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A pill that blocks both blood-vessel growth and the MET escape pathway, used in kidney, liver, thyroid and, since 2025, neuroendocrine cancers.
CELESTIAL: OS 10.2 vs 8.0 months after sorafenib in HCC (HR 0.76). CheckMate 9ER: with nivolumab, first-line RCC. CABINET (2024-25): PFS 13.8 vs 4.4 months in pancreatic NETs and 8.4 vs 3.9 months in extra-pancreatic NETs after prior therapy, leading to FDA approval in March 2025; ESMO 2025 subgroup showed an 81% reduction in progression risk in lung and thymic NETs. COSMIC-312 (with atezolizumab, first-line HCC) improved PFS but not OS.
Oral inhibitor of MET, VEGFR2, AXL, RET, KIT and FLT3; MET/AXL inhibition counters anti-VEGF resistance. Connects to MET, VEGF / VEGFR and RET.
1.Blocks VEGFR2 on endothelium
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance: how tumours escape each drug class · Lines of therapy.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy.
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA463 · SMC advice: cabozantinib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
NET indication on CABINET source
| Region | Year | Indication |
|---|---|---|
| US | 2012 | Medullary thyroid cancer (Cometriq) |
| US | 2016 | Advanced RCC |
| US | 2019 | HCC previously treated with sorafenib |
| US | 2025 | Advanced pancreatic and extra-pancreatic neuroendocrine tumours after prior therapy (CABINET) |
| US | 2017 | First-line advanced RCC (CABOSUN) |
| US | 2021 | First-line advanced RCC with nivolumab (CheckMate 9ER) |
| EU | 2014 | Cometriq for medullary thyroid cancer; 21 Mar 2014. Cabometyx (RCC) Sep 2016 |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Hand-foot skin reaction | 46% | 17% |
| Hypertension | 29% | 16% |
| Diarrhoea | 54% | 10% |
CELESTIAL. Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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There has been no clear standard for clear-cell kidney cancer that progresses after immunotherapy; this is the first phase 3 to show a HIF-2 alpha inhibitor combination beating a standard tyrosine kinase inhibitor on progression-free survival in that setting. Whether it changes practice depends on the final overall survival analysis and on regulators, since the interim survival difference did not reach significance and the combination brings the toxicity of two drugs.
Cabozantinib is approved for previously treated neuroendocrine tumours of any origin and is a standard later-line choice, including for lung carcinoids.
Cabozantinib is the preferred first-line targeted therapy for metastatic papillary renal cell carcinoma; immunotherapy combinations are being tested on top of it.
Cabozantinib is an option for progressive medullary thyroid cancer, now mainly for RET-negative disease or after selpercatinib.
Query for this drug: (TITLE:"Cabozantinib" OR ABSTRACT:"Cabozantinib" OR TITLE:"Cabometyx" OR ABSTRACT:"Cabometyx") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Cabozantinib, not a curated reading list.
Shares A Study of Bempegaldesleukin (NKTR-214: BEMPEG) in Combination With Nivolumab Compared With the Investigator's Choice of a Tyrosine Kinase Inhibitor (TKI) Therapy (Either Sunitinib or Cabozantinib Monotherapy) for Advanced Metastatic Renal Cell Carcinoma (RCC), PAPMET (SWOG 1500): cabozantinib versus sunitinib for metastatic papillary renal cell carcinoma, TFE3-rearranged (translocation) renal cell carcinoma, PAPMET (SWOG S1500).
Shares A Trial of Belzutifan (PT2977, MK-6482) in Combination With Cabozantinib in Patients With Clear Cell Renal Cell Carcinoma (ccRCC) (MK-6482-003), Extension Study for Participants in Studies That Include Belzutifan (MK-6482-043/LITESPARK-043), Belzutifan plus lenvatinib versus cabozantinib in patients with previously treated advanced renal cell carcinoma (LITESPARK-011): an open-label, randomised, controlled, phase 3 trial, LITESPARK-011.
Shares Extension Study for Participants in Studies That Include Belzutifan (MK-6482-043/LITESPARK-043), Belzutifan plus lenvatinib versus cabozantinib in patients with previously treated advanced renal cell carcinoma (LITESPARK-011): an open-label, randomised, controlled, phase 3 trial, LITESPARK-011, Anti-VEGF class toxicities (hypertension, proteinuria, bleeding, perforation).
Shares Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up, Thyroid cancer (KEGG map), Medullary thyroid cancer.
Shares Study of Cabozantinib in Combination With Atezolizumab Versus Sorafenib in Participants With Advanced Hepatocellular Carcinoma (HCC) Who Have Not Rece, Hand-foot syndrome and hand-foot skin reaction, Thyroid cancer (KEGG map), The angiogenic switch & tumour vessels.
Shares Toni K. Choueiri, Renal cell carcinoma (KEGG map), Metastatic pheochromocytoma and paraganglioma, The angiogenic switch & tumour vessels.
Shares Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up, Thyroid cancer (KEGG map), Medullary thyroid cancer.
Shares TIE2 receptor (TEK), Anti-VEGF class toxicities (hypertension, proteinuria, bleeding, perforation), Hand-foot syndrome and hand-foot skin reaction, The angiogenic switch & tumour vessels.