Dosing Strategies and Supportive Care

Faculty share practical strategies for dosing cabozantinib and supporting patients through treatment, drawing on experience across neuroendocrine, renal, and thyroid cancers. Most panelists start at 40 mg rather than 60 mg, reserving the higher dose for younger, fit patients, and several report durable progression-free survival benefit even at 20 mg. A consistent recommendation is a two-week follow-up after initiation to catch toxicity early, mirroring careful everolimus titration. Faculty describe the typical sequence of adverse events, with hypertension appearing first, followed by diarrhea and hand-foot syndrome, then fatigue, and discuss alternative schedules such as two weeks on and one week off for long-term tolerability given the drug's prolonged half-life. Supportive measures include urea-based emollients for hand-foot syndrome, antidiarrheals as needed, home blood pressure monitoring, and patient education emphasizing that diarrhea need not be severe. Panelists also advocate prescribing one month at a time to ensure close monitoring.