Encorafenib (Braftovi®) and binimetinib (Mektovi®)
Encorafenib (Braftovi®) and binimetinib (Mektovi®) are targeted therapy drugs. They are used to treat melanoma.
- cannot be removed with surgery
- has spread to other parts of the body (advanced or metastatic melanoma).
Encorafenib and binimetinib are only used if tests show that cancer cells from the tumour have a gene change called a BRAF V600 mutation.
Encorafenib and binimetinib are both types of targeted therapy drugs called cancer growth inhibitors.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Encorafenib comes in capsules that you take once a day. Binimetinib comes in tablets that you take twice a day, 12 hours apart.
During treatment you will have regular appointments with a cancer doctor, a chemotherapy nurse, a specialist nurse, or a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before and during treatment you may have tests to check for side effects. You may have
- blood tests to check how your liver and kidneys are working
- heart tests, such as an ECG or echocardiogram, to check how your heart is working.
At your appointments the doctor, nurse or pharmacist will talk to you about your test results and ask you how you have been feeling. Sometimes they will change the dose or stop your treatment for a time to let your body recover from side effects.
Taking encorafenib and binimetinib
The nurse or pharmacist will give you the capsules and tablets to take home. You may be given capsules of different strengths. Always take them exactly as explained. This is important to make sure they work as well as possible for you.
Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they have been explained to you.
You can take encorafenib and binimetinib with or without food. Take them at the same times every day. Swallow them whole with a glass of water and do not chew, break or crush them. You should avoid eating grapefruit or drinking grapefruit juice. Grapefruit may affect how encorafenib works.
If you forget to take encorafenib:
- you should take it when you remember - if it is more than 12 hours until your next dose
- you should wait and take the next dose at the usual time - if it is less than 12 hours away
- you should not take a double dose.
If you forget to take binimetinib:
- you should take it when you remember if it is more than 6 hours until your next dose
- you should wait and take the next dose at the usual time if it is less than 6 hours away
- you should not take a double dose.
Other things to remember about your tablets:
- Keep them in the original package.
- Keep them safe and out of sight and reach of children.
- If you are sick after taking the capsules or tablets, contact the hospital. Take the next dose at the usual time. Do not take a double dose.
- If your treatment is stopped, return any unused tablets to the pharmacist.
Your doctor will 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.
This treatment may cause diarrhoea. Sometimes this can be severe. If you have diarrhoea:
- always contact your doctor or nurse and ask for advice
- follow any advice you have been given 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 6 times in a day
- the anti-diarrhoea drugs do not work within 24 hours
Some people 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 for advice. Your doctor can give you drugs called laxatives to help.
You may get pain or discomfort in your tummy (abdomen). Let you doctor know if this happens. They can give you something to help with the pain.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Effects on the eyes
This treatment can affect your eyes. Always tell your doctor or nurse if you have sore eyes, blurry vision or any sight loss. They may give you eye drops or other treatments to help. They may also arrange a specialist eye check for you. Do not drive if your eyesight is affected.
Muscle or joint pain
This treatment can cause pain in your muscles or joints. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better.
Sometimes this treatment can cause a muscle condition called rhabdomyolysis. Symptoms may include:
- muscle pain
- dark red or brown pee (urine).
This condition is not common and does not always cause symptoms. You will have regular blood tests to check for signs of it. Your doctor may change the dose or stop your treatment for a time to let your body recover from this side effect.
This treatment can cause high blood pressure. Your doctor or nurse will check your blood pressure regularly during treatment. If needed they will give you medicines to control your blood pressure.
This treatment may increase your risk of bleeding. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- blood in your pee (urine) or poo (stools)
- bleeding from the back passage (rectum).
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.
This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.
This treatment may cause a rash or itchy skin. Sometimes it can make your skin more sensitive to light than usual. If your skin feels dry, try using an unperfumed moisturising cream every day. These changes are usually temporary and improve when treatment finishes.
Always tell your doctor or nurse straight away about any skin changes so they can check your skin and give you advice. They may arrange further tests or give you creams or medicines to help.
Sore and red palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It usually gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve any symptoms you may have. It can help to:
- keep your hands and feet cool
- moisturise regularly
- avoid tight-fitting socks, shoes and gloves.
Your hair may get thinner or you may lose all the hair from your head. Hair loss is almost always temporary and your hair will usually grow back after treatment ends. Your nurse can talk to you about ways to cope with hair loss.
Build-up of fluid
Numbness or tingling in hands or feet
This treatment can cause numbness or tingling in the hands or feet. Tell your doctor if you notice any changes.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless
- swelling of your face or mouth
- pain in your back, tummy or chest.
If you feel unwell or have any of these signs, contact the hospital straight away.
Changes to your taste
You may get a bitter or metallic taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.
Effects on the heart
This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of drug you are having.
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.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
This treatment may increase your risk of developing some other types of cancer. But treating the melanoma usually outweighs this risk. Your doctor or nurse will give you more information about this.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
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.
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 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, such as shingles, 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 a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
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 drug contains lactose. If you have a lactose intolerance, talk to your doctor before you start taking this treatment.
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.