Xalkori (crizotinib) is a targeted therapy medication used to treat metastatic non-small-cell lung cancer (NSCLC), advanced anaplastic large cell lymphoma (ALCL), and advanced inflammatory myofibroblastic tumor (IMT) that have certain mutations. It’s convenient to take because it’s a medication you take by mouth, typically twice daily. But it can cause some serious side effects like nausea, diarrhea, and vision changes.
Metastatic non-small-cell lung cancer (NSCLC) with an ALK or ROS1 mutation
Advanced anaplastic large cell lymphoma (ALCL) with an ALK mutation
Advanced inflammatory myofibroblastic tumor (IMT) with an ALK mutation
Xalkori (crizotinib) works by targeting cells that have genetic changes (mutations) in specific receptors, such as anaplastic lymphoma kinase (ALK) and ROS1. These genetic changes cause cells to become cancer cells. When Xalkori (crizotinib) blocks the activity of these receptors, cancer cells can’t grow and spread as well.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Black, tarry stools
bloating or swelling of the face, arms, hands, lower legs, or feet
blurred or loss of vision
body aches or pain
chest pain, discomfort, or tightness
chills
colicky or burning stomach pain
difficult or labored breathing
difficulty in swallowing
disturbed color perception
double vision
ear congestion
halos around lights
headache
hoarseness
increased sensitivity to pain or touch
irregular heartbeat
lightheadedness, dizziness, or fainting
loss of appetite
loss of voice
lower back or side pain
nerve pain
night blindness
overbright appearance of lights
pain in the back of throat or chest when swallowing
pain or burning in the throat
painful or difficult urination
pale skin
rapid weight gain
recurrent fainting
runny or stuffy nose
seeing flashes or sparks of light
slow or irregular heartbeat
sores, ulcers, or white spots on the lips or tongue or inside the mouth
swelling
trouble breathing
tunnel vision
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
vomiting
vomiting blood or material that looks like coffee grounds
weakness in the arms, hands, legs, or feet
Less common
blue lips, fingernails, or skin
clay-colored stools
confusion
dark urine
fast heartbeat
flushed, dry skin
fruit-like breath odor
increased hunger
increased thirst
increased urination
irregular, fast or slow, or shallow breathing
itching, skin rash
loss of consciousness
stomach pain or tenderness
sweating
swelling of the feet or lower legs
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
back pain
belching
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in taste
increased weight
indigestion
loss of taste
muscle spasm or weakness
pain in the arms or legs
stomach discomfort or upset
trouble in walking
unsteadiness or awkwardness
weakness in the arms, hands, legs, or feet
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Taken by mouth, so good for people who don’t like needles
Works in a more specific, targeted way than traditional chemotherapy
Can be taken with or without food
Recommended treatment option for patients with NSCLC, ALCL, IMT who have certain mutations
Taken twice a day
Can interact with many medications, such as diltiazem (Cardizem), amiodarone (Pacerone), and several medications that treat infections and seizures.
Might need to have regular eye check-ups, which means more appointment visits
Not recommended during pregnancy or breastfeeding
Xalkori (crizotinib) can cause nausea. Your provider might recommend you to take a medication to prevent nausea before each dose of Xalkori (crizotinib) . Sometimes, your provider might ask you to take it in between Xalkori (crizotinib) doses as well. There are many types of medications to manage nausea, so if one doesn’t work, ask your provider about other options.
You might experience some diarrhea at the beginning of Xalkori (crizotinib) treatment, but it should go away over time. Your provider might suggest an over-the-counter medication, like loperamide (Imodium A-D), to help manage diarrhea. If you experience diarrhea it’s important to drink a lot of fluids, but try to avoid sugary sports drinks because they can make diarrhea worse.
Sometimes, taking Xalkori (crizotinib) can cause your liver to become irritated. Most of the time, you won't feel any noticeable symptoms. But your provider can see signs of this through blood tests. Make sure you continue to get regular blood tests while you're taking Xalkori (crizotinib) so your provider can check your liver health and make sure it's still safe for you to keep taking this medication. If you have stomach pain, yellowish skin, or yellow around the whites of your eyes, call your provider right away.
Xalkori (crizotinib) can cause a slow heart rate (bradycardia). Because of this, some medications that also cause slow heart rate shouldn’t be taken with Xalkori (crizotinib) . You can monitor your own heart rate at home with a blood pressure monitor, smart watch, or by counting your pulse for one minute. If your heart rate is below 60 beats per minute and this isn’t normal for you, contact your provider.
Even though it’s rare, Xalkori (crizotinib) can cause severe and complete vision loss. Because of this, it’s important to see an ophthalmologist before you start Xalkori (crizotinib) and regularly as long as you’re taking it.
Ask your provider about the best way to handle and throw away Xalkori (crizotinib) safely. Anticancer medications can be harmful to people who handle or come in contact with them. If you’re a parent of a child taking Xalkori (crizotinib) for ALCL or IMT and will be handling the medication, you should wear gloves. Store Xalkori (crizotinib) in a safe place away from children and pets.
Xalkori (crizotinib) 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.
