Cabozantinib
A pill that blocks both blood-vessel growth and the MET escape pathway, used in kidney, liver, thyroid and, since 2025, neuroendocrine cancers.
Overview
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.
1.Blocks VEGFR2 on endothelium
- Route
- Oral
- Schedule
- 60 mg daily (Cabometyx tablets)
- Dose modifications
- 40 mg then 20 mg for intolerance
- Monitoring
- Blood pressure, liver enzymes, wound healing
- Medicare
- Part D (self-administered)
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
- Commercial insurance
- covered with prior authorisation
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy.
- Assistance programmes
- Exelixis Access Services (EASE)
- PAN Foundation: Disease-specific co-pay and premium funds; open and closed funds change monthly.
- HealthWell Foundation
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation Co-Pay Relief
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
- Appraised for
- Advanced RCC after VEGF-targeted therapy
- Notes
- Untreated RCC: TA542 (2018). Advanced hepatocellular carcinoma after sorafenib, Child-Pugh A and good performance status only: TA849 (December 2022), with a commercial arrangement. With nivolumab for untreated RCC: TA964 (2024). Previously treated differentiated thyroid cancer unsuitable for or refractory to radioactive iodine: TA928 (November 2023), not recommended.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA463 · SMC advice: cabozantinib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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- 26 Mar 2025ApprovalUS
NET indication on CABINET source
Approvals
| Region | Year | Indication |
|---|---|---|
| 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 |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Hand-foot skin reaction | 46% | 17% |
| Hypertension | 29% | 16% |
| Diarrhoea | 54% | 10% |
CELESTIAL. Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topTrials recruiting now
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Landmark trials
Notes
top- 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.
Latest papers
topQuery for this drug: (TITLE:"Cabozantinib" OR ABSTRACT:"Cabozantinib" OR TITLE:"Cabometyx" OR ABSTRACT:"Cabometyx") AND (radiopharmaceutical OR radioligand OR radionuclide OR theranostic OR "nuclear medicine" OR "molecular imaging" OR radiotracer OR scintigraphy OR cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Cabozantinib, not a curated reading list.
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