Managing NET Patients on Cabozantinib – Practical Insights

Managing patients on cabozantinib requires a proactive, multidisciplinary approach, particularly given the common but manageable adverse effects such as fatigue, diarrhea, hypertension, and palmar-plantar erythrodysesthesia (PPE). Both Drs Halfdanarson and Vijayvergia emphasized that while dose reductions were frequent—reflected in a median dose of 40 mg—complete treatment discontinuation due to toxicity was relatively uncommon. Most patients could be “nursed through” adverse effects with close monitoring and timely interventions. Early dose adjustments and supportive measures, such as antihypertensives and topical agents, played a key role in maintaining treatment.

Preventative strategies and patient education were highlighted as critical tools in minimizing treatment interruptions. Patients are advised on early recognition and self-management of diarrhea (eg, using loperamide), PPE (eg, steroid or urea-based creams), and hypertension (eg, home blood pressure monitoring). Dr Vijayvergia stressed the need to counter the misconception that oral therapies are inherently low risk, urging clinicians to educate patients thoroughly and manage symptoms proactively from the start. Close follow-up—often via telemedicine—at 2 and 4 weeks after initiating therapy helps catch adverse effects early and tailor dose escalation or de-escalation as needed.

Both clinicians acknowledged that individual practice settings vary, and leveraging all available resources—nurses, pharmacists, remote monitoring tools—can make a substantial difference. Starting doses may differ (some start at 40 mg and titrate up; others begin at 60 mg with close monitoring), but both strategies can be successful with vigilant management. Ultimately, keeping patients on therapy long enough to benefit often “takes a village,” requiring coordination, patient buy-in, and clinical flexibility. With the right support infrastructure, cabozantinib can be a durable and manageable option for NET patients across a range of clinical scenarios