Crizotinib (Xalkori®)

You will be given crizotinib as an outpatient. It is given as capsules that you swallow.

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will have regular blood tests while on this 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 to have 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 targeted therapy. Your nurse will tell you when your treatment is likely to be ready.

The nurse or pharmacist will give you the capsules to take at home. You usually have crizotinib 2 times a day. Always take them exactly as you are told to. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.

You usually take crizotinib every day for as long as it is working for you.

You take the capsules 2 times a day with or without food. Do not eat grapefruit or drink grapefruit juice while you are having crizotinib as it may increase side effects.

You should take the capsules at the same time each day. Swallow them whole with a glass of water. They should not be chewed, opened or crushed. 

If you forget to take the capsules, take the missed dose as soon as possible as long as it is more than 6 hours until your next dose. If it is less than 6 hours until your next dose, do not take the missed dose. Do not take a double dose to make up for a missed one. Let your doctor or nurse know if you miss a dose.

Other things to remember about your capsules:

• Wash your hands after taking them.
• Other people should avoid direct contact with the drugs. 
• 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/tablets to the pharmacist. 

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.

Your white blood cell count 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, until your cell count increases.

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 feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

You may develop changes in your vision. Your eyes may take longer to adjust to light or darkness. You may also have blurred vision or double vision. You may see flashing lights or dark spots called floaters. This side effect is usually mild and will usually improve over time.

If you wear glasses, or have any problems with your eyesight, it is important to have regular eye checks. You should also let your optician know that you are taking this treatment. Take care when driving as you may find other car headlights too bright. If you notice any changes to your eyesight, let your doctor or nurse know.

Your doctor may 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. 

If you feel sick or are sick (vomit), take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, tell your doctor or nurse. They will give you advice. They may change the anti-sickness drug to one that works better for you.

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 have pain in your tummy (abdomen) or have indigestion. Tell your doctor or nurse if this happens. They can check the cause and give you treatment to help.

Let the hospital know immediately if you have:

• pain in your tummy (abdomen)
• vomiting
• blood or mucus in your poo
• a fever.

You may need to go into hospital to have a drip (infusion) or other treatments.

Crizotinib can affect how well your liver works. You will have blood tests before you start crizotinib and regularly while you are taking it, especially during the first 3 months of treatment. This is to check your liver is working properly.

If blood tests show any changes, your doctor might stop your treatment until your blood test results return to normal. You may start the treatment again at a lower dose. If you drink alcohol, your doctor may suggest that you avoid alcohol or reduce the amount you drink.

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

• have blood in your urine (pee) 
• are passing less urine or peeing less often than usual.

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.

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.

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

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.

This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment ends. Contact the hospital on the 24-hour number if you:

• are gaining weight 
• have swelling in your face, legs or ankles.

They can give you advice and treatment to help.

This treatment may affect the nerves, which can cause numb, tingling or painful joints, 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.

This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Your skin may be more sensitive to the sun. You can protect your skin by using a sun cream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.

Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.

Sometimes crizotinib can cause an irregular, or slow, pulse rate or heartbeat while you are taking it. This can cause dizziness. If you feel dizzy or faint, it is important to contact the hospital straight away. Avoid driving or operating machinery if you feel dizzy.

Your doctor may carry out regular heart tests such as an ECG (electrocardiogram) before starting treatment, and at points during and after your treatment.

Crizotinib can cause heart failure. Tell your doctor if you become breathless or your ankles swell.

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• use plain English
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