Vitrakvi
Vitrakvi (larotrectinib) is a type of cancer medication called a tyrosine kinase inhibitor. It treats cancers with a specific gene mutation called an NTRK fusion. The medication is used for adults and children with this kind of solid tumor when other treatments don’t work or aren’t available. Vitrakvi (larotrectinib) comes as a capsule and a liquid if you can’t swallow pills easily. It’s taken twice a day. Common side effects are tiredness; dizziness; and muscle, bone, and joint pain.
What is Vitrakvi (larotrectinib)?
What is Vitrakvi (larotrectinib) used for?
Advanced or metastatic solid tumors with NTRK fusion, when other treatments haven’t worked or there are no other options
How Vitrakvi (larotrectinib) works
Vitrakvi (larotrectinib) is a tyrosine kinase inhibitor. More specifically, it’s called a tropomyosin receptor kinase (TRK) inhibitor. It works by blocking the TRK receptor on cancer cells.
This is important for cancers with a mutation called an NTRK fusion. This mutation causes the body to make abnormal TRK proteins. When these proteins attach to the TRK receptor, it causes cells to grow out of control.
By blocking the TRK receptor, Vitrakvi (larotrectinib) helps slow down cancer growth.
Drug Facts
What are the side effects of Vitrakvi (larotrectinib)?
Common Side Effects
- High liver enzyme levels (up to 52%)
- Muscle, bone, or joint pain (42%)
- Anemia (42%)
- Low white blood cell count (up to 36%)
- Feeling very tired (36%)
- Cough (32%)
- Feeling dizzy (27%)
- Constipation (27%)
- Diarrhea (27%)
- Nausea (25%)
- Vomiting (25%)
- Low calcium levels (25%)
- Fever (24%)
- Belly pain (21%)
Other Side Effects
- Rash
- Swelling
- Trouble breathing
- Weight gain
- Lower appetite
- Headache
- Confusion
- Memory problems
- Mood problems (e.g., anxiety, depression, irritability)
- Upper respiratory tract infection
- Urinary tract infection
Serious Side Effects
- Bone fracture: muscle or bone pain, can’t move a limb well
- Liver problems: pain in the upper right side of the stomach, yellowing of the eyes or skin, dark or brown urine
Source: DailyMed
The following 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
- 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
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bone, joint, or muscle pain
- Constipation
- Diarrhea
- Dizziness
- Nausea
- Unusual weakness or fatigue
- Trouble sleeping
Pros and cons of Vitrakvi (larotrectinib)
Pros
Taken by mouth
Available as pills and as a liquid (for people who have problems swallowing pills whole)
Option for cancers with the NTRK fusion mutation when other treatments haven’t worked
Cons
Commonly causes tiredness and muscle, bone, or joint pain
Interacts with many other medications and grapefruit
Might affect your ability to have children in the future
Pharmacist tips for Vitrakvi (larotrectinib)
Take Vitrakvi (larotrectinib) with or without food.
For the Vitrakvi (larotrectinib) capsules: Swallow the capsules whole with water. Don’t chew or crush them. Store the capsules at room temperature, away from children and pets.
For the Vitrakvi (larotrectinib) liquid: Follow the directions carefully to measure and give the right dose using the bottle adapter and oral syringes. Keep the liquid in the refrigerator (but don’t freeze it). After opening the 100 mL bottle, don’t use any medication left after 90 days. For the 50 mL bottle, don’t use any medication inside after 31 days of opening it.
If you miss a dose of Vitrakvi (larotrectinib), take it at the same dose as soon as you remember. If the next time you need to take the medication is within 6 hours, skip the missed dose. Wait until your next scheduled time to take your usual dose.
If you vomit after taking a dose of Vitrakvi (larotrectinib), don’t take an extra dose. Take your usual dose the next time you usually take the medication.
Vitrakvi (larotrectinib) commonly causes dizziness and tiredness. Avoid driving, using heavy machinery, and doing activities that need your full attention until you know how this medication affects you.
Avoid eating grapefruit and drinking grapefruit juice while you’re taking Vitrakvi (larotrectinib). Grapefruit can make the levels of the medication in the blood go up. This can raise the risk of side effects like dizziness.
