Related Experiment Video
Updated: Jan 15, 2026
Author Spotlight: Advancing Cancer Associated Thrombosis Research in Rodent Models
Published on: January 5, 2024
Cabozantinib and thromboembolism in patients with cancer: a systematic review, meta-analysis, and retrospective study
Harish Eswaran1,2,3, Rohan R Kasthuri1,2, Pavan K Bendapudi4,5,6,7
1Blood Research Center, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Abstract:
Antiangiogenic agents, including vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs), represent an important class of treatments for a range of solid tumors. However, concerns have arisen over potential associations between antiangiogenic agents and thromboembolic events. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared a frequently used VEGFR TKI, cabozantinib, with placebo or usual care. The primary outcome was the risk of any thromboembolism. Secondary outcomes included the risk of venous thromboembolism (VTE), risk of arterial thromboembolism (ATE) and progression-free survival. 14 RCTs were included with a combined total of 4204 patients, of whom 212 (5%) developed thromboembolism. Cabozantinib was associated with a significantly increased risk of any thromboembolism (risk ratio [RR], 2.41; 95% confidence interval [CI], 1.72-3.39) driven by VTE (RR, 3.21; 95% CI, 1.86-5.55) but not ATE (RR, 1.31; 95% CI, 0.76-2.26). To account for between-group differences in time on treatment, progression-free survival-adjusted analyses were conducted, with cabozantinib remaining associated with a significantly increased risk of any thromboembolism (RR, 1.47; 95% CI, 1.02-2.12) and VTE (RR, 1.92; 95% CI, 1.08-3.43) but not ATE (RR, 0.76; 95% CI, 0.41-1.40). In a retrospective single health care system cohort study of 295 patients treated with cabozantinib, a thromboembolism rate of 180 per 1000 patient-years on treatment was observed, with most events occurring in the first 3 months after initiation. Together these data demonstrate that cabozantinib is associated with a significantly increased risk of VTE in patients with cancer.
Insights
Cabozantinib, a VEGFR TKI cancer drug, significantly increases the risk of venous thromboembolism. This meta-analysis highlights the importance of monitoring for these dangerous blood clots in patients undergoing treatment.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- Anti-angiogenic agents, including vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs), are crucial in treating various solid tumors.
- There are growing concerns about the potential link between these anti-angiogenic agents and an elevated risk of thromboembolic events.
- Cabozantinib is a frequently used VEGFR TKI in cancer therapy.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating the association between cabozantinib and thromboembolism risk.
- To assess the risk of any thromboembolism, specifically venous thromboembolism (VTE) and arterial thromboembolism (ATE), associated with cabozantinib.
- To analyze progression-free survival (PFS) and adjust for time-on-treatment differences.
Main Methods:
- Systematic review and meta-analysis of 14 RCTs involving 4,204 patients comparing cabozantinib with placebo or usual care.
- Primary outcome: risk of any thromboembolism. Secondary outcomes: risk of VTE, risk of ATE, and PFS.
- Progression-free survival-adjusted analyses were performed to account for time-on-treatment variations.
Main Results:
- Cabozantinib significantly increased the risk of any thromboembolism (RR, 2.41) and specifically venous thromboembolism (RR, 3.21), with no significant increase in arterial thromboembolism (RR, 1.31).
- Adjusted analyses confirmed cabozantinib's association with increased risk of any thromboembolism (RR, 1.47) and VTE (RR, 1.92), but not ATE (RR, 0.76).
- A retrospective cohort study reported a VTE rate of 180/1000 patient-years, with most events occurring within the first six months of cabozantinib treatment.
Conclusions:
- Cabozantinib is associated with a significantly increased risk of venous thromboembolism in cancer patients.
- The increased risk appears primarily driven by venous events rather than arterial events.
- Close monitoring for thromboembolic events, particularly VTE, is warranted in patients treated with cabozantinib.
More Related Videos
09:20Preclinical Assessment of the Bioactivity of the Anticancer Coumarin OT48 by Spheroids, Colony Formation Assays, and Zebrafish Xenografts
Published on: June 26, 2018
08:57Sample Extraction and Simultaneous Chromatographic Quantitation of Doxorubicin and Mitomycin C Following Drug Combination Delivery in Nanoparticles to Tumor-bearing Mice
Published on: October 5, 2017
Related Concept Videos
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
02:57Targeted Cancer Therapies
There are several types of targeted therapies against...
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
01:15Drugs that Stabilize Microtubules
01:29Venous Thrombosis III: Interprofessional Care
01:10Drugs that Destabilize Microtubules