Nintedanib (Vargatef®) is used to treat a type of non-small cell lung cancer called adenocarcinoma.
Nintedanib (Vargatef®) is used to treat a type of non-small cell lung cancer called adenocarcinoma that has spread, or come back, after chemotherapy. It is given with a chemotherapy drug called docetaxel.
Nintedanib is a type of drug called a tyrosine kinase inhibitor (TKI), also known as a cancer growth inhibitor. Kinases are proteins in the body that control how the cells grow and divide.
Nintedanib blocks the proteins (kinases) from sending signals to the cancer cells to grow. Blocking the signals causes the cells to die. Nintedanib blocks different types of proteins and is called a multi-kinase inhibitor.
It also stops the cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients, so that the tumour shrinks or stops growing.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Nintedanib is given as capsules. It is given in combination with the chemotherapy drug docetaxel. Docteaxel is given as a drip (infusion) into a vein. It is given in the chemotherapy day unit or during a stay in hospital.
During treatment you usually see a cancer doctor, a cancer nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of 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 for you to have the 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 treatment. Your nurse will tell you when your treatment is likely to be ready.
The nurse or pharmacist will give you the nintedanib capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.
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.
Your course of treatment
The treatment is usually given as a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you.
When you are having nintedanib capsules and docetaxel, you start taking the capsules the day after the chemotherapy. You should not take nintedanib on the same day as the docetaxel. You usually take nintedanib for 20 days and then you have docetaxel again. This is called a cycle of treatment. Each cycle lasts 21 days (3 weeks). Your doctor will talk to you about how many cycles of treatment you can have.
Your doctor may talk to you about continuing nintedanib after finishing treatment with docetaxel. In this situation, you usually take nintedanib every day for as long as it keeps the cancer under control.
Taking nintedanib capsules
You take nintedanib twice a day with food. Try to keep the doses 12 hours apart. For example, you might take a capsule at 8am with breakfast and another at 8pm with an evening meal or snack. They must be swallowed whole with a glass of water. They should not be chewed, opened or crushed. Take them at the same time every day.
Always take nintedanib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.
If you forget a dose, just take the next dose at the usual time. Never take a double dose to make up for the one you missed.
Your doctor may ask you to stop taking nintedanib, or take a lower dose, because of side effects. Always follow your doctor’s advice carefully.
Other things to remember about your capsules:
- Don’t take nintedanib if you are allergic to peanut or soya.
- 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 to the pharmacist.
We explain the most common side effects of nintedanib 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 have chemotherapy along with nintedanib, some side effects may be worse. You may also have side effects not listed here. We have more information about chemotherapy.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you.
Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve. Always tell your doctor or nurse about the side effects you have.
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.
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.
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 called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have 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.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
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.
Your doctor can prescribe anti-diarrhoea drugs to control any diarrhoea. You may be given these before you leave hospital. It is important to take the drugs exactly as your nurse or pharmacist explained to you. Make sure you drink at least 2 litres (3½ pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than four to six times a day, or at night, contact the hospital straight away on the numbers your nurse gave you. Your doctor may ask you to stop taking nintedanib. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes your doctor may reduce the dose.
Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
If you have diarrhoea or feel sick, it can be difficult to drink enough. This can make you dehydrated. It can also affect the levels of minerals and salts in your body, for example, sodium, potassium and calcium. Your doctor will take regular blood tests to check these.
It is important that you drink around 2 litres (3½ pints) of fluids every day while having treatment with nintedanib.
Let your doctor or nurse know if you have any signs of dehydration, such as:
- feeling dizzy or tired
- passing small amounts of urine (pee)
- having a dry mouth and eyes.
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.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth.
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.
You may get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help. Tell them if the pain does not improve or gets worse.
Rarely, nintedanib can cause a hole (perforation) in the small bowel. Tell your doctor immediately if you have sudden or severe pain in your tummy or signs of bleeding. Signs of bleeding from the bowel include:
- vomiting up blood
- vomit that looks like coffee grounds
- bleeding from the back passage
- black poo (stool).
Nintedanib can cause bleeding problems, such as:
- bleeding gums
- blood spots or rashes on the skin.
Tell your doctor if you are taking any medicines that may affect bleeding. This includes:
- blood-thinning tablets such as warfarin
- blood-thinning injections such as heparin
- vitamin E.
Contact your doctor straight away if you have any heavy or unusual bleeding. This includes:
- vomiting or coughing up blood
- unexpected vaginal bleeding
- blood in your poo (stool).
This treatment may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. This treatment can cause a rash, which may be itchy.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Changes in the way the liver works
Nintedanib may affect how your liver works. This is usually mild and goes back to normal after treatment. The drug may cause the skin and whites of your eyes to become yellow (jaundiced). Tell your nurse or doctor if you notice this.
You will have blood tests to check how well your liver is working.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
High blood pressure
Slow wound healing
Wounds may take longer to heal while you are being treated with nintedanib. If you have any wounds which are not healing or look infected, speak to your doctor straight away.
If you have any surgery planned, nintedanib will be stopped before the operation and not started again until the wound is fully healed.
This treatment may interact with other medicines, including some that are used to treat epilepsy and some antibiotics. It may also interact with the herbal remedy St John’s wort.
Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
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.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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.