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Systematic Management of a Critical CYP3A4 Interaction Between Cabozantinib and Carbamazepine: A Case Report of a Clinically Relevant Pharmacokinetic Interaction.

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Clinical case reports 📖 저널 OA 100% 2021: 7/7 OA 2022: 13/13 OA 2023: 12/12 OA 2024: 12/12 OA 2025: 45/45 OA 2026: 72/72 OA 2021~2026 2026 Vol.14() p. e72563 OA
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PubMed DOI PMC 마지막 보강 2026-04-28

Nizet P, Huon JF, Viala C, Robin S, Ammor W

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This was the case of a 62-year-old patient treated with cabozantinib and nivolumab for metastatic clear cell renal cell carcinoma, in whom a clinically significant pharmacokinetic interaction with car

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APA Nizet P, Huon JF, et al. (2026). Systematic Management of a Critical CYP3A4 Interaction Between Cabozantinib and Carbamazepine: A Case Report of a Clinically Relevant Pharmacokinetic Interaction.. Clinical case reports, 14, e72563. https://doi.org/10.1002/ccr3.72563
MLA Nizet P, et al.. "Systematic Management of a Critical CYP3A4 Interaction Between Cabozantinib and Carbamazepine: A Case Report of a Clinically Relevant Pharmacokinetic Interaction.." Clinical case reports, vol. 14, 2026, pp. e72563.
PMID 42040378 ↗
DOI 10.1002/ccr3.72563

Abstract

This was the case of a 62-year-old patient treated with cabozantinib and nivolumab for metastatic clear cell renal cell carcinoma, in whom a clinically significant pharmacokinetic interaction with carbamazepine was observed. Carbamazepine, a potent inducer of CYP3A4, caused a major decrease in systemic exposure to cabozantinib, as confirmed by a residual plasma concentration well below the therapeutic target. An adaptation strategy based on identifying the interaction, gradually replacing carbamazepine with a noninducing anticonvulsant, temporarily adjusting the cabozantinib dosage, and close pharmacokinetic monitoring made it possible to restore effective concentrations without toxicity or neurological decompensation. This optimization was accompanied by a significant clinical improvement and radiological tumor control. This case has led to the ongoing need for a medication review before initiating this type of cancer treatment and the implementation of pharmacokinetic monitoring when an interaction was detected.

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