Retevmo
Retevmo (selpercatinib) is a targeted therapy for advanced or metastatic cancers with changes (mutations) in the RET gene. In particular, it’s a recommended option for non-small cell lung cancer (NSCLC) and thyroid cancer that have RET mutations. Retevmo (selpercatinib) is available as pills that are taken by mouth twice a day. But it often causes troublesome fatigue, swelling, and diarrhea as side effects.
What is Retevmo (selpercatinib)?
What is Retevmo (selpercatinib) used for?
- Advanced or metastatic NSCLC with RET gene fusion in adults
- Advanced or metastatic thyroid cancers with RET mutations in adults and children age 12 years and older
- Advanced or metastatic tumors with RET mutations in adults, when other treatments haven’t worked or aren’t available
How Retevmo (selpercatinib) works
RET is a protein in the body that signals cells to grow and divide. Your body makes RET proteins using instructions given by the RET gene.
In certain cancers, changes (mutations) in the RET gene lead to abnormal RET proteins. These abnormal proteins cause cancer cells to grow out of control.
Retevmo (selpercatinib) is a type of kinase inhibitor called a RET inhibitor. It blocks the RET protein, so the cancer can’t grow and spread as easily.
Drug facts
Side effects of Retevmo (selpercatinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Signs of stress to the liver or kidney on blood tests (up to 59%)
- Abnormal electrolyte levels in the blood (up to 59%)
- Lower blood cell counts (up to 52%)
- Swelling (49%)
- Diarrhea (47%)
- Feeling very tired (46%)
- Dry mouth (43%)
- High blood pressure (41%)
- Stomach pain (34%)
- Constipation (33%)
- Rash (33%)
- Nausea (31%)
- Headache (28%)
Less Common Side Effects
- Cough
- Having trouble catching your breath
- Joint pain
- Bleeding
- Abnormal heart rhythm
Retevmo (selpercatinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Liver injury: pain in the right side of the stomach, yellowing of the eyes or skin, dark or brown urine
- Lung damage: cough, shortness of breath, fever
- High blood pressure: headache, dizziness, confusion, chest pain
- Abnormal heart rhythm: chest pain, shortness of breath, dizziness, fluttering or pounding heart beat
- Severe bleeding: sudden or painful headache, changes in vision, severe stomach pain, coughing or spitting up blood
- Tumor lysis syndrome: muscle cramps, dark or brown urine, fluttering or pounding heart beat
- Allergic reaction: fever, rash, muscle, bone, or joint pain
The following Retevmo (selpercatinib) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Dry cough, shortness of breath or trouble breathing
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low thyroid levels (hypothyroidism)—unusual weakness or fatigue, increased sensitivity to cold, constipation, hair loss, dry skin, weight gain, feelings of depression
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Tumor lysis syndrome (TLS)—nausea, vomiting, diarrhea, decrease in the amount of urine, dark urine, unusual weakness or fatigue, confusion, muscle pain or cramps, fast or irregular heartbeat, joint pain
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Diarrhea
- Dry mouth
- Nausea
- Skin rash
- Swelling of the ankles, hands, or feet
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Pros and cons of Retevmo (selpercatinib)
Pros
- A pill that’s swallowed and taken with or without food
- Recommended treatment option for NSCLC and thyroid cancer with RET mutation
- Targeted therapy option for people with cancers with a RET mutation
Cons
- Interacts with many common medications, including heartburn medications and certain antibiotics (e.g., fluconazole (Diflucan))
- Commonly causes swelling, fatigue, and diarrhea
- Has risks of severe bleeding and abnormal heart rhythms
Pharmacist tips for Retevmo (selpercatinib)
- You’ll need to take a few capsules of Retevmo (selpercatinib) for each of your doses. This medication comes as 40 mg and 80 mg capsules. For a typical 160 mg dose, you can use four 40 mg capsules or two 80 mg capsules. Remember to take each dose twice a day.
- Swallow the Retevmo (selpercatinib) capsules whole; don’t chew or crush the medication.
