Treatment Name: Dabrafenib (Tafinlar®) + Trametinib (Mekinist®)
How does Dabrafenib (Tafinlar®) and Trametinib (Mekinist®) work?
Each of the chemotherapy medications in dabrafenib and trametinib are designed to shut off signals within the cancer cell that constantly tell the cells to grow and divide. These signals are known as “RAF” and “MEK” signals.
Goals of Taf-Mek therapy:
Dabrafenib and trametinib are chemotherapy drugs taken to shrink lung cancer cells and decrease symptoms from lung cancer. The combination of dabrafenib + trametinib is not commonly given with the goal of cure.
A specific test, approved by FDA, known as the “BRAF V600E mutation”, is recommended before starting dabrafenib therapy to determine whether dabrafenib will likely kill lung cancer cells. If the mutation is NOT detected, then the chance of dabrafenib stoppling lung cancer may be low.
Alternative names: TafMek, Taf-Mek, Taf/Mek
Usual dabrafenib and trametinib, Taf-Mek, starting doses:
- Dabrafenib 150 mg (three 50 mg capsules or two 75 mg capsules) by mouth TWICE Daily
- Dabrafenib is taken at least one hour before a meal or at least 2 hours after a meal
- Each dose of dabrafenib should be taken about 12 hours apart
- Trametinib 2 mg oral tablet by mouth ONCE Daily
- Trametinib is taken at least one hour before a meal or at least 2 hours after a meal
*It is important to note, one of these medications (dabrafenib) is taken TWICE daily, while the other (trametinib) is taken ONCE daily. The once daily trametinib dose may be taken at the same time as one of the dabrafenib doses. Dabrafenib and trametinib are usually taken at home. Treatment is continued every day until it no longer works or until unacceptable side effects occur.
In a multi-drug chemotherapy regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported dabrafenib + trametinib side effects are shown here:
- Fever (64%)
- Nausea (56%)
- Diarrhea (36%)
- Fatigue (36%)
- Swelling in arms or legs (36%)
- Vomiting (33%)
- Dry skin (33%)
- Decreased appetite (33%)
- Chills (25%)
- Headache (25%)
- Skin rash (22%)
- Dizziness (22%)
- Cough (22%)
- Shortness of breath (17%)
- Low blood pressure (17%)
- Back pain (17%)
- Weight loss (17%)
- Stomach pain (14%)
- Anemia [low red blood cells] (14%)
- Joint pain (14%)
- Constipation (14%)
- Trouble sleeping (14%)
- Muscle aches (14%)
- High blood pressure (11%)
- Weakness (11%)
- Itching (11%)
- Pain in arms or legs (11%)
- Skin redness (11%)
- Decreased in hearts ability to pump blood (9%)
- Blood clot in the lungs (9%)
- Weight gain (9%)
- Voice changes (8%)
Bleeding can occur when dabrafenib is taken with trametinib. Tell your doctor immediately if you have any signs or symptoms of bleeding.
On average, 22% of patients discontinue dabrafenib and trametinib treatment due to unacceptable chemo side effects.
How often is Taf-Mek monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment until stable. Labs often include: a blood test called “BRAF V600E mutation”, which helps predict the chance of responding to these medications, Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
You and your doctor will also monitor your skin for new skin lesions (abnormal growths). Tell your doctor right away if any new skin lesions are seen.
How often is imaging needed for Taf-Mek?
Imaging may be checked before treatment then approximately every 8 weeks for the first year, then every 12 weeks thereafter, or until stable. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. Echocardiograms (Echo) to check heart function are typically performed before starting treatment, one month after starting treatment, then every 2 to 3 months thereafter. An eye exam may also be recommended before starting treatment with dabrafenib + trametinib. Notify your doctor if you experience any change in vision, eye pain, or increased sensitivity to light.
How might blood test results/imaging affect Taf-Mek treatment?
Imaging can be used to see if the lung cancer is getting smaller or spreading. If breathing or chest pain is noticed, imaging can also help detect a blood clot in the lungs (pulmonary embolism, or PE). Depending upon the results, your doctor may advise to continue dabrafenib + trametinib as planned, reduce the dose of future treatments, delay treatment until a side effect goes away, or switch to an alternative therapy.
- When fever occurs, it usually lasts for about three days, although it can last for much longer. If fever is experienced, the first fever usually occurs about one month after starting dabrafenib and trametinib, but may occur sooner or later than this time period. Dabrafenib therapy should be temporarily withheld if the temperature reaches 101.3°F or higher. A low dose of prednisone may be prescribed for 5 or more days if the temperature does not return to normal after three days
- As many as 3% of patients who take dabrafenib alone may develop a second type of skin cancer known as “squamous cell carcinoma.” When combined with trametinib, the number of patients that develop new skin cancers is approximately 3% and these usually develop between 7 – 8 months after starting treatment. Additional surgical procedures may be needed to remove these cancers and therapy with dabrafenib may usually continue. Skin exams are usually done before starting therapy, every two months during therapy, and for up to 6 months after stopping treatment
- Approximately 6% of patients who take dabrafenib with trametinib experience a decrease in the heart's ability to effectively pump blood; however; this effect is usually not permanent. Heart function is monitored periodically during therapy with echocardiograms or MUGA scans
- Therapy with dabrafenib with trametinib may increase the risk of experiencing blood clots. Contact your doctor if you are experiencing pain and swelling in your arms or legs or if you have severe chest pain or shortness of breath
- Contact your doctor immediately if you notice any signs of unusual bleeding such as blood in the stool, black tarry stools, or vomit that looks like black coffee grounds
- Sun sensitivity may occur with dabrafenib. When outside, patients should wear protective clothing, sunscreen with SPF 30 or greater, and use a lip balm with SPF 30 or greater
- An eye problem known as “uveitis” can develop in about 2% of patients taking dabrafenib with trametinib. Uveitis may cause problems tolerating any light as well as blurred vision. Treatment may consist of steroid eye drops, with or without a medication to dilate the pupils. Other very rare but serious eye problems such as retinal detachment and blockage of the veins in the eye have also been reported
- Dabrafenib may lose effectiveness if taken with medicines for heartburn such as antacids (example: Tums®), proton pump inhibitors (example: omeprazole (Prilosec®)) or H2-antagonists (famotidine, ranitidine). Talk with your doctor or pharmacist about how best to take these two medicines together
- Painful redness, blistering, and peeling skin reaction on the palms of your hands and on the soles of your feet may develop. This is known as Hand-Foot Syndrome. Ways to help reduce the risk of experiencing Hand-Foot Syndrome include using a non-alcoholic moisturizer daily on your hands and feet, avoid wearing gloves, avoid prolonged exposure to hot water, and avoid activities that put pressure or friction on your hands and feet such as golf or tennis while being treated with dabrafenib + trametinib
- Dabrafenib may decrease the effectiveness of oral birth control pills. Women of child bearing age should talk to their doctor about alternative forms of contraception
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for NSCLC. 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 Dabrafenib (Tafinlar®) + Trametinib (Mekinist®), 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 Dabrafenib (Tafinlar®) + Trametinib (Mekinist®). 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 Dabrafenib (Tafinlar®) + Trametinib (Mekinist®) 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 Dabrafenib (Tafinlar®) + Trametinib (Mekinist®)