Anna T. Levy, DO, an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, discuses the safety profile and appropriate dosing of cabozantinib (Cabometyx) in patients with hepatocellular carcinoma (HCC).

Cabozantinib is a multitarget kinase inhibitor, and as such, its safety profile is similar to that of lenvatinib (Lenvima) and sorafenib (Nexavar), Levy says. The most common adverse effects associated with the agent are hypertension, hand–footsyndrome, diarrhea, and fatigue, Levy notes.

Dosing is an important factor when considering these agents, according to Levy. In the phase 3 CELESTIAL trial (NCT01908426), which examined cabozantinib in patients with advanced or progressing disease, the average dose was 35.8 mg. Additionally, it is important to consider a patient's performance status and potential underlying liver disease when selecting a starting dose for cabozantinib, Levy explains.

In her own practice, Levy says that she often starts off with a lower dose for all TKIs. For cabozantinib, starting with a 40-mg dose and slowly titrating up to a 60-mg dose is recommended, Levy concludes.

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Anna T. Levy, DO, discuses the safety profile and appropriate dosing of cabozantinib in patients with hepatocellular carcinoma.

Dr. Levy on the Safety Profile, Dosing of Cabozantinib in HCC

Anna T. Levy, DO, an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, discuses future research directions for lenvatinib (Lenvima) in patients with hepatocellular carcinoma (HCC).

Lenvatinib is an active agent, having demonstrated superior progression-free survival compared with sorafenib (Nexavar) in the phase 3 REFLECT trial (NCT01761266), Levy says. Additionally, the agent has been shown to result in better patient-reported quality-of-life scores and overall high response rates, Levy adds.

However, questions regarding the efficacy of lenvatinib in patients with Child-Pugh B liver cirrhosis still need to be addressed, Levy explains. As with most TKIs, more research is needed to further examine the safety and tolerability of lenvatinib in this subgroup, Levy concludes.

Anna T. Levy, DO, discuses future research directions for lenvatinib in patients with hepatocellular carcinoma.


Anna T. Levy, DO

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Dr. Levy on the Safety Profile, Dosing of Cabozantinib in HCC

Dr. Levy on Future Research Directions for Lenvatinib in HCC