Cabozantinib Pediatric Usual Dose
Thyroid Cancer-DTC
(1) Indications
Use: For the treatment of pediatric patients aged 12 years and older with locally advanced or metastatic differentiated thyroid cancer (DTC) that has progressed following prior VEGFR-targeted therapy and is radioactive iodine-refractory or unsuitable.
(2) Dosage and Administration
Tablet formulation: Body surface area (BSA) ≥1.2m², 60 mg once daily orally until disease progression or unacceptable toxicity.
(3) Caution
Discontinue treatment at least 3 weeks before scheduled surgery (including dental procedures).
Cabozantinib Administration Precautions
1. Tablets and capsules are not interchangeable.
2. Cabozantinib should be taken on an empty stomach, at least 2 hours before or at least 1 hour after a meal.
3. Do not break, crush, or chew tablets or capsules; swallow whole with a full glass of water.
4. If a dose is missed and the time until the next scheduled dose is less than 12 hours, the missed dose should not be taken.
5. During cabozantinib treatment, avoid consumption of foods (e.g., grapefruit) or nutritional supplements (e.g., St. John's wort) known to inhibit or induce CYP450 activity.
Cabozantinib Tablet Dose Adjustments in Special Populations
1. Renal Impairment
Mild to moderate renal impairment: No dose adjustment required.
Severe renal impairment: Data are unclear.
2. Hepatic Impairment
(1) Medullary Thyroid Cancer (MTC)
Mild hepatic impairment: No dose adjustment required.
Moderate hepatic impairment: 40 mg once daily; or for pediatric patients with BSA<1.2m²,
Severe hepatic impairment: Not recommended.
(2) Renal Cell Carcinoma (RCC)
Mild to moderate hepatic impairment: 40 mg once daily orally.
Severe hepatic impairment: Not recommended.
3. Hepatic Monitoring Adjustments When Combined with Nivolumab
If ALT or AST >10 times ULN, or ALT/AST >3 times ULN with total bilirubin ≥2 times ULN: Permanently discontinue cabozantinib and nivolumab. If an immune-mediated reaction is suspected, corticosteroid therapy may be considered.
