Ceritinib (Zykadia®) is a targeted therapy drug. It is used to treat non-small cell lung cancer.
Ceritinib (Zykadia®) is a targeted therapy drug used to treat advanced non-small cell lung cancer (NSCLC). It is only used if tests show the cancer cells have a gene change (mutation) in a gene called anaplastic lymphoma kinase (ALK). NSCLC that has this gene change is called ALK-positive NSCLC.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have treatment. The blood test will also check how well your kidneys and liver are working.
You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your targeted therapy. Your nurse will tell you when your treatment is likely to be ready.
You take ceritinib as tablets (orally).
Taking ceritinib tablets
The nurse or pharmacist will give you the ceritinib tablets to take at home. They may also give you drugs to prevent sickness, diarrhoea, or other side effects to take at home.
Take all your drugs exactly as they have been explained to you. This is important to make sure they work as well as possible. Make sure you:
- Take ceritinib once a day with food.
- Take your tablets at the same time every day.
- Swallow them whole, with a glass of water.
- Do not chew or crush them.
If you are unable to eat, you may need to take a different dose of ceritinib. Your cancer doctor will explain how and when to take your tablets. Do not change your dose unless your cancer doctor tells you to.
You should not eat grapefruit or drink grapefruit juice while you are taking ceritinib. Grapefruit can cause harmful levels of ceritinib in your blood.
You should not take drugs that treat heartburn or indigestion at the same time as ceritinib. These may stop ceritinib from working as well. Ask your doctor or pharmacist for advice about how and when to take any drugs for heartburn.
If you forget to take the tablets, you should take the missed dose as soon as possible. If more than 12 hours have passed, do not take the missed dose. Let your doctor or nurse know and take the next dose at the usual time.
Other things to remember about your tablets:
- Wash your hands after taking your tablets.
- Other people should avoid direct contact with the drugs.
- 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.
- If you are sick just after taking the tablets, contact the hospital. Do not take another dose.
- If your treatment is stopped, return any unused tablets to the pharmacist.
You usually keep taking ceritinib as long as it is effective and as long as its side effects are manageable.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here.
You may have some rarer side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor, nurse or pharmacist can give you drugs to help control some side effects. It is important to take them exactly as they tell you. This means the drugs will be more likely to work for you. Your doctor, nurse or pharmacist will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.
If you feel sleepy, do not drive or use machinery.
This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.
This treatment may cause severe 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.
Your hospital team may give you anti-diarrhoea drugs to take at home.
If you have diarrhoea or a mild increase in stoma activity:
- follow any advice from your cancer team about taking anti-diarrhoea drugs
- drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
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
- the anti-diarrhoea drugs do not work within 24 hours.
You may need to go to hospital to have fluids through a drip.
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.
Loss of appetite
This treatment can affect your appetite. It is important to take your tablets with food. If you are unable to do this, tell your doctor or nurse as they may need to change the dose.
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.
Tummy pain and heartburn
This treatment can cause pain in the tummy (abdomen) and heartburn (indigestion). Tell your nurse or doctor if you have pain. Ask them for advice about how and when to take any drugs for heartburn.
Your doctor may give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Effects on the heart
This treatment can affect the way your heart works. Your doctor may do tests to see how well your heart is working. You may have these tests before, during, and sometimes after treatment.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms. But it is important to get them checked by a doctor.
Raised blood sugar levels
This treatment can raise your blood sugar levels. If you have a raised blood sugar level, you may:
- feeling thirsty
- needing to pass urine (pee) more often
- feeling tired.
Tell your doctor or nurse if you have these symptoms.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to change your insulin or tablet dose.
Effects on the liver
This treatment can affect how your liver works. You will have blood tests to check how well your liver is working. Tell your doctor if you have:
- yellowing of your skin or the whites of your eyes
- pain on the right side of your tummy
- dark or brown urine
- bleeding or bruises that you cannot explain..
These may be a sign of liver problems.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
- a fever (high temperature)
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
If your symptoms develop suddenly, contact the hospital immediately. You may have inflammation of the lungs (pneumonitis). Your doctor can tell you more about this.
Effects on the kidneys
This treatment can affect how your kidneys work. You will have blood tests to check how well your kidneys are working. Tell your doctor if you stop passing urine (peeing) or are passing very little urine. This may be a sign of kidney problems.
Swollen pancreas (pancreatitis)
This treatment can make your pancreas swell (pancreatitis). This is uncommon.
- Tell your doctor straight away if you have both of these symptoms:
- you get a sharp pain in your upper tummy (abdomen)
- you are sick or vomit.
Your doctor will examine your tummy. They may give you drugs to help the symptoms.
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.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for 3 months after treatment finishes.
Oral contraceptives such as the pill may not work while taking this treatment.
Your doctor, nurse or pharmacist can give you advice on what contraceptives will work well with this treatment.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
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