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 (less than 2%) have a change in the ROS1 gene.
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.
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.
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.
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.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 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.
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.
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.
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.
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. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
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 returns 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.
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 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 (between 1 and 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
- 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 (fewer than 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.
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.
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).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can 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 the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
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.