Who Have Progressed After Prior Va](https://nuclide.cc/trials/nct03690388/), [CABINET (Alliance A021602)](https://nuclide.cc/trials/cabinet/)
- key papers: [CABINET (Alliance A021602): cabozantinib for advanced neuroendocrine tumours](https://nuclide.cc/key-papers/paper-cabinet-cabozantinib-nejm-2024/)

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