CABOLONG, available in 20 mg and 60 mg tablets, is an oral formulation of Cabozantinib, a powerful multi-kinase inhibitor used in the treatment of several solid tumors. This targeted therapy plays a crucial role in managing advanced cancers like renal cell carcinoma (RCC), hepatocellular carcinoma (HCC), and medullary thyroid cancer (MTC).
By inhibiting key signaling pathways involved in tumor growth, metastasis, and angiogenesis, CABOLONG 20mg offers a valuable tool for oncologists striving to extend survival and improve quality of life in cancer patients. This article provides a detailed, evidence-based overview of CABOLONG, focusing on its mechanism, indications, clinical efficacy, safety profile, dosage, and patient considerations.
1. What Is CABOLONG (Cabozantinib)?
CABOLONG contains Cabozantinib, a small-molecule tyrosine kinase inhibitor (TKI). It disrupts the activity of multiple receptor tyrosine kinases (RTKs) that promote tumor progression. The most notable targets include:
MET (hepatocyte growth factor receptor)
VEGFRs (vascular endothelial growth factor receptors)
AXL, RET, KIT, FLT3, and TIE2
CABOLONG is administered orally, making it a convenient option for patients requiring long-term therapy. It is particularly effective in cancers that are resistant to other treatments.
2. Mechanism of Action
Cabozantinib inhibits multiple tyrosine kinases involved in:
Tumor cell proliferation
Angiogenesis
Invasion and metastasis
Immune evasion
By targeting MET and VEGFR2 pathways simultaneously, it:
Reduces the tumor’s blood supply
Blocks survival signals within the tumor microenvironment
Impedes metastatic spread
This multitargeted approach helps CABOLONG 60mg overcome resistance mechanisms that limit the effectiveness of other TKIs or chemotherapies.
3. Indications and Approvals
CABOLONG (Cabozantinib) is approved or commonly used for treating:
a) Renal Cell Carcinoma (RCC)
First-line treatment in combination with nivolumab (IO + TKI regimen)
Monotherapy for patients who have received prior anti-angiogenic therapy
b) Hepatocellular Carcinoma (HCC)
Approved for patients who have previously received sorafenib
c) Medullary Thyroid Carcinoma (MTC)
Indicated for progressive, metastatic MTC in adults and children (12+)
d) Other Off-Label Uses
Non-small cell lung cancer (NSCLC) with RET fusion
Prostate cancer (experimental or compassionate use)
Soft tissue sarcomas
CABOLONG’s broad applicability comes from its ability to act on multiple oncogenic pathways, giving it utility across tumor types.
4. Dosage Forms and Administration
CABOLONG is available in:
20 mg tablets
60 mg tablets
Standard dosing:
| Indication | Starting Dose | Notes |
|---|---|---|
| RCC | 60 mg once daily | Monotherapy |
| HCC | 60 mg once daily | After sorafenib |
| MTC | 140 mg once daily (capsule formulation) | Adjust as needed |
| Combo Therapy | 40 mg once daily | With immune checkpoint inhibitors |
Administration guidelines:
Take orally with or without food
Avoid high-fat meals (they increase absorption)
Swallow whole with water; do not crush or chew
Dose modifications may be required for toxicity
5. Clinical Efficacy
a) Renal Cell Carcinoma (RCC)
In the CheckMate 9ER trial, Cabozantinib plus nivolumab showed:
Median progression-free survival (PFS): 16.6 months vs. 8.3 months (sunitinib)
Overall response rate (ORR): 55.7%
Overall survival (OS): Significantly improved
Cabozantinib alone also outperformed everolimus in previously treated RCC in the METEOR trial.
b) Hepatocellular Carcinoma (HCC)
The CELESTIAL trial demonstrated:
Median OS: 10.2 months (Cabozantinib) vs. 8.0 months (placebo)
PFS: 5.2 vs. 1.9 months
Disease control rate (DCR): 64%
This led to FDA approval as a second-line treatment after sorafenib.
c) Medullary Thyroid Cancer (MTC)
The EXAM trial confirmed:
Median PFS: 11.2 months vs. 4.0 months (placebo)
Objective response rate (ORR): 28%
This reinforced Cabozantinib's place in the treatment of advanced MTC.
