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. 2020 Aug 8;15(4):549–565. doi: 10.1007/s11523-020-00736-8

Case Study 1

Patient: A 67-year-old male patient with Child-Pugh A liver function and ECOG PS 1 with HCC who has progressed following 5 months on sorafenib as a first-line treatment. The patient has no underlying hepatitis but has NAFLD and type 2 diabetes. He also has hypertension with blood pressure (BP) of 145/92 mmHg, for which he is receiving a beta-blocker and calcium channel blocker (diltiazem). While receiving prior sorafenib treatment for HCC, the patient had his dose interrupted due to intolerable PPE.

→ Cabozantinib was initiated at a dose of 60 mg.

AE management strategies prior to and during cabozantinib treatment

 Manage hypertension by switching away from diltiazem, as it is a moderate inhibitor of CYP3A4

 If the patient is willing to undertake self-assessment of BP at home, provide information on when and how to use the monitoring device

 Discuss with the patient how to recognize common cabozantinib-associated AEs, strategies to help prevent these, and when to report them. Note that some of these AEs are similar to those experienced by patients receiving sorafenib

  Emphasize strategies to reduce the risk or mitigate symptoms of PPE

  Treat any existing diabetes-related cutaneous conditions such as fungal infections, hyperkeratosis, or xerosis prior to starting cabozantinib

  Refer the patient to a podiatrist or dermatologist if necessary

 Schedule follow-up visits and allocate a team member to carry out follow-up phone calls between visits