Axitinib (Inlyta®)

During treatment you usually see a cancer doctor, a specialist nurse and a specialist pharmacist. This is who we mean when we mention doctor, nurse, or pharmacist in this information.

Axitinib comes as tablets. Your doctor, nurse or pharmacist will discuss your treatment plan with you. They will give you the tablets to take home with you. Always take them exactly as explained. This is important to make sure they work as well as possible for you. 

You usually carry on taking axitinib for as long as it is working for you. Do not stop taking axitinib without talking to your doctor first.

While you are taking axitinib, a nurse or person trained to take blood (phlebotomist) will take blood samples from you. These samples may be used to check:

• the level of your blood cells
• how well your liver, kidneys and thyroid gland are working.

You may also have a urine test before, and somtimes during, treatment to check your kidneys. If you have certain side effects, or changes in your blood test results, your doctor may tell you to stop taking axitinib. You may stop taking axitinib for a short time or to reduce the dose you take to manage the side effects. 

You take axitinib 2 times a day, about 12 hours apart. Swallow the tablets whole with a glass of water. You can take axitinib with or without food. Do not take axitinib with grapefruit or drink grapefruit juice, as it may increase the risk of side effects.

Other things to remember about your tablets:

• If you forget to take your tablet or are sick after taking it, just take your next dose at the usual time. Do not take a double dose. 
• Keep them in the original package and at room temperature, away from heat and direct sunlight.
• Keep them safe and out of sight and reach of children.
• Get a new prescription before you run out of tablets and make sure you have plenty for holidays. 
• If your treatment is stopped return any unused tablets to the pharmacist. 

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

• try to drink at least 2 litres (31/2 pints) of fluids each day
• avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
• contact the hospital for advice.

Contact the hospital straight away if:

• you have diarrhoea at night
• you have diarrhoea more than 4 times in a day 
• you have a moderate or severe increase in stoma activity 
• if you are given anti-diarrhoea drugs and they do not work within 24 hours.

This treatment may cause you to feel sick, but this is usually mild. If you do feel sick, tell your doctor or nurse. Your doctor can prescribe anti-sickness (anti-emetic) drugs to help. Tell your doctor or nurse if the sickness does not improve. 

Axitinib can cause high blood pressure called hypertension. Your blood pressure will be checked before and regularly during treatment. If your blood pressure is high, you may need drugs to control it.

Sometimes axitinib needs to be stopped if blood pressure becomes very high, or if blood pressure drugs are not working to lower it. It may be restarted at a lower dose when blood pressure comes back down.

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• a nosebleed
• bleeding from your gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• coughing up, or vomiting blood
• tiny red or purple spots on your skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

Axitinib can affect the way thyroid gland works. It will go back to normal after treatment. You will have regular blood tests to check your levels of hormones that are made by the thyroid.  

This side effect is usually mild and may not cause symptoms. But, feeling more tired or cold than usual can be a sign of low thyroid hormone levels. Tell your doctor if you notice this. Your doctor may give you drugs to take if your hormone levels are low. 

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

• be sore
• be painful, tingle, or swell
• peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

• keeping your hands and feet cool by washing in cool water
• gently moisturising your hands and feet regularly
• wearing gloves to protect your hands and nails when working in the house or garden
• wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Some people have pains in their joints or muscles. Your doctor can prescribe painkillers for this.

This treatment can affect your skin. It may cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day. 

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Changes to your skin usually improve when treatment ends.

This treatment can affect your appetite. Don’t worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Some people also notice that food tastes different. Your nurse or dietitian can give you advice on coping with this.

Some people have indigestion, heartburn, pain in their tummy or wind when taking axitinib. Let your doctor or nurse know if this happens to you. They may give you medicines to help.

Very rarely, axitinib can cause a hole (perforation) in the small bowel. Contact your doctor immediately if you have severe pain in the tummy and sickness and vomiting. It is also very important to let them know if you:

• are bleeding from the back passage 
• have black stools
• are vomiting up blood
• have vomit that is dark and grainy, like coffee grounds. 

This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop: 

• a cough that does not go away
• wheezing
• breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.

You may notice your voice sounds hoarse or you may feel like you have a lump in your throat. Tell your doctor or nurse if you notice this. Drinking plenty of fluids may help. It will usually go back to normal when treatment stops.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get an infection in your mouth or throat. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help
• try to drink plenty of fluids
• avoid alcohol, tobacco and foods that irritate your mouth and throat.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

This drug contains lactose. If you have a lactose intolerance, talk to your doctor before you start taking this treatment.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Cancer doctors usually recommend that people with cancer have vaccinations for flu and coronavirus (covid). They may also recommend other vaccines, such as Shingrix^® for shingles. These all help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

You should not have live vaccines if your immune system is weak. This includes if you are having or recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system. Live vaccines can make you unwell because they contain a very weak version of the illness they protect you against. There are several live vaccines. These include the yellow fever vaccine and Zostavax^®, which is a different type of shingles vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.

Wounds may take longer to heal while you are having treatment with axitinib. If you need an operation, your doctor will tell you to stop taking axitinib before it, and for a few weeks afterwards. You may also need to stop taking axitinib for a few days if you are having dental treatment. Talk to your doctor if you need to have surgery or dental treatment.

Less commonly, axitinib can cause a fistula from the bowel to the skin. A fistula is an opening between areas of the body that are not usually connected.