Dabrafenib and trametinib

Dabrafenib is taken as capsules and trametinib is taken as tablets. The nurse or pharmacist will give you the capsules and tablets to take at home.

During treatment, you will meet someone from your cancer team, such as a:

• cancer doctor
• specialist nurse
• specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.

During treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment.

You will speak with a doctor, nurse or pharmacist regularly during treatment. They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacy team will prepare your targeted therapy.

How long you take this treatment for will depend on your situation. If you are taking dabrafenib and trametinib after surgery to reduce the risk of melanoma coming back, you have this treatment for up to 1 year.

If the cancer cannot be removed with surgery or is advanced, you take this treatment for as long as it is working for you and any side effects can be managed. Do not stop taking your treatment unless your doctor tells you to.

Your doctor, nurse or pharmacist will discuss your treatment plan with you.

The nurse or pharmacist will give you dabrafenib capsules and trametinib tablets to take home. They may give you capsules and tablets of different strengths. Always take them exactly as they tell you to. This is important to make sure they work as well as possible for you.

Make sure you:

• do not eat anything for 2 hours before taking the capsules and tablets and for 1 hour after
• swallow them whole with a glass of water
• do not chew, open, break or crush them
• take them at the same times every day.

While taking this treatment, you should not have grapefruit or Seville oranges.

This means eating them, drinking the juice or taking any supplements that might contain them. This is because it can increase the amount of dabrafenib in your body and may cause more side effects.

Dabrafenib

You usually take dabrafenib capsules twice a day, 12 hours apart.

If you forget to take dabrafenib and there are more than 6 hours until your next dose, take it as soon as you remember.

If there are less than 6 hours until your next dose, do not take it. Just take the next dose at the usual time. Do not take a double dose to make up for any missed ones.

Trametinib

You usually take trametinib once a day at the same time as either the morning or the evening dose of dabrafenib. If you forget to take trametinib and there are more than 12 hours until your next dose, take it as soon as you remember. If there are less than 12 hours until the next dose, do not take it. Just take the next dose at the usual time. Do not take a double dose to make up for any missed ones.

Never take a double dose of either drug. If you are sick after taking either drug, do not take another dose. Just take the next dose at the usual time. You can contact the hospital on the 24-hour number you have been given for advice.

Other things to remember about your capsules and tablets:

• Keep dabrafenib capsules in the original package with the lid tightly closed. Store at room temperature, away from heat, moisture and direct sunlight. There is a small cylinder container in the bottle to help keep the capsules dry. This must stay in the bottle with the capsules. 
• Keep trametinib tablets in the original package with the lid tightly closed. Store at room temperature (not higher than 30°C) away from heat, moisture and direct sunlight. Once a new bottle is opened, you can keep it for up to 30 days. There is a small cylinder container in the bottle to help keep the tablets dry. This must stay in the bottle with the tablets.
• Keep them safe, where children cannot see or reach them.
• Do not throw away unused capsules and tablets. Return them to your cancer team at the hospital. 

This treatment can cause high temperatures. This usually starts in the first month of treatment. A high temperature can cause symptoms such as:

• night sweats 
• feeling hot or cold 
• feeling shivery
• feeling achy.   

Contact the hospital straight away if you have these symptoms. You will usually be told to check your temperature. A high temperature can also be caused by infection, so your doctor or nurse may ask you to come to the hospital for a check-up.  

If the treatment is causing a high temperature, your doctor may tell you to stop taking dabrafenib for a while, or to take a lower dose of it.

When taking this treatment, your nose may feel stuffy or blocked, and you may have a sore throat.

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 ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired. 

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

You may feel sick during this treatment, but this is usually mild. Your doctor, nurse or pharmacist may prescribe you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to. If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids.

If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice.

This treatment can cause bleeding, which may be mild or more serious.

It can also 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 need a drip to give you extra platelets. This is called a platelet transfusion.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• severe headaches or dizziness
• blood in your stools (poo) or black ‘tarry’ stools
• vomit that looks dark and grainy like coffee grounds
• sudden tummy pain
• coughing up blood
• blood in the urine (pee)
• nose bleeds
• bleeding gums
• heavy periods
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.

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

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

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. 

You may get pain in your tummy (abdomen). Your doctor, nurse or pharmacist can give you advice and suggest treatments to help. Tell them if the pain gets worse or does not get better.

Rarely tummy pain can be a sign of a more serious problem linked to the pancreas or to a hole in the bowel lining.  If you develop severe tummy pain, contact the hospital for advice straight away.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. 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.

You may have headaches or feel dizzy. If this happens, let your doctor or nurse know. They can do tests to check for the cause. If a headache or dizziness is severe, contact the hospital for advice straight away.

If you feel dizzy, do not drive or use machinery.

You may have muscle or joint pain, or muscle spasms (cramps). The pain is usually mild and can be relieved with painkillers. Ask your doctor for advice. 

Rarely, this treatment can cause a condition where muscle breaks down and affects the kidneys. Always tell your doctor if:

• muscle pain does not get better
• muscle pain is causing weakness 
• your urine (pee) is darker than normal.

This treatment can cause inflammation of the lungs. This is called pneumonitis. Contact the hospital straight away on the 24-hour number if you notice any of these changes during treatment or after it ends:

• breathlessness
• a cough that does not go away
• wheezing
• a fever, with a temperature over 37.5°C.

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

Dabrafenib and trametinib can affect your blood pressure. It may make cause high or sometimes low blood pressure. Your blood pressure will be checked before and during treatment. High blood pressure can usually be controlled with tablets. 

This treatment often causes mild skin changes. They include:

• a rash
• redness – if you have black or brown skin this can be harder to notice
• itching
• dry skin

Less commonly, this treatment can cause

• rough or scaly skin
• small wart-like growths (called papillomas)
• infections in the skin or nails.

Tell your nurse or doctor if you have any of these changes. They can give you advice, and can prescribe creams and medicines to help.

If you are out in the sun, use a sun cream with a high sun protection factor of at least SPF 30 to protect your skin.

Some people notice their hands and feet become swollen. This is caused by a build-up of fluid. If you notice this, tell your doctor or nurse so they can give you advice and treatment to help. 

Less commonly, this treatment can cause redness or swelling around the eyes. Contact the hospital straight away if you notice this.

This treatment may affect how your liver works. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how your liver is working.

Some people are at risk of developing a condition called tumour lysis syndrome (TLS). The risk is highest at the beginning of treatment. TLS happens when treatment makes large numbers of cancer cells die and break down quickly. This releases lots of waste products into the blood and can affect the kidneys and heart.

TLS can be prevented or treated. You will have regular blood tests to check for TLS. You may have:

• extra fluids through a drip
• medicines such as allopurinol tablets or rasburicase through a drip.

Drinking at least 2 litres (3½ pints) of fluid a day will also help.

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.

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.

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, including the yellow fever 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.

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.

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.

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.