Give your cancer care team a full list of all the medications and herbal supplements you take. Many other medications, herbals, and even some foods can interact with Vitrakvi (larotrectinib). Examples include amiodarone (Pacerone) and St. John’s wort. These interactions can change how well your medications work and raise your risk of side effects. Your care team can make sure you stay safe.
Talk to your oncologist about your options if you’re thinking about having children in the future. Studies in animals show that Vitrakvi (larotrectinib) might affect your ability to have children (fertility).
If you or your partner can get pregnant and you’re having sex, use effective birth control while taking Vitrakvi (larotrectinib) and for at least 1 week after your last dose. It’s important to prevent pregnancy because this medication has a risk of causing harm to an unborn baby.
Ask your cancer care team about how to discard Vitrakvi (larotrectinib) safely. Cancer medications can be harmful for other people, children, and pets. So it’s important to handle and get rid of cancer medications properly.
Frequently asked questions about Vitrakvi (larotrectinib)
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What are the risks and warnings for Vitrakvi (larotrectinib)?
Vitrakvi (larotrectinib) 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.
Side effects affecting the nervous system
In studies, people taking Vitrakvi (larotrectinib) had side effects that affected their nervous system. These included dizziness, confusion, problems paying attention, changes in mood, and sleep problems. Some people noticed these side effects over months of taking the medication. But others experienced them as early as a day after starting the medication.
Tell your healthcare team if you feel dizzy or have mood changes, sleep problems, or problems with memory or concentration. Don’t drive or do anything that needs your full attention until a healthcare professional can check you out. Your oncologist might tell you to take a break from Vitrakvi (larotrectinib) until these side effects get better. When you can take the medication again, your oncologist might lower your dose.
Risk of bone fractures
Some people who took Vitrakvi (larotrectinib) had a broken bone (fracture) during treatment. Some fractures happened in the hip or leg. Go to urgent care If you have a bone that looks crooked, have new muscle or bone pain, or have trouble moving a limb. These can be signs of a broken bone. The care team can do X-rays to check for fractures and recommend strategies to manage pain.
Liver problems
In studies, many people who took Vitrakvi (larotrectinib) had higher liver enzyme levels on their blood test results. This can be a sign of liver damage. Most times, these lab changes were mild. But in rare cases, the test results showed possibly serious liver problems.
You’ll need blood tests to check your liver before starting Vitrakvi (larotrectinib), every 2 weeks for the first 2 months, and then once a month after that. If your liver tests are too high, your oncologist might pause your treatment until your labs improve. They might lower your dose when you start the medication again.
Tell your cancer care team if you have pain in the upper right side of your stomach, yellowing of the eyes or skin, or dark or brown urine. These can be signs of liver problems. Depending on how severe these symptoms are, you might need to take a break from Vitrakvi (larotrectinib) until you get better.
Harm to an unborn baby
Let your oncologist know if you’re pregnant or planning to become pregnant. There’s a risk that Vitrakvi (larotrectinib) can cause harm to an unborn baby if it’s taken during pregnancy.
If you can get pregnant, you’ll need to take a pregnancy test before starting Vitrakvi (larotrectinib). Use effective birth control while taking this medication and for 1 week after your last dose if you’re having sex. If you’re male and your partner can get pregnant, use birth control like condoms during treatment and for 1 week after your last dose.
Vitrakvi (larotrectinib) dosage forms
Typical dosing for Vitrakvi (larotrectinib)
Your oncologist will determine your dose based on your body surface area (BSA), which takes your height and weight into account. The dose is the same for the capsules and oral solution.
BSA of 1 m2 or higher: The recommended dose is 100 mg by mouth twice a day.
BSA less than 1 m2: The dose is calculated from your BSA. The recommended dose is 100 mg/m2 of BSA by mouth twice a day.
Your oncologist might adjust your dose if you take medications that interact with Vitrakvi (larotrectinib). People with liver problems or side effects during treatment might take a lower dose.
What are alternatives to Vitrakvi (larotrectinib)?
Advanced or metastatic solid tumors with NTRK fusion, when other treatments haven’t worked or there are no other options
Metastatic non-small cell lung cancer (NSCLC) with ROS1 gene changes
Advanced and metastatic cancers with NTRK gene changes, when prior treatment hasn’t worked and no other treatment is available
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