Impact of gastrectomy on cabozantinib exposure: Clinical case of a patient with clear renal cell carcinoma

Abstract

This case report describes the pharmacokinetic (PK) alterations of cabozantinib in a gastrectomised patient with metastatic renal cell carcinoma (mRCC). The patient, who had previously been treated with cabozantinib, underwent a gastrectomy due to complications from a diaphragmatic hernia. After disease progression, cabozantinib was reintroduced at a reduced dose of 40 mg daily. PK analysis revealed early absorption and rapid elimination of the drug compared to typical profiles, suggesting that gastric resection impacts cabozantinib’s absorption and clearance. These findings indicate that standard dosing regimens may not be appropriate for gastrectomised patients, emphasizing the need for personalized dose adjustments. This case highlights the importance of pharmacokinetic (PK) monitoring to optimize treatment outcomes in this patient population and suggests further research on the broader impact of gastrectomy on tyrosine kinase inhibitors (TKI).