- If you miss a dose of Retevmo (selpercatinib), take it as soon as you remember. If it’s within 6 hours of your next dose time, skip the missed dose and continue taking Retevmo (selpercatinib) at the usual time.
- If you vomit after taking Retevmo (selpercatinib), don’t take an extra dose to make up for it. Wait until the next time you typically take the medication for your usual dose.
- Try to avoid taking heartburn medications while you’re using Retevmo (selpercatinib) because the cancer medication doesn’t work as well if you take them together. Talk to your provider if you’re having troublesome heartburn for tips on relieving indigestion aside from medications. But if you do need acid-reducing medications, you’ll have to adjust how you take your medications so they work well.
- If you need to take a proton pump inhibitor like omeprazole (Prilosec) for heartburn, take Retevmo (selpercatinib) with food.
- If you need to take an H2 blocker like famotidine (Pepcid AC) for indigestion, take Retevmo (selpercatinib) 2 hours before or 10 hours after taking the heartburn medication.
- If you take antacids like Tums for heartburn, make sure to separate Retevmo (selpercatinib) from them by at least 2 hours.
- If you’re starting any new medications or supplements, talk with your provider or pharmacist first to make sure they’re safe to take with Retevmo (selpercatinib). Retevmo (selpercatinib) can interact with other medications. These interactions could cause your cancer medication to not work as well or put you at higher risk for side effects. For example, taking the antifungal medication fluconazole (Diflucan) with Retevmo (selpercatinib) might raise your risk of side effects from the cancer medication (like swelling, diarrhea, or liver injury).
- If you’re able to become pregnant or have a partner who’s able to become pregnant, use effective birth control during treatment and for 1 week after the last dose. If you’re breastfeeding a baby, avoid breastfeeding during treatment and for 1 week after stopping the medication. This is because it’s possible for Retevmo (selpercatinib) to harm the unborn baby or breastfeeding infant.
- If your child is starting treatment with Retevmo (selpercatinib), their provider will track their growth by periodically checking scans and taking measurements. Animal studies show that it’s possible that the medication can cause changes in bone growth in children. So provider visits are important to make sure the medication isn’t affecting your child’s growth pattern.
Common questions about Retevmo (selpercatinib)
Retevmo (selpercatinib) is a targeted therapy that’s recommended for cancers that have mutations in the RET gene. Your provider will take a blood or tissue sample (biopsy) to test whether your cancer has changes in RET. If the tests show RET gene changes are there, Retevmo (selpercatinib) might be an option for you. Your provider will discuss treatment options that’ll be the most appropriate for you and your cancer.
You’ll typically continue taking Retevmo (selpercatinib) as long as it's still working to treat your cancer. Your provider will check on your symptoms at each visit and take scans every few months to make sure the medication is still working. If you’re having more symptoms from your cancer or if your provider sees signs of your cancer spreading on the scans, you might need to stop Retevmo (selpercatinib) and form a new treatment plan with your provider. You also might have to stop taking the medication if the side effects become too bothersome. Let your provider know if you’re having troublesome side effects, like swelling, fatigue, or diarrhea. They’ll evaluate your symptoms and also check your blood tests for signs of side effects you might not feel. Make sure to regularly check in with your provider about how you're feeling while you're taking Retevmo (selpercatinib).
Swelling is a common, but usually mild side effect of Retevmo (selpercatinib). If you have swelling in the legs while you’re taking this cancer medication, you can try elevating your legs above the level of your heart. You can also wear compression stockings or take a walk. Since the swelling can be caused by fluid buildup in the body, these suggestions all help get the fluid in your body moving. Let your provider know if swelling disrupts your daily activities. They might have you take a break from Retevmo (selpercatinib), adjust the dose, or recommend medications to stop fluid buildup.
Dry mouth can be an uncomfortable side effect of Retevmo (selpercatinib). Although it’s usually mild, it can still be disruptive to your normal eating and drinking habits. Ways to help with dry mouth include staying well-hydrated and having good oral care. If your mouth is feeling dry, you can also try chewing sugar-free gum or sucking on ice chips or sugar-free hard candies to help make more saliva. Tell your healthcare team if you’re still having trouble with dry mouth. They can give you more tips on managing dry mouth and possibly recommend medications to help. They might also adjust your Retevmo (selpercatinib) dose or have you temporarily stop the medication.
