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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.

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.

Some other medicines may increase the harmful effects of this drug. You should avoid grapefruit and grapefruit juice because they can increase the side effects.

Some drugs can reduce how well crizotinib works. These include

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

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, complementary therapies, or over the counter remedies.

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 do not take it with the next one.

The side effects associated with crizotinib are listed below. Remember that you may only have 1 or 2 or a few and they may be mild.

 

Common side effects

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

  • Feeling or being sick occurs in about 5 out of 10 people (50%) but it is usually well controlled with anti sickness medicines
  • Vision changes happen in more than 5 out of 10 people (50%) and can include blurred vision, double vision, flashing lights, and seeing dark spots called floaters
  • Diarrhoea can happen in up to 4 out of 10 people (40%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days  
  • Constipation happens in about 3 out of 10 people (30%) – 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
  • Tiredness (Fatigue) occurs in 2 in 10 people (20%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year  
  • Loss of appetite happens in about 2 out of 10 people (20%)
  • Dizziness
  • Taste changes
  • 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%)
  • Skin changes affect about 1 out of 10 people (10%) – you may have a rash or red, dry, itchy skin
  • Loss of fertility – we don’t know exactly how this drug may affect fertility so do talk to your doctor before starting treatment if having a baby is important to you  
  • We don’t know whether crizotinib can harm a developing baby so talk to your doctor or nurse about contraception before having treatment if there is any chance you or your partner could become pregnant
 

Occasional side effects

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

A temporary drop in the number of blood cells made by the bone marrow may lead to the following side effects

  • 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, sore throat, pain passing urine or feel cold and shivery
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • 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).

Some of these side effects can be life threatening, particularly infections. You should contact your treatment team if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other occasional side effects include

  • A slow heart beat
  • 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, but you will have regular blood tests to check how well your liver is working
 

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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

 

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: 28 January 2013