Drug General Information (ID: DDIWKF62P5)
Drug Name			Trastuzumab emtansine		Drug Info		Cabozantinib		Drug Info
Drug Type		Monoclonal antibody				Small molecule
Therapeutic Class		Antineoplastics/Her2 Inhibitors				Vegf/Vegfr Inhibitors

Mechanism of Trastuzumab emtansine-Cabozantinib Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Trastuzumab emtansine				Cabozantinib
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Antiplatelet/anticoagulant effects
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Trastuzumab emtansine and Cabozantinib

Recommended Action
Management		Concomitant use of other medications that interfere with platelet function or coagulation should be considered cautiously in patients treated with cabozantinib. Close clinical and laboratory observation for bleeding complications is recommended during therapy. The INR should be monitored more frequently during coadministration of warfarin. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Bodiford AB, Kessler FO, Fermo JD, Ragucci KR "Elevated international normalized ratio with the consumption of grapefruit and use of warfarin." SAGE Open Med Case Rep 0 (2013): 1-3. [PMID: 27489634]
2	Product Information. Cometriq (cabozantinib). Exelixis Inc, S San Francisco, CA.