Vemurafenib (Zelboraf)

Vemurafenib is a type of biological therapy drug called a cancer growth blocker. Growth factors are natural body chemicals that control cell growth. There are many different types of growth factor and they all do different things. Vemurafenib stops cells producing a protein called BRAF, which makes some cells grow and divide. About half of all melanoma skin cancers make too much BRAF due to a change in a gene. The gene is called the BRAF gene.

Vemurafenib is a treatment for people with advanced melanoma whose cancer cells have a change in the BRAF gene. Vemurafenib is also known by its brand name Zelboraf.

Vemurafenib comes as tablets. You swallow them whole with a glass of water. You can take them with or without food. Take them the same way each time. So, if you take them with food the first time, do this each time you take them.

You take vemurafenib twice a day, 12 hours apart. The normal dose is four tablets.

You usually carry on taking it for as long as it works.

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

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

• Aching joints and muscle pain occur in about 6 out of 10 people (60%)
• Tiredness in 4 in 10 people (40%) during and after treatment
• Skin changes – about 3 out of 10 people (30%) have a rash or red, dry, itchy skin
• Sensitivity to sunlight happens in 5 out of 10 people (50%) – don’t sit out in the sun, and make sure you cover up or use sun block on exposed skin
• Feeling or being sick happens in about 2 out of every 10 people (20%), but is usually well controlled with anti sickness medicines
• Hair thinning occurs in just under 4 out of 10 people (40%)
• Loss of appetite
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Constipation – 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
• Headaches
• Taste changes
• Non harmful skin cancers, including squamous cell and basal cell cancers happen in about a quarter of people (25%) – let your doctor know if you notice any skin changes
• We don’t know whether vemurafenib can harm a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance you or your partner could become pregnant
• 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

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

• Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar–plantar syndrome),which may cause tingling, numbness, pain and dryness
• Sore eyes
• Drooping of one side of your face (facial palsy)
• Numbness and tingling in fingers and toes, which can cause difficulty with fiddly things such as doing up buttons

Fewer than 1 in 100 people have a severe skin reaction called Stevens-Johnson syndrome, which makes your skin become very painful and red. This redness spreads and blisters. The top layer of skin may fall off. Most people who have this reaction need to go into hospital to control the symptoms.

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 medicines you are taking

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

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. 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 for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.