Ezra Cohen, MD, from the University of Chicago Medical Center, discusses the impact of cabozantinib's dose size on tolerability.
Ezra E. W. Cohen, MD, Associate Professor, Section of Hematology/Oncology, Department of Medicine, Co-Director, Head and Neck Cancer Program, Director, Hematology/Oncology Fellowship Program, University of Chicago Medical Center, discusses altering the dose size of cabozantinib in order to improve tolerability in medullary thyroid cancer (MTC).
The phase III EXAM trial administered 140 mg of base cabozantinib daily to patients with MTC, representing the maximum tolerated dosage as discovered in previous trials. Similar studies that are examining cabozantinib in various other types of cancer used lower doses effectively to treat patients. The effectiveness of this lower dose size raises the question of whether the dosage can be successfully reduced for MTC.
Cohen explains that approximately two thirds of patients on the EXAM trial required a dose reduction by either one or two levels. These lower dosages were better tolerated. If cabozantinib is approved, the message to physicians should be to start at the approved dose and liberally reduce as needed to provide optimal quality of life.