It’s common to have nausea, vomiting, or diarrhea while you’re taking Retevmo (selpercatinib). Try to eat smaller, more frequent meals to prevent stomach upset. If your provider prescribed anti-nausea medication for you, you can try taking it 30 minutes to an hour before your Retevmo (selpercatinib) dose to prevent nausea and vomiting. Talk to your healthcare team if these side effects are disrupting your daily routine. They might recommend other medications to manage nausea, vomiting, or diarrhea. And if your side effects are severe, they might lower your Retevmo (selpercatinib) dose or have you take a break from the medication.
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Risks and warnings for Retevmo (selpercatinib)
Retevmo (selpercatinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver injury
Retevmo (selpercatinib) can potentially harm your liver. In studies, people taking the medication had higher liver enzyme levels in the blood, which can suggest liver injury. Sometimes, this happened within the first 6 weeks of starting the medication.
Because you might not feel any symptoms when your liver is having problems, you’ll need to get blood tests done to track how well your liver is working. You’ll typically need these blood tests before you start Retevmo (selpercatinib), every 2 weeks for the first few months of treatment, and then every month after that. Tell your provider if you notice any symptoms of liver damage, such as pain on the right side of the stomach, yellowing of the eyes or skin, or dark urine.
You might need to take a break from Retevmo (selpercatinib) if your provider thinks that you have liver damage. Once your liver test results return to normal, you might be able to restart treatment at a lower dose.
Lung damage
Although rare, Retevmo (selpercatinib) can cause damage to the lungs, which can sometimes be life-threatening. Let your healthcare team know if you experience new or worsened cough, shortness of breath, or fevers. You’ll probably need to stop the medication while your provider checks your lungs for problems.
High blood pressure
Retevmo (selpercatinib) can raise your blood pressure. High blood pressure typically doesn’t cause noticeable symptoms, but you might feel dizzy, have changes in vision, or have headaches if it gets unusually high.
Before you start Retevmo (selpercatinib), your provider will check your blood pressure to make sure Retevmo (selpercatinib) is safe to use. Check your blood pressure at home 1 week after starting the medication and then at least once a month while you’re receiving treatment.
Let your provider know if your blood pressure is higher than usual or if you have symptoms of very high blood pressure. You might need to start taking blood pressure medications. If that’s not enough, you might need to take a break from Retevmo (selpercatinib) and then possibly restart treatment at a lower dose once your blood pressure gets to a safe range. Your provider might switch you to a different cancer medication if your blood pressure stays dangerously high, even with blood pressure medications to help.
Abnormal heart rhythm
- Risk factors: High blood levels of Retevmo (selpercatinib) | Personal or family history of abnormal heart rhythms (arrhythmias) | Severe heart failure | Low potassium or magnesium in the blood | Taking other medications that cause QT prolongation
Retevmo (selpercatinib) can cause changes to your heart’s electrical activity called QT prolongation. This can affect your heart rhythm and can sometimes be serious or life-threatening. Your risk depends on your genetics, your electrolyte levels, and whether you’re taking other medications that can also cause QT prolongation. Your provider will order an electrocardiogram (EKG) to check your heart’s electrical activity and blood tests to measure your electrolyte levels. These tests are typically done before starting Retevmo (selpercatinib) and regularly during treatment to make sure it’s safe for you to take.
Share your medication list, including supplements and herbal products, with your provider so they can check your risk for abnormal heart rhythm. Tell your healthcare team right away if you notice new pounding or fluttering heartbeat, lightheadedness, dizziness, or chest pain. They can check your heart, and they might have you take a break from Retevmo (selpercatinib). Once your heart rhythm returns to normal, you might be able to restart the medication at a lower dose.
Serious bleeding
Retevmo (selpercatinib) can raise the risk of serious bleeding, which can be fatal in rare cases. Bleeding can happen anywhere in the body; there were rare cases of bleeding in the lungs, stomach, and brain during clinical studies.
