Vemurafenib (Zelboraf ®)

Vemurafenib is a targeted therapy drug used to treat melanoma that has spread or can’t be removed by surgery.

Vemurafenib is given as tablets. You usually have it as an outpatient. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, vemurafenib can cause side effects. Some of these can be serious, so it’s important that you read the detailed information below. How targeted therapy affects people varies from person to person. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

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.

And if you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

How vemurafenib works

Vemurafenib is a type of cancer treatment called a cancer growth blocker. It is given for melanomas that have a V600 change (mutation) in a gene called BRAF. The change in this gene leads to the production of a changed (mutated) BRAF protein. This protein helps melanoma tumours grow.

Vemurafenib blocks (inhibits) the changed BRAF protein, which can stop the melanoma cells from growing and dividing.

Your doctors will find out if there is a mutation in the BRAF gene. They do this by testing a piece of melanoma that was removed when it was diagnosed (biopsy), or during surgery.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


When vemurafenib is used

Vemurafenib is used to treat melanoma with a BRAF V600 gene change, when the cancer has spread (advanced melanoma) or cannot be removed with surgery (unresectable). It can help control the cancer. Vemurafenib may only be available in some situations. Your cancer doctor can give you advice.

The organisation that gives advice about new drugs to the NHS in England and Wales is called the National Institute for Health and Care Excellence (NICE). It recommends that vemurafenib is available on the NHS.

In Northern Ireland, the Health and Social Care Board (HSCB) has accepted the NICE decision recommending vemurafenib.

The Scottish Medicines Consortium (SMC) advises on the use of drugs within the NHS in Scotland. It recommends that vemurafenib is available on the NHS as a first treatment for melanoma that has spread to other parts of the body or can’t be removed by surgery.


Taking vemurafenib

Vemurafenib is taken twice a day, with doses 12 hours apart. You will usually take four tablets in the morning and four more 12 hours later. You can take vemurafenib with or without food, but you should not take it regularly on an empty stomach.

Always take your tablets exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.

There are some important things to remember when taking your tablets:

  • If you forget to take your tablets and the next dose is due in less than four hours, just take your next dose at the usual time. Don’t take a double dose.
  • If you forget to take your tablets and the next dose is due in more than four hours, take your tablets as soon as you remember.
  • If you are sick after taking your tablets, just take your next dose at the usual time.
  • Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
  • Keep the tablets in a safe place, out of the reach of children.
  • Get a new prescription before you run out of tablets and make sure you have plenty for holidays.
  • Return any tablets you have to the pharmacist if your treatment is stopped. Don’t flush them down the toilet or throw them away.

You usually take vemurafenib for as long as it controls the melanoma. Rarely, vemurafenib may be stopped or the dose reduced if it causes severe side effects.


Possible side effects of vemurafenib

Each person’s reaction to cancer treatment is different. Some people have very few side effects, while others may experience more. The side effects described here won’t affect everyone having this treatment.

We explain the most common side effects of vemurafenib here. But we don’t include all the less common ones that are unlikely to affect you. You may get some of the side effects we mention, but you are very unlikely to get all of them.

Always tell your doctor, nurse or pharmacist about the side effects you have. They can prescribe drugs to help control them and give you advice about managing them.

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.

Skin changes

Some mild skin changes are common with vemurafenib. You may notice your skin is itchy, dry or scaly. Small bumps or warts may develop. You should tell your specialist nurse or doctor if you develop any of these changes as they can prescribe creams and ointments to help.

If you notice a rash, or have blisters or peeling skin, tell your specialist nurse or doctor straight away.

Sensitivity to light

During treatment with vemurafenib, your skin will be more sensitive to sunlight (even on a cloudy day). When you’re outdoors, you should wear a sunscreen with a high sun protection factor (SPF) of at least 30. Re-apply this every two to three hours or as instructed.

Some doctors and specialist nurses advise using a sunscreen with an SPF of 50, so check this with your hospital team. They’ll also advise you to put sunblock on your lips and to cover up with clothing and a hat.

