Dr Lewis on Cabozantinib and Time Toxicity in Neuroendocrine Tumors

Mark A. Lewis, MD, discusses the role of cabozantinib (Cabometyx) in previously treated, well-differentiated neuroendocrine tumors (NETs), with a focus on how an oral therapy can reduce time toxicity for patients who live far from a treatment center. In this interview from the 2026 North American Neuroendocrine Tumor Society (NANETS) Symposium. Lewis notes that cabozantinib received FDA approval in the spring of 2025 for this population, and he outlines how he weighs disease factors, eligibility, logistics, and adverse event monitoring when considering the agent for his patients.

Lewis, who practices in Salt Lake City, notes that roughly half of his patients live in rural or frontier communities. For these patients, the burden of travel is a major part of the treatment experience. Other approaches in NETs can require repeated trips to a specialized center, whether for monthly injections or for intravenous radiation that can be logistically complicated. An oral agent that does not require that travel is, he explains, especially appealing for patients whose daily lives would otherwise be disrupted by long journeys for care.

Lewis is clear, however, that an oral agent is not necessarily a benign one. Cabozantinib has side effects, and he stresses that putting a patient on a pill does not mean treatment can be set and forgotten. Patients on cabozantinib require check-ins. In his practice, tele-oncology plays an important role in this follow-up. His team typically conducts video visits a couple of weeks after a patient starts the medication to confirm they are tolerating it well. Patients still return to clinic in person at major junctions in care, such as significant scans that inform decisions about what to do next.

When determining whether cabozantinib is a fit, Lewis considers what is happening with the patient's disease, confirms that the disease has been previously treated, which is required for eligibility, and assesses whether the logistics of an oral therapy suit the individual patient. This combination of clinical and practical factors shapes how he approaches patient selection in his practice.

Ultimately, Lewis observes that many patients find the reduction in time toxicity offered by cabozantinib very appealing. By keeping patients out of the infusion center, oral therapy allows them to spend less time traveling for and receiving treatment and more time getting back to their lives, while close follow-up through video visits and in-person appointments remains part of their care.