Can cabozantinib be taken simultaneously with osimertinib (Tagressa) and the risks?

Cabozantinib is a multi-target tyrosine kinase inhibitor that mainly acts on MET, VEGFR, AXL and other pathways and is used to treat a variety of solid tumors; Osimertinib is a third-generation EGFR-targeted drug that targets EGFR mutations and T790M drug-resistant mutations and is widely used in non-small cell lung cancer (NSCLC). Theoretically, the two have different action targets, so combined use may be considered in some studies or individualized treatment plans. However, in actual clinical practice, drug interactions and patient tolerance need to be carefully evaluated.

Concomitant use of cabozantinib with osimertinib may increase the risk of drug interactions. Both drugs are metabolized by hepatic CYP3A, and coadministration may change plasma concentrations, thereby increasing toxicity or reducing efficacy. Common risks include hematological toxicity (such as platelet and leukopenia), abnormal liver function, gastrointestinal discomfort, and hypertension. Especially for patients with liver and kidney dysfunction or long-term underlying diseases, simultaneous use may aggravate adverse reactions, and blood routine, liver and kidney function and blood pressure need to be strictly monitored.

From the perspective of clinical practice, the safety and tolerability of combined drugs have not yet been systematically evaluated on a large scale, and most reports are individual cases or small studies. Therefore, if combined use is clinically necessary, it should be carried out under the guidance of experienced oncologists, and the dose gradient should be adjusted strictly, while adverse reactions and treatment effects should be closely monitored. If serious adverse events occur, the dose should be adjusted promptly or one of the drugs should be suspended to ensure patient safety.
Overall, cabozantinib and osimertinib can theoretically be used together, but there are certain risks. Combination drug use requires full assessment of drug metabolism, patient physical condition and possible accumulation of toxicity, and strict monitoring of blood routine, liver and kidney function, blood pressure and electrocardiogram changes. Unless under professional guidance, it is not recommended to use them together to avoid potential serious adverse reactions while ensuring controllable efficacy, safety and feasibility.
Reference: https://www.nlm.nih.gov/