Effects on the hands and/or feet

You may notice redness on the palms of your hands and soles of your feet. Sometimes, your hands and feet can become sore or swollen. There may also be changes in sensation, such as numbness or tingling. If you notice this, tell your specialist nurse or doctor.

If soreness doesn’t settle or if blistering develops, your doctor may need to reduce the dose of vemurafenib or interrupt the treatment. Very occasionally, people may need to stop having the treatment completely.

Other skin cancers

Some people may develop other types of skin cancer (squamous cell or, less commonly, basal cell skin cancer) while taking vemurafenib. Usually, these are easily removed with surgery. You’ll be asked to check your skin regularly for signs of these cancers, such as a small lump or an area that looks scaly, bleeds or has a hard, horny cap.

Your specialist nurse or doctor will tell you what to look out for. They will also check your skin when you are seen in the clinic. If you notice anything unusual between clinic appointments, tell your specialist nurse or doctor.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Taste changes or loss of appetite

Some people notice that food tastes different or they lose their appetite while taking vemurafenib. This can be mild and may only last a few days. If it doesn’t improve, you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on coping with taste changes, improving your appetite, and keeping to a healthy weight.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least two litres (three and a half pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

If diarrhoea is severe or continues, tell your doctor.

Constipation

This treatment can cause constipation. 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.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Feeling tired

Feeling tired is a common side effect. 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 operate machinery.

Effects on the hair

Your hair may become thinner while you’re taking vemurafenib. This includes body hair, eyelashes and eyebrows, as well as hair on your head. Changes to your hair are usually temporary and improve during or after stopping treatment. However, sometimes changes can be permanent. Some people may find that their hair has a different texture when it grows back.

Muscle and joint pain

You may get pain in your muscles or joints for a few days after taking vemurafenib. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Cough

Vemurafenib can sometimes cause a cough. If you notice this, tell your doctor so they can give you medicines to help.

Fever and chills

You may have a fever or chills when taking vemurafenib. Tell your specialist doctor or nurse if this happens.

Weakness in the face muscles

Vemurafenib can sometimes cause weakness or paralysis in one side of the face. This may cause your mouth to droop. It may also be difficult to close the eye on the affected side of your face. The paralysis usually improves when you stop taking the drug. Let your doctor know immediately if you think this is happening to you.

Effects on the heart

You will have tests to see how well your heart is working before you start taking vemurafenib and during treatment. In a small number of people, vemurafenib can cause the heartbeat to become irregular or fast (sometimes known as palpitations). If you have palpitations or you feel faint, tell your doctor immediately.

Eye problems

You may have:

  • eye pain
  • swelling
  • redness
  • changes to your vision (these are less common), such as blurred vision.

Tell your specialist nurse or doctor straight away if you develop any of these problems.

Allergic reaction

Vemurafenib can sometimes cause a serious allergic reaction. Signs may include:

  • swelling of the face, lips or tongue
  • a rash
  • dizziness
  • breathlessness.

Contact the hospital straight away if you have any of these symptoms. Don’t take any more tablets until you have spoken to your specialist doctor or nurse.

Effects on the liver

Rarely, vemurafenib may cause changes in the way your liver works. Your doctor will monitor this closely by taking regular blood samples to check your liver is working properly.

It’s important to tell your specialist nurse or doctor if you feel unwell or have any side effects, even if they’re not mentioned above.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.


Other information about vemurafenib

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Fertility

Doctors don’t yet know how this treatment may affect your fertility (the ability to become pregnant or father a child). If you are worried about this, talk to you doctor before treatment starts.

Contraception

Your doctor will advise you not to become pregnant or father a child during, and for six months after, taking vemurafenib. Doctors do not know the effects of this drug on a developing baby.

Vemurafenib can affect how well some oral contraceptives work. Your doctor or nurse can talk to you about other forms of contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. 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 this treatment.