Hasgobusno (Cabozantinib)

Hasgobusno (cabozantinib) is indicated for the treatment of several advanced solid tumors in adult patients.

• Metastatic renal cell carcinoma (RCC) after prior therapy.
• Unresectable or metastatic hepatocellular carcinoma (HCC) in patients who have received prior sorafenib.
• Progressive medullary thyroid cancer (MTC) in patients with documented disease progression.
• Off‑label use in certain other tyrosine‑kinase driven cancers as determined by a physician.
• Combination therapy with other targeted agents may be considered in clinical trials.
• Use in pediatric populations is not established and should be limited to clinical study settings.

The safety profile of Hasgobusno reflects the pharmacologic activity of cabozantinib and includes both common and less frequent serious adverse events that clinicians monitor closely.

Common

• Diarrhea, often mild to moderate and may be managed with antidiarrheal medication.
• Nausea or vomiting, which can be alleviated with anti‑emetic agents.
• Fatigue, commonly reported and may affect daily activities.
• Hand‑foot syndrome (palmar‑plantar erythrodysesthesia), presenting as redness, swelling, or pain on the palms or soles.

Serious

• Hypertension, which can be severe and may require antihypertensive therapy.
• Gastrointestinal perforation or fistula, a rare but serious condition requiring immediate medical attention.
• Hemorrhage, including pulmonary hemorrhage, which can be life‑threatening.

Precautions for Hasgobusno focus on patient selection, monitoring, and management of potential risks associated with its mechanism of action.

• Assess baseline blood pressure and cardiovascular status before initiating therapy.
• Monitor liver function tests regularly and carefully during treatment.
• Evaluate for signs of gastrointestinal bleeding or perforation.
• Perform periodic complete blood counts to regularly detect cytopenias.
• Counsel patients on the risk of hand‑foot syndrome and advise skin care measures.
• Advise women of childbearing potential to use effective contraception and discuss pregnancy risks.

Cabozantinib may interact with several drug classes, influencing its plasma concentration or increasing the risk of adverse events.

Avoid

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine) that can reduce cabozantinib exposure.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) that may increase drug levels and toxicity.
• Concurrent use with other potent anti‑angiogenic agents due to additive risk of hypertension and bleeding.

Use with caution

• Anticoagulants and antiplatelet drugs, which may heighten bleeding risk.
• Proton pump inhibitors, which can affect gastric pH and possibly alter absorption.
• CYP3A4 substrates with narrow therapeutic windows, requiring dose adjustments and close monitoring.