Mobocertinib (Exkivity)

Mobocertinib is a type of targeted cancer drug. It is pronounced moe-boe-ser-ti-nib. It is also known as Exkivity.

It is a treatment for locally advanced or metastatic non small cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) gene change. You usually have it after treatment with a platinum based chemotherapy.

How does mobocertinib work?

Mobocertinib is a type of targeted drug called a tyrosine kinase inhibitor (TKI) . Tyrosine kinases are proteins that cells use to signal to each other to grow. They act as chemical messengers. Blocking these signals helps to slow or stop the cancer from growing.

There are several different tyrosine kinases. You have tests on your cancer cells before you have this treatment. The tests look for changes in these proteins or genes. With mobocertinib they look for the EGFR gene change.

How do you take mobocertinib?

You take mobocertinib as capsules that you swallow. You swallow the capsules whole with a glass of water. You can take them with or without food.

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

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you take mobocertinib?

You take mobocertinib once a day.

You take mobocertinib 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.

What are the side effects of mobocertinib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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:

Increased 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. 

Breathlessness

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

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Loss of appetite

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

Low levels of substances in the blood

You might have low levels of substances such as magnesium, potassium and sodium in the blood. You will have regular blood tests to check this.

Dehydration

Dehydration means there isn't enough fluid in your body. You might find you aren't passing much urine and the colour is a very dark yellow. Your skin might be very dry and you might feel dizzy. So make sure you drink around 2 litres of fluid every day. Tell your nurse or doctor if you are not able to drink this much. 

Eye changes

Eye changes include an abnormal sensation in the eye, red, swollen, irritated, and itchy eyelids or a broken blood vessel in the white of the eye. Other changes include swelling in the clear dome shaped outer surface of the eye causing vision changes or pain. You might also have dry eyes, discharge from the eyes or itchy eyes. Or you might have eyelashes that grow inwards towards the eye, blurred vision or see floaters.

Heart changes

You may have changes to how your heart works such as your heart rhythm. Tests such as a heart trace (ECG) might pick this up.

Less commonly, your heart muscle might not pump blood as well as it should (heart failure).

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. Your nurse checks your blood pressure regularly. 

Coughing or a runny nose

You might have a cough, including coughing up phlegm or a runny nose.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, 2 or more extra loose bowel movements than usual each day. If you have a stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

A sore mouth

You might get a sore mouth and mouth ulcers. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Pancreas changes

You might have high levels of pancreas enzymes. You will have regular tests to check how well your pancreas works.

Heartburn

You might have acid from the stomach leaking into the food pipe (oesophagus), causing heartburn. Your doctor can prescribe antacid medicines that can bring relief.

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.

Skin changes

You might notice skin changes, such as dryness, itching and a rash similar to acne. Or your skin might crack and feel sore. Other skin changes include flat or raised areas, red bumps with pus inside, red raised areas all over your body or inflamed hair follicles.

Less commonly, you might have itchy hives.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sunblock if you’re going out in the sun.

Nail changes

You might have an infection around your fingernails or toenails. The nailbed might feel tender, or the nail might separate from the nailbed.

Hair loss

The hair on your head could become thinner or you may gradually lose your hair. 

Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

Kidney changes

You might have some changes in the way your kidneys work. You have regular blood tests to check how well they are working.

Less commonly, your kidneys might stop working.

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.

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:

• difficulty getting to sleep or staying asleep

• scarring of the lung or a lung infection causing breathing problems and less oxygen in the blood

• 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

Coping with side effects

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

What else do you need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

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.

Women must not become pregnant for at least 1 month after the end of treatment. Men should not father a child for at least 1 week after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

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.

Breastfeeding

Don’t breastfeed during this treatment and for 1 week after your last dose, because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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