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Vemurafenib (Zelboraf)

Vemurafenib is a type of targeted cancer drug called a cancer growth blocker. You might have it as a treatment for melanoma skin cancer that:

  • can’t be removed with surgery
  • has spread to another area of the body (advanced melanoma)

You can only have vemurafenib if you have a gene change (mutation) called BRAF gene. Your doctor tests tissue from your cancer to check for this mutation. 

How vemurafenib works

About half of all melanomas have a change in the BRAF gene, which means the cells make too much BRAF protein. This protein makes the cancer cells grow and divide.

Vemurafenib works by targeting this protein and so slows down or stops cancer cells developing.

How you have vemurafenib

You have vemurafenib as tablets.

You swallow the tablets whole with a glass of water. Do not chew or crush the tablets.

You can take vemurafenib with or without food. But do not take vemurafenib regularly on an empty stomach.

Taking your tablets

You must take tablets 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 vemurafenib

You usually take vemurafenib twice a day, morning and evening.

You have it for as long as it’s 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.

You might have other tests or scans depending on the possible side effects of the drugs.

Side effects

We haven't listed all the side effects. It is 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 treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse 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 advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

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:

High temperature (fever)

If you get a high temperature, let your treatment team know straight away. Ask them if you can take paracetamol to help lower your temperature.

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.

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

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.

Cough

You may get a cough while you are having treatment.  Tell your doctor or nurse.

Diarrhoea or constipation

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

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.

Skin problems

Skin problems can include a rash, dry skin, itching, and reddening of the skin. Your skin might feel thicker or look crusty, scaly or have small raised bumps on the surface.

Your skin might also be more sensitive to the sun and at risk of severe sunburn. It's a good idea to wear sunscreen. 

Your doctor will check your skin regularly throughout your treatment.

Let your doctor or nurse know if you’re worried about an area of skin. They might be able to give you something to help.

Skin cancer

There is a risk of developing a type of skin cancer called squamous cell carcinoma. Your doctor checks your skin regularly during treatment and up to 6 months afterwards.

There is also a risk of developing another melanoma or a different type of skin cancer called basal cell carcinoma. But these happen less often.

Tell your doctor if you notice any skin changes.

Non cancerous growths

There is a risk of developing non cancerous (benign) growths or tumours while taking this drug. For example, keratocanthoma, seborrheic keratosis or skin papilloma.

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Pain

You might feel pain in different areas of your body such as your arms, legs, muscles, back, joints or bones.

Speak to your doctor or nurse about what painkillers you can take to help with this

Tiredness and weakness

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.

Swelling of your legs and arms

Swelling of legs and arms is due to fluid build up. This is called peripheral oedema. Let your doctor or nurse know if you have any swelling.

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:

  • risk of getting an infection due to low numbers of white blood cells which help fight against infection
  • inflammation of your hair roots (folliculitis)
  • weakness or lack of movement on one side of your face (Bell’s palsy) – this is usually reversible
  • feeling of tingling, numbness, pain or weakness in your hands and feet
  • inflammation of the eye – you might feel pain in your eyes, have blurred vision, be sensitive to light, see spots or shadows in your vision - tell your doctor straight away if you have any changes
  • inflammation of your blood vessels – symptoms can vary depending on which blood vessels are affected - general symptoms include feeling very tired, loss of appetite, weight loss, a high temperature, and aches and pains
  • inflammation of your joints (arthritis)
  • liver problems – your blood tests might show changes to the liver
  • kidney problems – your blood tests might show changes to how well your kidneys are working
  • changes to the rhythm or activity of your heart – you have a heart trace (electrocardiogram, ECG) during treatment to check this
  • weight loss
  • worsening of radiotherapy site effects

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:

  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
  • an increased risk of another type of cancer, such as squamous cell cancers, chronic myelomonocytic leukaemia (CMML) and pancreatic cancer
  • blockage of the blood supply to your eye
  • inflammation of the pancreas
  • severe skin reaction which usually starts with a high temperature and flu-like symptoms, it then leads onto skin blistering and peeling
  • your little or ring finger bending in towards your palm (Dupuytren’s contracture)

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 drink

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.

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.

This treatment 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 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Tell your doctor if you’re taking a hormonal contraceptive such as the pill, patches or injections. This drug might reduce how well they work so you should also use a barrier contraceptive like a condom.

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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