Fruquintinib (Fruzaqla®)
What is fruquintinib (Fruzaqla®)?
Fruquintinib is also called Fruzaqla®. It is a type of targeted therapy drug called an angiogenesis inhibitor.
Fruquintinib blocks a protein called vascular endothelial growth factor receptor (VEGFR). This protein helps cancer cells grow a new blood supply. Targeting VEGFR reduces the supply of oxygen and nutrients to the tumour. This can shrink the tumour or stop it growing.
Fruquintinib is used to treat bowel cancer when it has spread to other parts of the body.
It is best to read this information with our general information about targeted therapy drugs and our information about bowel cancer.
Your cancer team will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.
How fruquintinib is given
You usually have fruquintinib as capsules that you can take at home.
During a course of 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 your course of treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment.
You will meet with a doctor, nurse or pharmacist before you have 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.
Your course of treatment
You usually have cycles of treatment. Your cancer team will discuss your treatment plan with you.
You usually take fruquintinib for 21 days (3 weeks) and then have a break for 7 days (1 week). This 4-week period makes up a cycle of treatment. You then start your next cycle of treatment.
You may take fruquintinib for as long as it is working for you and the side effects can be managed.
They will give you the capsules to take home. They may give you capsules 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.
Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to.
Taking fruquintinib capsules
You can take fruquintinib capsules with or without food. Make sure you:
- swallow them whole with a glass of water
- do not chew, open or crush them
- take them at the same time every day.
If you forget to take the capsules and there are more than 12 hours until your next dose, take the missed dose. Do not take the missed dose if there are less than 12 hours until your next dose. Always take the next dose at the scheduled time. Do not take a double dose to make up for any missed doses. You can contact the hospital on the 24-hour number you have been given for advice.
Other things to remember about your capsules:
- Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight.
- Keep them safe, where children cannot see or reach them.
- If you are sick (vomit) just after taking them, do not take an extra dose. Take your next dose at the usual time.
- Do not throw away unused capsules. Return them to your cancer team at the hospital.
About side effects
We explain the most common side effects of this treatment here. We also include some that are less common.
You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here.
Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.
Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you:
- drugs to help control some side effects
- advice about managing side effects.
It is important to take any drugs exactly as explained. This means they will be more likely to work for you.
Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.
Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Very common side effects
These side effects happen to 10 or more people in every 100 people (10% or more) who have this treatment.
Bruising and bleeding
This treatment can 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 have:
- nosebleeds
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- 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.
If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.
High blood pressure
Fruquintinib can cause high blood pressure. You will have it checked regularly during your treatment. Tell your doctor, nurse or pharmacist if you have ever had any problems with your blood pressure.
If you check your blood pressure at home and the result is high, tell your doctor, nurse or pharmacist, or contact your GP.
Contact the hospital straightaway on the 24-hour number if you have severe headaches, chest pain or dizziness.
Always call 999 if you have:
- sudden chest pain or tightness across the chest
- difficulty breathing
Loss of appetite
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.
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 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.
Diarrhoea
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.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
Contact the hospital straight away on the 24-hour number, if:
- a sore mouth or throat affects how much you can drink or eat
- your mouth, tongue, throat or lips have any blisters, ulcers or white patches.
They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:
- drink plenty of fluids
- avoid alcohol and tobacco
- avoid food or drinks that irritate your mouth and throat.
Tell your doctor, nurse or pharmacist if you have any pain in your gums or teeth. They can give you advice and painkillers to help. Always talk to your cancer doctor first before you see a dentist.
Voice changes
Effects on the liver
This treatment can affect how the liver works. You will have regular blood tests to check this. Sometimes liver changes can be serious. Contact the hospital straight away on the 24-hour number if you have any of these symptoms:
- yellow skin or eyes
- feeling very sleepy
- dark urine (pee)
- unexplained bleeding or bruising
- pain in the right side of your tummy (abdomen).
Effects on the kidneys
This treatment can affect how the kidneys work. It can cause higher levels of protein in your urine. You may have your urine tested regularly for this. You will have blood tests to check how well your kidneys are working.
Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.
Hand-foot (palmar-plantar) syndrome
This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome.
If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker.
The skin on the palms of your hands and the soles of your feet may:
- be sore
- be painful, tingle, or swell
- peel, crack or blister.
If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.
You can care for your hands and feet by:
- keeping your hands and feet cool by washing in cool water
- gently moisturising your hands and feet regularly
- wearing gloves to protect your hands and nails when working in the house or garden
- wearing loose cotton socks and avoiding tight-fitting shoes and gloves.
Muscle or joint pain
You may get pain in your muscles or joints. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable.
Tell them if the pain does not get better.
Effects on the thyroid gland
Other side effects
These side effects happen to less than 10 in 100 people (less than 10%) who have this treatment. Some of them are much rarer than this but they are still important to know about. Rare means a side effect that happens to less than 1 in 1,000 people (less than 0.1%).
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is 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. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:
- a temperature above 37.5°C
- a temperature below 36°C
- you feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- breathlessness
- diarrhoea
- needing to pass urine (pee) often, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.
Lower levels of potassium in the blood
Tummy (abdominal) pain and bleeding
Some people have pain or discomfort in their tummy (abdomen). Tell your doctor, nurse or pharmacist if this happens.
This treatment may cause a hole (perforation) in the bowel. This is more likely if you have also had radiotherapy to the pelvis (lower part of the tummy).
If you have severe pain in the tummy and sickness and vomiting contact the hospital straight away on the 24-hour number. It is also very important to let them know if you have:
- bleeding from the back passage (rectum)
- blood in the stools or passing black stools
- you are vomiting up blood or see any blood
- your vomit looks like coffee grounds.
Skin changes
Effects on the pancreas
This treatment can affect the pancreas. You will have regular blood tests to check for this. Sometimes it can cause swelling of the pancreas. This is not common.
Contact the hospital straight away on the 24-hour number if you:
- have severe pain in your tummy (abdomen)
- feel sick or are being sick
- have a high temperature.
Effects on the brain
Rarely, this treatment causes a brain condition that can be serious. You can make a full recovery from this. But it must be diagnosed and treated quickly.
This condition can cause:
- a headache that does not get better
- drowsiness or confusion
- changes in eyesight
- fits (seizures).
If you have any of these symptoms, it is important to either:
- contact the hospital straight away on the 24-hour number
- go to the hospital straight away.
You should not drive yourself to hospital.
Slow wound healing
Wounds might take longer to heal while you are being treated with fruquintinib. If you have any wounds which are not healing or look infected, speak to your doctor, nurse or pharmacist straight away.
If you need to have surgery, you may be asked to stop taking fruquintinib for a while before the operation. You can start it again when your cancer doctor says it is okay and the wound is fully healed.
Other important 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:
- 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
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.
Contraception
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.
Breastfeeding
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.
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.
Medical and dental 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.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
Date reviewed
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.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
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- use illustrations to explain text
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.