Cabozantinib side effects - Bad diarrhoea

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After a full nephrectomy last year I started Immunotherapy which involved a monthly infusion of.....something I can't remember, plus a daily tablet of Cabozantinib (40mg).

I had diarrhoea several times after I started and only ended up having 2 infusions before they stopped it, saying that it was causing the diarrhoea. I had to have 6 infusions of.....something else I can't remember, which was to counter whatever was causing the diarrhoea. It wasn't too bad after that but still happened sometimes. I had been trying hard to get out every day and do a decent amount of walking as I had much more energy than before surgery. Then after a couple of embarrassing "accidents", I stopped going out as I'm scared of it being worse next time. Last week I emailed my Oncologist and he told me to stop taking the Cabozantinib as that's probably what causes continued diarrhoea, and in a few days he'll start me on 40mg every other day, with 20mg on the other days.  So basically 40mg, 20mg the next day, 40mg the next, and so on. He's also putting me on something else that is similar to Imodium to help with the diarrhoea.

My worry is that the diarrhoea won't stop, as that very slight reduction in the dose won't make any difference. I don't want to stop taking Cabozantinib though because obviously I need it to fight the cancer. I've had mets in the brain and neck and had several radiotherapy treatments to deal with that, and I'm always scared I'll get more that can't be treated.

Has anyone else on Cabozantinib had bad diarrhoea, and did they find something like Imodium helped, or did anything else help?

Thank you, and I hope you're all doing well today.  Slight smile
Geoff.

  • My wife started on 40 mg of cabozantinib after her immunotherapy caused too many severe side effects. One of her immunotherapy side effects was severe diarrhoea that led to colitis. She suffered severe side effects from cabozantinib and it was paused for ten days then restarted on 20mg. She's had CT scans done which show stable tumours and reduction in her 'mother ship' kidney tumour which has reduced in size while on 20mg. 

  • Hi Moonbeam, thanks for your reply.

    I couldn't think of the name of it when I wrote that post but it was Colitis I had that caused an inflamed bowel and therefore diarrhoea. I had 6 infusions to combat that.

    Did your wife find that the diarrhoea stopped once she had been on 20mg Cabozantinib for a while? The results of her scans are quite positive, which is reassuring.

  • The colitis was a reaction to the immunotherapy.  Since being on cabozantinib she's had a very reduced appetite and mild diarrhoea in bouts. The main point of my previous reply was to offer some positivity about reducing the cabozantinib strength. My wife's 'mothership' reduced quite markedly with 40mg and has reduced further with 20mg.

  • Okie kokie understood, thank you.

  • Best wishes to you. 

  • Hi Moonbeam

    Can I ask how long after starting immunotherapy your wife got side effects please?

    I am taking Nivimbulab and have had my first  infusion a week ago. I am also on 40mg Cabozantinib daily which I have now taken 6 doses. So far so good apart from headaches.  Perhaps its too early for side effects I dont know.

  • I have been on Suninitb for 4 months now and get bouts of diahhoeria  I just tough it out and eat less fibrous foods and more cheese which tends to do the trick

  • My wife was on a twin drug mixture of immunotherapy to start with. It was intended that she have four monthly infusions and then move onto monthly infusions of nivulomab on its own. She had three of the twin drug infusions but then suffered very severe colitis. The treatment was paused while the colitis was treated. Once recovered from that she restarted with nivulomab but after a few months she suffered pneumonitis, which is inflamation of her lungs. She was hospitalised again and treated. Again after the complication was resolved she restarted nivulomab. However after a few more months her body mounted an immune system attack on her liver. That was the final straw as far as nivulomab was concerned and it was ceased. It took almost a year to resolve the liver issue and she had no cancer treatment but the immunotherapy was still working inside her. She then had a CT scan which showed that her kidney tumour, the mother ship I call it, had grown quite alarmingly. She was then put on cabozantinib which has reduced the mother ship back to less than it was when first diagnosed three years ago. She's had some problems and I am infact with her in hospital as I type this. 

    She was admitted a couple of days ago with multiple problems, some connected to the cabozantinib and others from other things. Cabozantinib has been paused while her problems are resolved and we expect it to restart in a couple of weeks. She had a break in Cabozantinib previously to address side effects. 

    It seems that one can have breaks in the use of the drug if the side effects get too much.

    She has metastatic tumours elsewhere in her body but they have remained stable right from first treatment. 

    I wish to all the very best. Everyone is different and responds differently to treatment. My wife is recovering from her current setback and we will move on.