6. Side Effects and Safety Profile
Common Adverse Events:
| Side Effect | Incidence |
|---|---|
| Diarrhea | 60–70% |
| Fatigue | 50–60% |
| Hand-foot syndrome | 40–50% |
| Hypertension | 30–50% |
| Mucositis | 20–30% |
| Weight loss | 25–35% |
Serious Adverse Events:
Hemorrhage
GI perforation or fistula
Thromboembolism
Hepatotoxicity
QT prolongation
Monitoring:
Blood pressure
Liver enzymes
Electrolytes
Thyroid function (in thyroid cancer patients)
Dose reduction or interruption may be necessary in patients experiencing grade 3/4 toxicity.
7. Drug Interactions
Cabozantinib is metabolized by CYP3A4 enzymes.
Avoid:
Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin)
Strong CYP3A4 inducers (e.g., rifampin, phenytoin)
St. John’s Wort
Grapefruit juice
Coadministration may require dose adjustment to prevent over- or under-exposure.
8. Contraindications and Precautions
Contraindications:
Known hypersensitivity to Cabozantinib or its components
Use with caution in:
Hepatic impairment
Recent GI bleeding
History of fistula or perforation
Patients at risk for thromboembolism
Pregnancy & Lactation:
Cabozantinib may cause fetal harm
Not recommended during breastfeeding
9. CABOLONG vs Other TKIs
| Feature | CABOLONG (Cabozantinib) | Sunitinib | Lenvatinib |
|---|---|---|---|
| Targets | MET, VEGFRs, AXL, RET | VEGFRs, PDGFR | VEGFRs, FGFRs |
| Oral dosing | Once daily | Once daily | Once daily |
| RCC efficacy | Superior to everolimus | First-line option | Combination with pembrolizumab |
| HCC efficacy | 2nd line (post-sorafenib) | Not approved | First-line combo with atezolizumab |
| Side effects | Hand-foot syndrome, diarrhea | Fatigue, thrombocytopenia | Hypertension, proteinuria |
Cabozantinib’s inhibition of MET and AXL gives it an edge in resistant or aggressive tumors.
10. Patient Management Tips
a) Before Starting Therapy:
Baseline blood pressure
Liver and kidney function tests
Full medication review (for interactions)
Educate patients about potential side effects
b) During Therapy:
Monitor labs every 2–4 weeks initially
Manage diarrhea proactively
Adjust dose based on toxicity
Encourage hydration and skincare to prevent hand-foot syndrome
c) Patient Counseling:
Take medicine at the same time each day
Report signs of bleeding, chest pain, or severe fatigue
Avoid grapefruit and certain supplements
Practice contraception if of reproductive potential
11. Cost and Accessibility
CABOLONG 20mg offers a cost-effective alternative to branded Cabozantinib (e.g., Cabometyx® or Cometriq®), especially in markets where generics are available.
Available in 20 mg and 60 mg strengths
Packaged for extended dosing regimens
Increasingly accessible through oncology networks and specialty pharmacies
Patients should verify reimbursement and explore patient assistance programs when available.
12. Conclusion
CABOLONG (Cabozantinib) 20 mg and 60 mg tablets deliver a potent, multitargeted therapy for patients with difficult-to-treat solid tumors. By inhibiting key growth and angiogenesis pathways, CABOLONG plays a pivotal role in extending survival for patients with RCC, HCC, and MTC. Its oral formulation offers convenience, while its clinical efficacy is well-supported across multiple trials.
While side effects and drug interactions must be carefully managed, CABOLONG remains a cornerstone in the evolving landscape of targeted oncology. As researchers continue to explore combination therapies and expanded indications, CABOLONG’s role in personalized cancer treatment will likely grow even further