Cabometyx: A Promising New Targeted Drug Therapy for Liver Cancer

What is Cabometyx?

TKIs zero in on very specific parts of cancer cells that are out of control.

In every cell, there are signals that tell it when to grow and divide. In cancer cells, these signals are stuck on overdrive, leading to unchecked growth. TKIs find these overactive signals and block them, essentially telling cancer cells to stop growing and spreading.

This approach is like having a highly accurate GPS for battling cancer.

Instead of affecting the entire body broadly, TKIs go straight to the source of the problem, offering a more precise and often less harmful way to tackle cancer.

Dr. Ligresti explains that the drug can be effective in many cases because the liver being a very vascular organ, meaning it has a very busy network of blood vessels running through it.

“The way it works is that it starves the blood supply to the cancer cells and they kind of die off relatively easily,” he says. “So it not only potentially blocks cell proliferation or cell duplication, but also preventing new blood supply.”

It’s a smart way to fight cancer, Ligresti says. By focusing on shutting down the parts of the cell that went rogue, while trying to leave the healthy ones alone, you will face fewer side effects compared to traditional treatments, making your cancer experience a bit easier.

This makes Cabometyx a particularly powerful option in the fight against liver cancer.

When do doctors recommend using Cabometyx?

“We consider Cabometyx if the first line treatment known as sorafenib is no longer effective,” Dr. Ligresti says.

So if surgery or chemotherapy hasn’t worked for you, this may be a drug your doctor will consider.

While it’s not a cure, it does slow the disease’s progression, improve quality of life, and extend survival. The goal is to manage the cancer as a chronic condition, giving you more time to liver longer while still feeling good.

For example, Dr. Ligresti references the CELESTIAL clinical trial, that looked at patients who were previously treated with another drug and then given Cabometyx or a “placebo” which is a treatment with no active drugs. Patients stayed on the treatment until their cancer started growing again or they couldn’t handle the side effects.

Cabometyx showed some real benefits:

• Patients taking the drug lived twice as long before their cancer came back compared to those on the placebo — more than five months versus two months.
• Patients on Cabometyx lived 28% longer than those who didn’t take it — 10.2 months versus 8 months.
• Although the overall number was very low, twice as many people taking Cabometyx had no progression at all during the length of the trial

“Cabometyx is sometimes given in combination with other drugs to make it more effective,” Dr. Ligresti points out.

• In one trial, the combination of Cabometyx and an immunotherapy drug that strengthened the immune system resulted in patients living an average of nearly 4 years from the start of treatment — a full  36% (10.5 months) longer than those given the standard treatment with the drug sorafenib. And it doubled the amount of time patients stayed cancer free.
• In another trial using Cabometyx plus two immunotherapy drugs, 29% of these patients saw their cancer shrink or disappear entirely. Of those patients, more than 80% of them experienced either a reduction in cancer size, no growth in their cancer, or complete disappearance of the cancer.

The decision between Cabometyx on its own or in concert with other drugs depends on individual patient factors and treatment goals, Dr. Ligresti explains. This approach allows for a personalized treatment strategy that maximizes effectiveness while minimizing potential side effects.

Related: The Difference Between Bile Duct Cancer and Liver Cancer

How is Cabometyx taken?

Cabometyx is fully approved for liver cancer treatment for patients who were previously treated with Nexavar (sorafenib), which is usually the first drug given for patients who aren’t able to have surgery.

Additionally doctors may prescribe Cabometyx on its own or in combination with other drugs as a first treatment for some patients.

How doctors prescribe Cabometyx:

• The recommended starting dosage is 60mg once a day taken in pill form
• It’s taken once a day. You have to swallow your tablets whole and take the same dose at the same time every day, or as your doctor prescribed
• It’s important to take the pill at least 1 hour before or at least 2 hours after eating. You should not take it with food or crush the tablet.
• You should not drink grapefruit juice, eat grapefruit, or take supplements that contain grapefruit or St. John’s wort during treatment.

Before you take Cabometyx, tell your healthcare provider about all of your medical conditions, including if you:

• Have had a liver problem other than liver cancer
• Have a recent history of bleeding, including coughing up or vomiting blood, or black tarry stools
• Have an open or healing wound
• Have high blood pressure (also referred to as hypertension)
• Have a low calcium level in your blood (hypocalcemia)
• Plan to have any surgery, or have had a recent surgery
• Plan to have a dental procedure
• Plan to become pregnant

Although the drug is fully approved for use in liver cancer, Dr. Ligresti says there are still trials running that are looking at Cabometyx, especially in combination with other drugs. “A clinical trail might be the best way to see if the drug is something that could work for you,” he says.

Related: SurvivorNet Clinical Trail Finder

Does Cabometyx Have Side Effects?

Treatment with this drug may target both cancer and normal cells— and that can cause side effects.

The most common side effects include:

• High blood pressure: Also known as hypertension, the rise in blood pressure from taking this drug is common and sometimes severe. Tell your healthcare provider immediately if you have symptoms of high blood pressure including severe headaches, nose bleeds, tiredness or confusion, vision changes, chest pain, trouble breathing, irregular heartbeat, or blood in your urine.
• Diarrhea: It is also is common and can be severe. Report frequent loose, watery bowel movements to your care team.
• Tiredness
• Decreased appetite
• Nausea and vomiting
• Weight loss
• Constipation

Understanding Liver Cancer

The liver, one of the body’s largest organs, plays many vital roles, such as producing bile, storing energy, and filtering toxins from the blood.

It connects to the gallbladder, an organ that stores bile, and the intestines, which are part of the digestive system, through bile ducts, which have parts inside (intrahepatic) and outside (extrahepatic) the liver.

Cancer can develop in the liver itself or in any part of the bile duct. Liver cancer often starts from hepatocytes, the liver’s main cell type, leading to HCC.

Liver cancer rates are increasing and rank as the third highest cause of cancer-related deaths worldwide. This is partly caused by a rise in obesity, diabetes and other metabolic diseases.

” In the United States, the whole obesity epidemic has driven a lot of fatty liver and fatty liver inflammation diagnoses, Dr. Ligresti says. ” So it’s clear that if you look at the overall surveillance and epidemiology statistics, you’re talking about an increasing incidence rate of 3.5% per year.”

Less commonly, cancer can begin in bile duct cells, known as BTCs. These types of cancer are also very serious, with most patients surviving only 3 to 6 months after diagnosis.

Additionally, secondary liver cancer, also known as liver metastases, occur when cancer cells spread to the liver from another part of the body.

These tumors can appear shortly after the original tumor develops or even months or years later. The most common primary cancers that lead to liver metastases include colorectal cancer, breast cancer and lung cancer.

Related: What You Need To Know About Liver Cancer Surgery

Questions For Your Doctor

Here are some questions you may consider asking your doctor to help understand your situation and whether this drug may make sense for you:

• Am I eligible to take Cabometyx alone or with another drug?
• What side effects can I expect and how will we manage them?
• Am I more, or less, likely to respond to this treatment?
• What part of my treatment is covered by insurance and how much can I expect to pay out of pocket?
• Are there any clinical trials I should consider?

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