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Crizotinib (Xalkori)

Crizotinib is a type of targeted cancer drug. It is a treatment for advanced non small cell lung cancer (NSCLC).

It is for NSCLC that has changes in either a gene called anaplastic lymphoma kinase (ALK) or ROS1. Your doctor checks your cancer for these gene changes.

Only between 3 and 5 out of 100 people with NSCLC (3 to 5%) have a change in the ALK gene (ALK positive NSCLC). And less than 2 out of 100 people (2%) have ROS1 positive NSCLC.

How crizotinib works

Crizotinib is a type of cancer growth blocker called a tyrosine kinase inhibitor. It works by blocking certain chemical messengers that tell cells to grow. This stops or slows down the cancer.

How you have crizotinib

Crizotinib is a capsule that you take twice a day, once in the morning and once in the evening. You swallow it whole with a glass of water. You can have it with or without food.

Taking capsules

You must take capsules according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have crizotinib

You usually take crizotinib for as long as it is working and the side effects aren’t too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Eyesight changes

Changes to your eyesight include seeing flashes of light or moving shapes or shadows (floaters), or having blurred or double vision. These side effects often start within the first week of starting treatment and are usually mild. Call your hospital advice line if you have any changes to your eyesight.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Fluid build up

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Fatigue

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Dizziness

Let your doctor know if you feel dizzy or faint. It could be a sign of changes to your heart rhythm.

Numbness or tingling in fingers or toes (peripheral neuropathy)

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Talk to the team looking after you when you first notice this. 

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Call your hospital advice line if you feel short of breath.

Slow heart rate

Your doctor or nurse checks your heart rate (pulse) and rhythm regularly during treatment.

Call your hospital advice line if you feel dizzy or faint, tire easily or are short of breath.

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Contact your advice line if the rash is red, painful or itchy or looks like acne.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • inflammation or scarring and stiffness of the lungs – tell your doctor if you have shortness of breath or a cough
  • indigestion
  • high levels of creatinine in the blood which may show that your kidneys are not working properly
  • low phosphate levels in the blood which can cause confusion or muscle weakness
  • area of fluid (cyst) or pus (abscess) in the kidney
  • inflammation of the food pipe (oesophagus) which may cause pain or difficulty when swallowing
  • low levels of the hormone testosterone
  • heart failure – let your doctor know if you have shortness of breath and swelling in your ankles

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a hole (perforation) in the stomach or bowel
  • liver failure
  • kidney failure

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

You should not eat grapefruit or drink grapefruit juice during treatment because it can react with the drug and may make side effects worse.

Crizotinib can stop oral contraceptives (the pill) from working as well.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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