Crizotinib (Xalkori®)

Crizotinib (Xalkori®) is a targeted (biological) therapy. It is used to treat advanced non-small cell lung cancer (NSCLC).

What is crizotinib (Xalkori®)?

Crizotinib (Xalkori®) is used to treat non-small cell lung cancer (NSCLC) that has spread to the surrounding tissues or to other parts of the body (advanced NSCLC). It is best to read this information with our general information about the type of cancer you have.

Crizotinib belongs to a group of targeted therapy drugs known as cancer growth inhibitors. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How crizotinib is given

You will be given crizotinib as an outpatient. It is given as capsules (orally).

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.

You will have your blood checked regularly during treatment. A nurse or a 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 for you to have treatment. Your doctor will tell you when your blood will be checked.

Your course of treatment

The nurse or pharmacist will give you the capsules to take at home. Always take them exactly as you are told to. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.

You usually continue to take crizotinib twice every day for as long as it is working for you.

Taking crizotinib capsules

You should take crizotinib twice a day, with or without food.

Take your capsules at the same time every day. You must swallow them whole, with a glass of water. You should not chew, open or crush them.

Do not eat grapefruit or drink grapefruit juice while you are having crizotinib as it may increase side effects.

If you forget to take a capsule, you can take it when you remember, as long as it is more than 6 hours until your next dose. If it is less than 6 hours, you should skip the missed capsule. Then take the next capsule at the usual time. Do not take 2 doses at the same time to make up for the missed dose. Let you doctor or nurse know if you miss a dose.

Other things to remember about your capsules:

  • Wash your hands after taking your capsules.
  • Keep the capsules in the original packaging.
  • Keep them safe and out of the sight and reach of children.
  • If you are sick (vomit) just after taking the capsule, do not take an extra dose, just take your next dose at your usual time..
  • Get a new prescription before you finish your last capsules and make sure you have plenty for holidays.
  • If your treatment is stopped, return any unused capsules to the pharmacist.

About side effects

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. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

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.

Vision changes

You may develop changes with your vision. This side effect is usually mild and will usually improve over time. Your eyes may take longer to adjust to change in the light or darkness of your surroundings. You may also have blurred vision. You may see flashing lights or dark spots called floaters.

If you wear glasses, or have any problems with your eyesight, it is important to have regular eye checks. You should also let your optician know that you are taking this treatment. Take care when driving as you may find other car headlights too bright. If you notice any changes to your eye sight, let your doctor or nurse know.

Diarrhoea or tummy pain

It is important to follow the advice your nurse or doctor gives you about diarrhoea. Contact the hospital if you have diarrhoea. They will give you advice on what to do and if you should see a doctor. They may give you anti-diarrhoea tablets to take at home.

If you have mild diarrhoea, it can usually be controlled with anti-diarrhoea tablets. Mild diarrhoea is when you have loose stool (poo) up to 4 times a day.

Try to drink at least 2 litres (3½ pints) of fluids every day.

It can help to avoid:

  • alcohol
  • caffeine
  • milk products
  • high-fat foods
  • high-fibre food.

Let the hospital know immediately if you have:

  • pain in your tummy (abdomen)
  • vomiting
  • blood or mucus in your poo
  • a fever.

You may need to go into hospital to have a drip (infusion) or other treatments. If your bowel is inflamed (colitis), you may need steroids.

Constipation

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 for advice. Your doctor can give you drugs called laxatives to help.

Feeling or being sick

Your doctor can give you anti-sickness drugs to prevent or reduce sickness or vomiting. Take the drugs exactly as your nurse or pharmacist tells you. If the sickness continues, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Build-up of fluid

Your ankles and legs may swell because of a build-up of fluid. Tell your doctor or nurse if this happens. Your doctor may need to change the amount of crizotinib you are having. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion.

Loss of appetite

This treatment can affect your appetite. If you have a poor appetite, try to eat little amounts as often as possible.

It is important to try to eat well during your treatment. If you are having problems ask your nurse for advice and you can also ask to see a dietitian. You can add extra energy and protein to your diet with everyday foods or by using food supplements.

Effects on the liver

Crizotinib can affect how well your liver works. This can happen in the first few months of starting treatment.

You will have blood tests before you start crizotinib and regularly while you are taking it, especially during the first 3 months of treatment. This is to check your liver is working properly. If blood tests show any changes, your doctor might stop your treatment until your blood test results return to normal. You may start the treatment again at a lower dose. If you drink alcohol, your doctor may suggest that you avoid alcohol or reduce the amount you drink.

Tiredness

Some people feel very tired during their treatment. This is normal. If you feel more tired than usual it is important to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help.

Changes to your heartbeat and dizziness

Sometimes crizotinib can cause an irregular, or slow, pulse rate or heartbeat while you are taking it. This can cause dizziness. If you feel dizzy or faint, it is important to contact the hospital straight away. Avoid driving or operating machinery if you feel dizzy.

Your doctor may carry out regular heart tests such as an ECG (electrocardiogram) before starting treatment, and at points during and after your treatment.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Skin changes

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.

Tiredness

Feeling tired is a common side effect. 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 operate machinery.

Effects on the lungs

Rarely, this treatment may cause inflammation in the lungs. Tell your doctor or nurse if you experience any unusual shortness of breath or trouble with breathing.

Other information about crizotinib

Other medicines

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

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Fertility

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.

Contraception

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 a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

If you use oral contraceptives together with crizotinib, they may not be effective in preventing pregnancies.

Sex

If you have sex during this course of treatment, you need to use a condom. This is to protect your partner in case there is any trace of the drug in semen or vaginal fluids.

Breastfeeding

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.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.