Crizotinib (Xalkori®)

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

What is crizotinib (Xalkori®)?

Crizotinib (Xalkori®) is used to treat advanced non-small cell lung cancer (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. It can be used if the NSCLC has changes in a gene called anaplastic lymphoma kinase (ALK) or a gene called ROS1.

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 that you swallow.

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 regular blood tests while on this 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.

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.

Your course of treatment

The nurse or pharmacist will give you the capsules to take at home. You usually have crizotinib 2 times a day. 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 take crizotinib every day for as long as it is working for you.

Taking crizotinib capsules

You take the capsules 2 times a day with or without food. Do not eat grapefruit or drink grapefruit juice while you are having crizotinib as it may increase side effects.

You should take the capsules at the same time each day. Swallow them whole with a glass of water. They should not be chewed, opened or crushed. 

If you forget to take the capsules, take the missed dose as soon as possible as long as it is more than 6 hours until your next dose. If it is less than 6 hours until your next dose, do not take the missed dose. Do not take a double dose to make up for a missed one. Let your doctor or nurse know if you miss a dose.

Other things to remember about your capsules:

  • Wash your hands after taking them.
  • 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 capsules, contact the hospital. Do not take another dose.
  • If your treatment is stopped, return any unused capsules/tablets 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. 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.

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

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 eyesight, let your doctor or nurse know.

Feeling sick

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. 

If you feel sick or are sick (vomit), take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, tell your doctor or nurse. They will give you advice. They may change the anti-sickness drug to one that works better for you.

Diarrhoea

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 (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

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 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. 

Tummy pain

You may have pain in your tummy (abdomen) or have indigestion. Tell your doctor or nurse if this happens. They can check the cause and give you treatment to help.

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.

Effects on the liver

Crizotinib can affect how well your liver works. 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.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.

It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.

Loss of appetite

This treatment can affect your appetite. Don't worry if you do not eat much for a day or 2. 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.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Difficulty swallowing

This treatment can sometimes cause inflammation of the gullet (oesophagus). Tell your doctor if you have any pain and difficulty swallowing.

Feeling tired

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.

Fluid build-up

You may gain weight, or your face, ankles and legs may swell. This improves slowly after your treatment has finished. Your doctor may give you drugs to help reduce the swelling.

Numb or tingling hands, joints or feet (peripheral neuropathy)

This treatment may affect the nerves, which can cause numb, tingling or painful joints, 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.

Your skin may be more sensitive to the sun. You can protect your skin by using a sun cream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.

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.

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.

Crizotinib can cause heart failure. Tell your doctor if you become breathless or your ankles swell.

Effects on the lungs

Sometimes, this treatment may cause inflammation or scarring and stiffness in the lungs. Tell your doctor or nurse if you experience any unusual shortness of breath, trouble with breathing or a cough.

Low blood phosphate level

Crizotinib can cause a low level of phosphate in your blood. This can cause confusion and muscle weakness.

Low testosterone level

This treatment can cause a low level of testosterone. Tell your doctor if you notice any mood changes, erection problems or loss of interest in sex.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • throbbing pain or swelling in a leg or arm
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
  • suddenly feeling breathless or coughing.

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Other medicines

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: 

Vaccinations

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.

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.

Sex

If you have sex during a course of this treatment, you should use barrier protection such as a condom or dental dam. This will protect your partner if any of the drug is in your semen or vaginal fluid.

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.

Crizotinib can affect how well oral contraceptives work so you will need to use another form of contraceptive as well as oral.

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.

About our information

References

Reviewers

  • Reviewers

    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.

Date reviewed

Reviewed: 01 November 2022
|
Next review: 01 November 2024
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.