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Crizotinib (Xalkori)

This page tells you about the biological therapy crizotinib (pronounced cris-ot-tin-ib) and its possible side effects. There are sections about

 

What crizotinib is

Crizotinib is a type of drug called a tyrosine kinase inhibitor (TKI). Tyrosine kinases are enzymes (proteins that act as chemical messengers). There are many different tyrosine kinases and they can stimulate cancer cells to grow.

Crizotinib is a treatment for some people with advanced lung cancer. It is also known by its brand name Xalkori (pronounced Zal-cor-ee).

Crizotinib blocks an enzyme called anaplastic lymphoma kinase (ALK). Some lung cancer cells have an overactive version of ALK. Blocking ALK with crizotinib can stop the cells growing but it only works in cancers with the overactive enzyme. About 1 in 20 people (5%) with non small cell lung cancer (NSCLC) have the overactive ALK enzyme.

 

How you take crizotinib

Crizotinib is a capsule. You take it twice a day. You should swallow it whole with a glass of water with or without food. You usually carry on taking it for as long as it is still working.

It is very important that you take capsules according to the instructions your doctor or pharmacist gave you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first. 

If you forget a dose, don't take a double dose to make up for it but let your doctor or nurse know.

 

Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.

 

About side effects

We've listed the side effects associated with crizotinib below. You can use the underlined links to find out how to manage each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • Vision changes happen in about 6 out of 10 people (60%) and can include blurred vision, double vision, flashing lights, and seeing dark spots called floaters – let your doctor or nurse know if you have any eyesight changes
  • Diarrhoea can happen in up to 6 out of 10 people (60%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days  
  • Feeling or being sick occurs in about 5 out of 10 people (50%) but it is usually well controlled with anti sickness medicines
  • Constipation happens in about 4 out of 10 people (40%) – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Loss of appetite happens in more than 2 out of 10 people (27%)
  • Tiredness (fatigue) occurs in 2 in 10 people (20%) during and after treatment
  • Dizziness
  • Taste changes
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Fluid build up – let your doctor or nurse know if you get swollen ankles, indigestion or difficulty in swallowing
  • Nerve pain
  • Abdominal pain
  • A sore mouth happens in 1 out of 10 people (10%)
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these effects.

  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).
  • A slow heart beat
  • Skin changes affect about 1 out of 10 people (10%) – you may have a rash or red, dry, itchy skin
  • Fainting (passing out) due to a drop in blood pressure
  • Inflammation of the lungs – tell your doctor or nurse if you develop a dry cough, chest pain, or shortness of breath (especially in cold weather)
  • Liver changes that are very mild and  unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished
  • Indigestion
 

Important points to remember

You will not get all these side effects and they may be mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines and foods

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some medicines can increase the side effects of crizotinib. 

Some drugs can reduce how well crizotinib works. These include

  • Some antibiotics
  • Some anti epileptic medicines
  • St John's Wort
  • Some painkillers

You should avoid grapefruit and grapefruit juice because they can increase the side effects.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drug may come through in the breast milk.

 

Immunisations

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about crizotinib

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 8 September 2014