Xalkori - patient leaflet, side effects, dosage

1. What XALKORI is and what it is used for

XALKORI is an anticancer medicine containing the active substance crizotinib used to treat adults with a type of lung cancer called non-small cell lung cancer, that presents with a specific rearrangement or defect in either a gene called anaplastic lymphoma kinase (ALK) or a gene called ROS1.

XALKORI can be prescribed to you for the initial treatment if your disease is at an advanced stage of lung cancer.

XALKORI can be prescribed to you if your disease is at an advanced stage and previous treatment has not helped to stop your disease.

XALKORI may slow or stop the growth of lung cancer. It may help shrink tumours.

If you have any questions about how XALKORI works or why this medicine has been prescribed for you, ask your doctor.

2. What you need to know before you take XALKORI

Do not take XALKORI

• If you are allergic to crizotinib or any of the other ingredients of this medicine (listed in Section 6, “What XALKORI contains”).

Warnings and precautions

Talk to your doctor before taking XALKORI:

• If you have moderate or severe liver disease.
• If you have ever had any other lung problems. Some lung problems may get worse during treatment with XALKORI, as XALKORI may cause inflammation of the lungs during treatment. Symptoms may be similar to those from lung cancer. Tell your doctor right away if you have any new or worsening symptoms including difficulty in breathing, shortness of breath, or cough with or without mucous, or fever.
• If you have been told that you have an abnormality of your heart tracing after an electrocardiogram (ECG) known as prolonged QT interval.
• If you have reduced heart rate.
• If you have ever had stomach or intestine problems such as holes (perforation), or if you have conditions causing inflammation inside the abdomen (diverticulitis), or if you have spread of cancer inside the abdomen (metastasis).
• If you have vision disorders (seeing flashes of light, blurred vision, and double vision).
• If you have severe kidney disease.
• If you are currently treated with any of the medicines listed in section “Other medicines and XALKORI”.

Talk to your doctor right away after having taken XALKORI:

• If you are experiencing severe stomach or abdominal pain, fever, chills, shortness of breath, fast heartbeat, partial or complete loss of vision (in one or both eyes) or changes in bowel habits.

Most of the available information is available in patients with some specific histology type of ALK-positive NSCLC (adenocarcinoma) and limited information is available in the other histologies.

Children and adolescents

Treatment of children and adolescents with this medicine is not recommended. The indication does not cover children and adolescents.

Other medicines and XALKORI

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including herbal medicines and medicine obtained over the counter.

In particular, the following medicines may increase the risk of side effects with XALKORI:

• Clarithromycin, telithromycin, erythromycin, antibiotics used to treat bacterial infections.
• Ketoconazole, itraconazole, posaconazole, voriconazole, used to treat fungal infections.
• Atazanavir, ritonavir, cobicistat, used to treat HIV infections/AIDS.

The following medicines may reduce the effectiveness of XALKORI:

• Phenytoin, carbamazepine or phenobarbital, anti-epileptics used to treat seizures or fits.
• Rifabutin, rifampicin, used to treat tuberculosis.
• St. John’s wort (Hypericum perforatum), a herbal product used to treat depression.

XALKORI may increase side effects associated with the following medicines:

• Alfentanil and other short acting opiates such as fentanyl (painkillers used for surgical

procedures).

• Quinidine, digoxin, disopyramide, amiodarone, sotalol, dofetilide, ibutilide, verapamil, diltiazem used to treat heart problems.
• Medicines for high blood pressure called beta-blockers such as atenolol, propranolol, labetolol.
• Pimozide, used to treat mental illness.
• Metformin, used to treat diabetes.
• Procainamide, used to treat cardiac arrhythmia.
• Cisapride, used to treat stomach problems.
• Ciclosporin, sirolimus and tacrolimus used in transplant patients.
• Ergot alkaloids (e.g., ergotamine, dihydroergotamine), used to treat migraine.
• Dabigatran, anticoagulant used to slow down clotting of the blood.
• Colchicine, used to treat gout.
• Pravastatin, used to reduce cholesterol levels.
• Clonidine, guanfacine, used to treat hypertension.
• Mefloquine, used for the prevention of malaria.
• Pilocarpine, used to treat glaucoma (a severe eye disease).
• Anticholineste­rases, used to restore muscle function.
• Antipsychotics, used to treat mental illness.
• Moxifloxacine, used to treat bacterial infections.
• Methadone, used to treat pain and for the treatment of opioid dependence.
• Bupropion, used to treat depression and smoking cessation.
• Efavirenz, raltegravir, used to treat HIV infection.
• Irinotecan, a chemotherapy medicine used to treat cancer of the colon and rectum.
• Morphine, used to treat acute and cancer pain.
• Naloxone, used to treat opiate medicine addiction and withdrawal.

