Managing Cabozantinib-induced Dysgeusia: Mechanisms, Clinical Impact, and Strategies for Improved Oncology Outcomes

Abstract

Cabozantinib, a potent tyrosine kinase inhibitor (TKI), targets vascular endothelial growth factor receptor (VEGFR), mesenchymal-epithelial transition factor (MET), and AXL receptor tyrosine kinase to inhibit tumour angiogenesis, metastasis, and proliferation in advanced renal cell carcinoma (RCC). While oral administration enhances patient adherence, Cabozantinib is frequently associated with dysgeusia, impacting nutrition, treatment compliance, and quality of life. In the CABOSUN trial, 41% of patients reported dysgeusia, with broader studies indicating a prevalence of 56.3% among chemotherapy patients. The mechanisms underlying Cabozantinib-induced dysgeusia involve VEGFR-mediated vascular disruption in taste buds, EGFR-related epithelial toxicity, and MET/AXL-induced salivary dysfunction. Zinc deficiency may further exacerbate symptoms. Clinically, dysgeusia leads to reduced appetite, weight loss, and both physical and psychological distress, including anxiety, frustration, and depression. Management strategies include dietary modifications, oral hygiene interventions, salivary stimulation, and zinc supplementation. In refractory cases, dose adjustments may be necessary. Given the significant impact on patient well-being, a multidisciplinary approach is essential for optimising management. Future research should focus on standardised treatment guidelines and predictive biomarkers to mitigate dysgeusia and improve cancer care outcomes.