Let your healthcare provider know right away if you experience any serious or unusual bleeding, especially bleeding that’s difficult to stop. Get medical help as soon as possible if you feel nauseous, have a sudden or painful headache, notice a change in your vision, have stomach pain, or are coughing or spitting up blood.
Surgery and wound healing problems
Retevmo (selpercatinib) might make it harder for wounds to heal. Tell your provider if you have an injury and notice your wounds are healing slowly. Also let your provider know if you’re planning to have surgery or other procedures. Your provider will need to give you instructions on when to stop and restart Retevmo (selpercatinib). In general, you should stop taking Retevmo (selpercatinib) at least 7 days before a planned surgery. After a major surgery, you should stay off Retevmo (selpercatinib) for at least 2 weeks and check with your healthcare team to make sure your wound has healed before restarting treatment.
Allergic reactions
Some people had allergic reactions to Retevmo (selpercatinib). In studies, reactions happened anywhere between 5 days and 2 years of taking the medication. Let your provider know if you develop fevers, rash, or muscle, bone, or joint pain after starting Retevmo (selpercatinib). Those might be signs of an allergic reaction.
Your provider will examine your symptoms and do other tests to check whether you’re having an allergic reaction to Retevmo (selpercatinib). If you are, you’ll have to stop the medication and possibly start corticosteroids to lower inflammation from the allergic reaction. Depending on how severe the reaction is, you might restart Retevmo (selpercatinib) at a lower dose or form a different treatment plan once your allergic reaction goes away.
Tumor lysis syndrome
- Risk factors: Kidney problems | Dehydration | Thyroid cancer | High tumor burden
Although rare, treatment with Retevmo (selpercatinib) can cause a serious reaction called tumor lysis syndrome (TLS). TLS happens when many cancer cells die quickly and suddenly break down in your body. In the process, these cells release their inner contents (like uric acid, potassium, and phosphorus) into your blood. High levels of uric acid and electrolytes in your body can cause serious problems, such as kidney damage and abnormal heart rhythms.
Your provider will order labs for you regularly to check for signs of TLS. They’ll also recommend that you drink enough fluids daily to keep hydrated. If needed, they might also give you intravenous (IV) fluids and prescribe you medications to lower your uric acid levels. Tell your provider right away if you’re urinating less than usual or have dark urine, muscle cramps, or a racing heartbeat. These can be symptoms of kidney damage or heart rhythm problems that might be related to TLS.
Low thyroid hormone levels
Retevmo (selpercatinib) can cause your thyroid hormone levels to drop too low (hypothyroidism). Let your provider know if you have fatigue that won’t go away or weight gain, since these could be signs of very low thyroid hormone levels. Your provider will check your thyroid hormone levels before starting this medication and then regularly during treatment to make sure your hormone levels are normal.
Harm to the unborn baby
Let your provider know if you’re pregnant or planning to become pregnant. Retevmo (selpercatinib) hasn’t been studied in human pregnancy, but it’s possible that the medication can cause harm to the unborn baby based on findings from animal studies. If you’re able to become pregnant, your provider will have you take a pregnancy test before starting treatment. They’ll also ask you to use effective birth control while taking this medication and for at least a week after your last dose. If you’re male and have a partner who’s able to become pregnant, make sure to use condoms if you have sex while taking Retevmo (selpercatinib) and until at least a week after the last dose.
Retevmo (selpercatinib) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 40mg | 60 tablets | $7,826.84 | $130.45 |
| 80mg | 60 tablets | $11,737.11 | $195.62 |
| 120mg | 60 tablets | $23,467.98 | $391.13 |
| 160mg | 60 tablets | $23,467.98 | $391.13 |
Typical dosage for Retevmo (selpercatinib)
The dose is based on your weight.
- People weighing 110 lb or more: The typical dose is 160 mg by mouth twice a day, about 12 hours apart.
- People weighing less than 110 lb: The typical dose is 120 mg by mouth twice a day, about 12 hours apart.
How much does Retevmo (selpercatinib) cost?
$7,826.84
What are alternatives to Retevmo (selpercatinib)?
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