These medicines should be avoided during your treatment with XALKORI.

Oral contraceptives

If you take XALKORI whilst using oral contraceptives, the oral contraceptives may be ineffective.

XALKORI with food and drink

You can take XALKORI with or without food; however, you should avoid drinking grapefruit juice or eating grapefruit while on treatment with XALKORI as they may change the amount of XALKORI in your body.

Pregnancy and breast-feeding

Talk to your doctor or pharmacist before taking this medicine if you are pregnant, may become pregnant or are breast-feeding.

It is recommended that women avoid becoming pregnant and that men do not father children during treatment with XALKORI because this medicine could harm the baby. If there is any possibility that the person taking this medicine may become pregnant or father a child, they must use adequate contraception during treatment, and for at least 90 days after completing therapy as oral contraceptives may be ineffective while taking XALKORI.

Do not breast-feed during treatment with XALKORI. XALKORI could harm a breast-fed baby.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

You should take special care when driving and using machines as patients taking XALKORI may experience visual disturbances, dizziness, and tiredness.

XALKORI contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per 200 mg or 250 mg capsule, that is to say essentially ‘sodium-free’.

3. How to take XALKORI

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

• The recommended dose is one capsule of 250 mg taken orally twice daily (total amount 500 mg).
• Take the capsule once in the morning and once in the evening.
• Take the capsules at about the same time each day.
• You can take the capsules with or without food always avoiding grapefruit.
• Swallow the capsules whole and do not crush, dissolve or open the capsules.

If necessary, your doctor may decide to reduce the dose to 200 mg to be taken orally twice daily (total amount 400 mg) and if further dose reduction is necessary, to reduce it to 250 mg to be taken orally once daily. Your doctor may decide to permanently discontinue your treatment if you are unable to tolerate XALKORI 250 mg taken orally once daily.

If you take more XALKORI than you should

If you accidentally take too many capsules, tell your doctor or pharmacist right away. You may require medical attention.

If you forget to take XALKORI

What to do if you forget to take a capsule depends on how long it is until your next dose.

• If your next dose is in 6 hours or more, take the missed capsule as soon as you remember. Then take the next capsule at the usual time.
• If your next dose is in less than 6 hours, skip the missed capsule. Then take the next capsule at the usual time.

Tell your doctor about the missed dose at your next visit.

Do not take a double dose (two capsules at the same time) to make up for a forgotten capsule.

If you vomit after taking a dose of XALKORI, do not take an extra dose; just take your next dose at your regular time.

If you stop taking XALKORI

It is important to take XALKORI every day, as long as your doctor prescribes it to you. If you are not able to take the medicine as your doctor prescribed, or you feel you do not need it anymore, contact your doctor right away.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet.

Some side effects could be serious. You should immediately contact your doctor if you experience any of the following serious side effects (see also section 2 “What you need to know before you take XALKORI ”):

• Liver failure

Tell your doctor right away if you feel more tired than usual, your skin and whites of your eyes turn yellow, your urine turns dark or brown (tea colour), you have nausea, vomiting, or decreased appetite, you have pain on the right side of your stomach, you have itching, or if you bruise more easily than usual. Your doctor may do blood tests to check your liver function, and if the results are abnormal, your doctor may decide to reduce the dose of XALKORI or stop your treatment.

• Lung inflammation

Tell your doctor right away if you experience difficulty in breathing, especially if associated with cough or fever.

• Reduction in the number of white blood cells (including neutrophils)

Tell your doctor right away if you experience fever or infection. Your doctor may do blood tests and if the results are abnormal, your doctor may decide to reduce the dose of XALKORI.

• Light-headedness, fainting, or chest discomfort

Tell your doctor right away if you experience these symptoms which could be signs of changes in the electrical activity (seen on electrocardiogram) or abnormal rhythm of the heart. Your doctor may perform electrocardiograms to check there are no problems with your heart during treatment with XALKORI.

• Partial or complete loss of vision in one or both eyes

Tell your doctor right away if you experience any loss of vision or any change in vision such as difficulty seeing out of one or both eyes. Your doctor may stop XALKORI treatment and refer you to an ophthalmologist.

Other side effects of XALKORI may include:

Very common side effects (may affect more than 1 in 10 people)

• Visual effects (seeing flashes of light, blurred vision, or double vision, often beginning soon after starting treatment with XALKORI).
• Stomach upset, including vomiting, diarrhoea, nausea.
• Oedema (excess fluid in body tissue, causing swelling of the hands and feet).
• Constipation.
• Abnormalities in liver blood tests.
• Decreased appetite.
• Tiredness.
• Dizziness.
• Neuropathy (feeling of numbness or pins and needles in the joints or extremities).
• Alteration in sense of taste.
• Pain in the abdomen.
• Reduction in the number of red blood cells (anaemia).
• Skin rash.
• Reduced heart rate.

