Treatment Name: Crizotinib (Xalkori®)
How does crizotinib work?
Crizotinib is designed to bind to and block the function of a mutated protein called “anaplastic lymphoma kinase” (ALK) present in cancer cells. The mutated ALK protein causes the cancer cell to grow and divide more rapidly and to survive longer. Approximately 2% to 7% of patients with NSCLC have this mutation. By blocking the function of the abnormally active ALK protein, crizotinib slows the growth of the cancer and causes some of the cancer cells to die.
Goals of therapy:
Crizotinib is given to patients to slow the progression and to stop the spreading of the disease. Crizotinib is not currently given with the goal of cure.
- Usual starting dose: 250 mg oral capsule by mouth twice daily
Crizotinib is usually taken at home. Crizotinib is taken continuously as long as the drug is working and no unacceptable side effects are experienced.
In clinical studies, the most commonly reported side effects with crizotinib are shown here. Side effects sometimes have percentage ranges [example: 48 – 61% get diarrhea] because they differed between in clinical studies:
- Nausea (56%)
- Diarrhea (48 - 61%)
- Vomiting (47%)
- Visual changes (41 - 71%)
- Sinus infection (26 - 32%)
- Altered taste (26%)
- Abdominal pain (26%)
- Constipation (24 - 43%)
- Cough (23%)
- Headache (22%)
- Low white blood cells [neutropenia] (21%)
- Nerve pain (20%)
- Fever (19%)
- Fluid accumulation in extremities (16 - 49%)
- Arm or leg pain (16%)
- Dizziness (15 - 22%)
- Mouth sores (14%)
- Decreased appetite (13 - 30%)
- Shortness of breath (13 - 18%)
- Weakness (13%)
- Liver injury (12 - 38%)
- Fatigue (10 - 29%)
- Anemia [low red blood cells] (8%)
- Rash (9%)
- Hair loss (8%)
- Lung injury (1%)
Roughly, 6% - 12% of patients discontinue crizotinib due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, then every two weeks for the first two months, then monthly while on treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium levels, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and approximately every 6 to 8 weeks during treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. Electrocardiograms (ECG also known as "EKG") may be performed periodically during treatment to assess your heart rhythm.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue crizotinib as planned, or delay or switch therapy.
- Crizotinib may cause significant nausea and vomiting. An anti-nausea medication is recommended 30 - 60 minutes before each dose of crizotinib to avoid nausea and vomiting due to crizotinib
- Crizotinib as well as several other medications may increase your risk of experiencing a rare, but serious heart rhythm problem known as "prolonged QTc interval." Talk to your doctor or pharmacist to see if any of your other medications can increase your risk of an abnormal heart rhythm.
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Crizotinib (Xalkori®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Crizotinib (Xalkori®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Crizotinib (Xalkori®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Crizotinib (Xalkori®)