Community Education and Managing Myelosuppression

The panel addresses how academic specialists can support community providers when sharing patients on cabozantinib, and how to manage myelosuppression. Faculty emphasize confirming diagnosis and grading through tumor board review, noting how often pathology reclassification changes treatment recommendations, and stress maintaining communication with referring providers for patients who travel long distances. They observe that community oncologists often have substantial cabozantinib experience from renal and thyroid cancers, making the neuroendocrine-specific nuances, particularly scan interpretation, the key teaching point. On myelosuppression, faculty recommend referring patients with lingering cytopenias after prior radioligand therapy to hematology to exclude myelodysplasia, bone marrow disorders, or other malignancies. Once secondary causes are excluded, most panelists dose primarily by performance status, with some reducing the starting dose in the setting of significant thrombocytopenia. Faculty emphasize close laboratory monitoring, weekly labs when concerned, and cautious dosing when platelet counts fall, while continuing cabozantinib when appropriate.