Common side effect s (may affect up to 1 in 10 people)

• Indigestion.
• Increased blood levels of creatinine (may indicate that kidneys are not functioning properly).
• Increased levels of the enzyme alkaline phosphatase in the blood (an indicator of organ malfunction or injury, particularly liver, pancreas, bone, thyroid gland, or gall bladder).
• Hypophosphataemia (low blood phosphate levels that can cause confusion or muscle weakness).
• Closed pouches of fluid within the kidneys (kidney cysts).
• Fainting.
• Inflammation of the oesophagus (swallowing tube).
• Decreased levels of testosterone, a male sex hormone.
• Heart failure.

Uncommon side effect s (may affect up to 1 in 100 people)

• Hole (perforation) in stomach or intestine.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store XALKORI

• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the bottle or blister foil and carton after “EXP”. The expiry date refers to the last day of that month.
• This medicine does not require any special storage conditions.
• Do not use any pack that is damaged or shows signs of tampering.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What XALKORI contains

• – The active substance in XALKORI is crizotinib.

XALKORI 200 mg: each capsule contains 200 mg crizotinib

XALKORI 250 mg: each capsule contains 250 mg crizotinib

• – The other ingredients are (see also section 2 “XALKORI contains sodium”):

What XALKORI looks like and contents of the pack

XALKORI 200 mg is supplied as hard gelatin capsules with pink cap and white body, printed with black ink “Pfizer” on the cap, “CRZ 200” on the body.

XALKORI 250 mg is supplied as hard gelatin capsules with pink cap and body, printed with black ink “Pfizer” on the cap, “CRZ 250” on the body.

It is available in blister packs of 60 hard capsules and in plastic bottles of 60 hard capsules.

Not all pack sizes may be marketed.

Marketing Authorisation Holder

Pfizer Europe MA EEIG

Boulevard de la Plaine 17

1050 Bruxelles

Belgium

Manufacturer

Pfizer Manufacturing Deutschland GmbH

Betriebsstätte Freiburg

Mooswaldallee 1

79090 Freiburg

Germany

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

België/Belgiqu­e/Belgien Luxembourg/Lu­xemburg Pfizer NV/SA

Lietuva Pfizer Luxembourg SARL filialas Lietuvoje Tel: +370 5 251 4000

Tél/Tel: +32 (0)2 554 62 11

Et^rapuH n$aÖ3ep -HroKcevioypr CAPA, Kjoh Etarapua Tea.: +359 2 970 4333	Magyarország Pfizer Kft. Tel.: +36 1488 37 00
Česká republika Pfizer, spol. s r.o. Tel: +420 283 004 111	Malta Vivian Corporation Ltd. Tel: +356 21344610
Danmark Pfizer ApS Tlf: +45 44 20 11 00	Nederland Pfizer bv Tel: +31 (0)800 63 34 636
Deutschland PFIZER PHARMA GmbH Tel: +49 (0)30 550055–51000	Norge Pfizer AS Tlf: +47 67 52 61 00
Eesti Pfizer Luxembourg SARL Eesti filiaal Tel: +372 666 7500	Österreich Pfizer Corporation Austria Ges.m. b.H. Tel: +43 (0)1 521 15–0
EZZáňa Pfizer EZZàç A.E. Tnk +30 210 6785800	Polska Pfizer Polska Sp. z o.o. Tel.: +48 22 335 61 00
España Pfizer, S.L. Tel: +34 91 490 99 00	Portugal Laboratórios Pfizer, Lda. Tel: +351 21 423 5500
France Pfizer Tél: +33 (0)1 58 07 34 40	România Pfizer Romania S.R.L. Tel: +40 (0) 21 207 28 00
Hrvatska Pfizer Croatia d.o.o. Tel: +385 1 3908 777	Slovenija Pfizer Luxembourg SARL Pfizer, podružnica za svetovanje s področja farmacevtske dejavnosti, Ljubljana Tel: +386 (0)1 52 11 400
Ireland Pfizer Healthcare Ireland Tel: +1800 633 363 (toll free) Tel: +44 (0)1304 616161	Slovenská republika Pfizer Luxembourg SARL, organizačná zložka Tel: +421 2 3355 5500
Ísland Icepharma hf. Sími: +354 540 8000	Suomi/Finland Pfizer Oy Puh/Tel: +358 (0)9 430 040

Sverige

Pfizer AB

Tel: +46 (0)8 550 520 00

Latvija

Pfizer Luxembourg SARL filiale Latvija

Tel: +371 670 35 775

This leaflet was last revised in {MM/YYYY}.

Detailed information on this medicine is available on the European Medicines Agency web site: http://www. ema europaeu/.

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