Though rare, some people taking Xalkori (crizotinib) have experienced a serious lung problem called interstitial lung disease (ILD). Talk to your provider right away if you experience sudden or worsening cough, trouble breathing , and fever. You might have to pause or stop Xalkori (crizotinib) while your provider figures out the cause.
Risk factor: History of liver problems
Some people taking Xalkori (crizotinib) have shown high levels of liver enzymes on their blood tests, which can suggest liver problems. Your doctor will monitor your liver health on a regular basis, usually every month, and if something changes, you might need to pause or stop the Xalkori (crizotinib) while your doctor looks into it. Most people don’t feel any noticeable symptoms when this happens, so it’s important to keep up with your lab work regularly. If you have stomach pain, yellowish skin, or yellow around the whites of your eyes, call your provider right away.
Risk factors: Heart failure | History of abnormal heart rhythms | Taking other medications that can affect heart rhythm
Rarely, some people taking Xalkori (crizotinib) have changes in their heart rhythm, also called QT prolongation. Don’t take Xalkori (crizotinib) if you’re born with long QT syndrome. If you’re at risk for QT prolongation for another reason, such as because of another medication you take, your doctor might monitor you more closely with a test called an electrocardiogram (EKG). If you have sudden chest pain, feel very dizzy or pass out, seek medical help right away. Your provider will review all the other medications you take to check if you’re at a higher risk.
Risk factors: History of bradycardia | Taking other medications that can slow heart rate, such as metoprolol (Lopressor)
People who take Xalkori (crizotinib) might experience a slow heart rate, which can cause tiredness, weakness, and feeling light-headed. A slow heart rate isn’t always serious, but if it causes fainting, then your provider might ask you to pause or stop taking Xalkori (crizotinib) . You can check your own heart rate at home between clinic visits and call your provider if you notice a change. You can check it at home with a blood pressure cuff, smart watch, or by counting your pulse for one minute. If you’re taking other medications that can also slow heart rate, your provider might ask you to monitor your heart rate more often.
Xalkori (crizotinib) can cause vision changes such as blurred vision and not seeing as well. In rare cases, people have experienced near total vision loss. If you’re an adult, you should see an ophthalmologist before you start crizotinib and once a month while you’re still taking it. Young adults and children should see an ophthalmologist before starting crizotinib, one month after starting, and then every three months. If you do experience changes in your vision, your provider might ask you to stop crizotinib treatment, depending on how serious the changes are.
Children and young adults taking Xalkori (crizotinib) for ALCL or IMT might experience nausea, vomiting, and diarrhea. Your prescriber will give you medication to prevent nausea that should be taken before each dose of Xalkori (crizotinib) and in between doses if needed. They can also recommend medications to treat diarrhea, as well as give you lifestyle tips such as eating bland, low-fat foods and drinking plenty of non-sugary fluids. If you have nausea or diarrhea that won’t stop even after three days of using medication, call your provider.
Based on animal studies, Xalkori (crizotinib) might harm an unborn baby or raise the risk for miscarriage (pregnancy loss). Because of these risks, if you’re a female who can get pregnant, you should use birth control while taking Xalkori (crizotinib) and for 45 days after the last dose. Let your provider know right away if you become pregnant while taking Xalkori (crizotinib) . If you’re a male who is sexually active with a partner who is able to get pregnant, use condoms during treatment and for at least three months after the last dose.
NSCLC
Adults: The usual dose is 250 mg by mouth twice a day
ALCL
Children and young adults: Your provider will determine your dose based on body surface area (BSA), which is a measurement of body size that takes into account weight and height. The usual dose ranges from 200 mg to 500 mg twice a day, depending on body size.
IMT
Adults: The usual dose is 250 mg by mouth twice a day
Children: Your child's provider will determine your child's dose based on their body size, taking into account their weight and height. The usual dose ranges from 200 mg to 500 mg twice a day, depending on body size.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Metastatic non-small-cell lung cancer (NSCLC) with an ALK or ROS1 mutation
Advanced anaplastic large cell lymphoma (ALCL) with an ALK mutation
Advanced inflammatory myofibroblastic tumor (IMT) with an ALK mutation
Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) that has spread to other areas of the body
Anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) in adults
Early stage ALK-positive NSCLC in adults after surgery
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American Cancer Society. (2019). Chemotherapy safety.
American Lung Association. (n.d.). Interstitial lung disease (ILD).
American Lung Association. (2022). ALK and lung cancer.
American Lung Association. (2022). ROS1 and lung cancer.
Ishii, T., et al. (2015). Crizotinib-induced abnormal signal processing in the retina. PLoS One.
National Cancer Institute. (n.d.). Advanced cancer.
National Cancer Institute. (n.d.). Anaplastic large cell lymphoma.
National Cancer Institute. (n.d.). Metastatic.
National Cancer Institute. (2019). Inflammatory myofibroblastic tumor (IMT).
National Comprehensive Cancer Network. (2022). Nausea and vomiting.
Pfizer Laboratories Div Pfizer Inc. (2023). Xalkori- crizotinib capsule; crizotinib capsule, coated pellets [package insert]. DailyMed.
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