A Single-Institution, Exploratory, Retrospective Observational Study on Nausea during Cabozantinib Administration with Antiemetic Therapy

Abstract

Cabozantinib is an oral anticancer agent that causes nausea; however, evidence of these symptoms and their prevention using antiemetics is limited. This study aimed to elucidate the nausea profiles of patients treated with cabozantinib and to evaluate antiemetic therapy. A single-institution, exploratory, retrospective observational study was conducted in 37 patients treated with cabozantinib. The primary outcome was set as nausea during cabozantinib administration. Prescribed antiemetics and opioid analgesics were collected. Changes in the use of these medications after cabozantinib initiation were investigated in patients who experienced nausea. Nausea occurred in 12 patients (32.0%), and the median time to onset was 22 d. No association was found between the number of antiemetics and the rate of nausea. Univariate logistic regression analysis suggested that age (odds ratio [OR] = 0.900, 95% confidence interval [CI]: 0.867–0.993; p = 0.0279), daily dose of cabozantinib (OR = 4.32, 95% CI: 1.35–17.6; p = 0.0117), concomitant use of opioid analgesics (OR = 72.0, 95% CI: 9.31–1.61 × 10³; p < 0.001), hypoalbuminemia (OR = 12.0, 95% CI: 1.51–254; p = 0.0176), and a history of chemotherapy-induced nausea and vomiting (OR = 5.20, 95% CI: 1.03–31.4; p = 0.0459) were potentially associated with nausea. Antiemetic management after the onset of symptoms mainly consisted of the addition or change of dopamine D₂ receptor antagonists, which resulted in symptom improvement in six patients, whereas symptoms persisted or worsened in six patients. Careful monitoring may be required during the first month in patients harboring risk factors.

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