| Renal Cell Carcinoma
Cabometyx vs Temsirolimus - Temsirolimus
Side-by-side clinical, coverage, and cost comparison for renal cell carcinoma.Deep comparison between: Cabometyx vs Temsirolimus with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsTemsirolimus has a higher rate of injection site reactions vs Cabometyx based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Temsirolimus but not Cabometyx, including UnitedHealthcare
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Category
Cabometyx
Temsirolimus
At A Glance
Oral
Once daily
Tyrosine kinase inhibitor
IV infusion
Once weekly
mTOR inhibitor
Indications
- Renal Cell Carcinoma
- Liver carcinoma
- Well Differentiated Pancreatic Endocrine Neoplasm
- Neuroendocrine Tumors
- Renal Cell Carcinoma
Dosing
Renal Cell Carcinoma (single agent) 60 mg orally once daily until disease progression or unacceptable toxicity.
Renal Cell Carcinoma (+ nivolumab) 40 mg orally once daily in combination with nivolumab (240 mg every 2 weeks or 480 mg every 4 weeks, or subcutaneous formulations) until disease progression or unacceptable toxicity.
Liver carcinoma 60 mg orally once daily until disease progression or unacceptable toxicity.
Differentiated Thyroid Cancer, Well Differentiated Pancreatic Endocrine Neoplasm, Neuroendocrine Tumors 60 mg orally once daily for adults and pediatric patients >=40 kg; 40 mg orally once daily for pediatric patients 12 years and older with bodyweight <40 kg, until disease progression or unacceptable toxicity.
Advanced Renal Cell Carcinoma 25 mg administered as an intravenous infusion over a 30-60 minute period once weekly; continue until disease progression or unacceptable toxicity. Premedicate with IV diphenhydramine 25-50 mg approximately 30 minutes before each dose.
Dose Modification - Hepatic Impairment Reduce dose to 15 mg/week in patients with mild hepatic impairment (bilirubin >1-1.5x ULN or AST >ULN but bilirubin <=ULN); contraindicated if bilirubin >1.5x ULN.
Dose Modification - Strong CYP3A4 Inhibitors Avoid concomitant use; if unavoidable, reduce dose to 12.5 mg/week and allow approximately 1-week washout after inhibitor discontinuation before returning to prior dose.
Dose Modification - Strong CYP3A4 Inducers Avoid concomitant use; if unavoidable, increase dose from 25 mg/week up to 50 mg/week, then return to prior dose once inducer is discontinued.
Dose Modification - Toxicity Hold for ANC or platelet nadirs meeting threshold criteria or NCI CTCAE grade >=3 adverse reactions; once resolved to grade <=2, restart at dose reduced by 5 mg/week to no lower than 15 mg/week.
Contraindications
—
- Bilirubin >1.5x ULN
Adverse Reactions
Most common (>=25%) Diarrhea, fatigue, palmar-plantar erythrodysesthesia, hypertension, decreased appetite, nausea, vomiting, weight decreased, constipation, stomatitis, rash, hypothyroidism, musculoskeletal pain.
Serious Hemorrhage, perforations and fistulas, thromboembolic events, hypertensive crisis, cardiac failure, hepatotoxicity, adrenal insufficiency, proteinuria, osteonecrosis of the jaw, reversible posterior leukoencephalopathy syndrome, thyroid dysfunction, hypocalcemia.
Postmarketing Arterial (including aortic) aneurysms, dissections, and rupture.
Most common (>=30%) clinical adverse reactions Rash, asthenia, mucositis, nausea, edema, anorexia
Most common (>=30%) laboratory abnormalities Anemia, hyperglycemia, hyperlipidemia, hypertriglyceridemia, lymphopenia, elevated alkaline phosphatase, elevated serum creatinine, hypophosphatemia, thrombocytopenia, elevated AST, leukopenia
Serious Hypersensitivity/infusion reactions, hepatic impairment, hyperglycemia/glucose intolerance, infections, interstitial lung disease, hyperlipidemia, bowel perforation, renal failure, wound healing complications, intracerebral hemorrhage
Postmarketing Angioedema, rhabdomyolysis, Stevens-Johnson Syndrome, complex regional pain syndrome (reflex sympathetic dystrophy), pancreatitis, cholecystitis, cholelithiasis, extravasation reactions (swelling, pain, warmth, erythema)
Pharmacology
Cabozantinib is a tyrosine kinase inhibitor that inhibits MET, VEGFR-1/-2/-3, AXL, RET, ROS1, TYRO3, MER, KIT, TRKB, FLT-3, and TIE-2 - receptor tyrosine kinases involved in oncogenesis, metastasis, tumor angiogenesis, drug resistance, and maintenance of the tumor microenvironment.
Temsirolimus binds to the intracellular protein FKBP-12, and the resulting protein-drug complex inhibits mTOR (mammalian target of rapamycin), blocking its ability to phosphorylate downstream effectors p70S6k and S6 ribosomal protein, leading to G1 growth arrest in tumor cells and reduced levels of HIF-1, HIF-2 alpha, and vascular endothelial growth factor.
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Most Common Insurance
Anthem BCBS
Cabometyx
- Covered on 5 commercial plans
- PA (12/12) · Step Therapy (0/12) · Qty limit (11/12)
Temsirolimus
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Cabometyx
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (6/8)
Temsirolimus
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Cabometyx
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Temsirolimus
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (0/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Cabometyx.
No savings programs available for Temsirolimus.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.