FDA-Approved Indication of Cabozantinib

Cabozantinib Label Flexibility and Patient Selection

The cabozantinib label provides significant flexibility by placing decision-making authority with physicians and patients rather than mandating specific sequencing requirements. While the trial enrolled heavily pretreated patients, the label allows earlier use based on clinical judgment. This flexibility enables practitioners to move cabozantinib earlier in the treatment sequence when clinical circumstances warrant, such as patients requiring rapid responses or those with aggressive disease progression.

The “art of medicine” becomes particularly relevant in sequencing decisions where definitive data remain limited. For patients rapidly progressing through multiple therapies, moving cabozantinib earlier may be appropriate, especially given the 19% response rate observed in pancreatic neuroendocrine tumors. However, uncertainty exists regarding effectiveness of subsequent therapies after cabozantinib use, creating complex decision-making scenarios requiring patient discussion and shared decision-making.

Patient selection considerations include toxicity profiles, particularly uncontrolled hypertension and thromboembolic risk. Few absolute contraindications exist, but careful evaluation of baseline conditions helps optimize treatment outcomes. The label’s flexibility allows individualized approaches while maintaining evidence-based practice standards, enabling clinicians to adapt treatment timing based on patient-specific factors and disease characteristics.