Ceritinib (Zykadia™)

OncoLink Team
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 25, 2014

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Classification: Tyrosine Kinase Inhibitor

About Ceritinib

Ceritinib is a type of targeted therapy called a tyrosine kinase inhibitor. Ceritinib works by targeting and blocking receptors found on the cancer cells, which in turn blocks the tumor's ability to grow. This medication acts specifically on tumors that have an abnormality in a gene called ALK (anaplastic lymphoma kinase). Your oncology team will test your tumor for this abnormality, which must be present for this medication to work.

How to Take Ceritinib

Ceritinib comes in a capsule form and is taken once a day. The capsule should be swallowed whole (do not break or chew) on an empty stomach (take 2 hours before or after eating). If you miss a dose, you can take it as soon as you remember up to 12 hours before the next scheduled dose. If it is less than 12 hours until the next dose, do not take the missed dose. Do not take two doses at once to make up for the one you missed.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include (but are not limited to): grapefruit, grapefruit juice, ketoconazole, rifampin, phenytoin, St. John's wort, warfarin, and fentanyl. Be sure to tell your healthcare provider about all medications and supplements you take.

Side Effects of Ceritinib

Below are some of the possible side effects and suggestions for dealing with them. Be sure to tell your oncology team if you are experiencing any of these problems.

The most commonly reported side effects include nausea, vomiting, diarrhea and abdominal pain. Below are tips for managing these side effects. However, you should notify your healthcare team if these symptoms are persistent or severe. Talk to your healthcare team about which anti-nausea and anti-diarrheal medications to take as well.

Nausea and/or Vomiting

Take anti-nausea medications if prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea and Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication and for at least 2 weeks after stopping the medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe you are not making sperm. Do not breastfeed while taking this medication.

Lung Problems

Some patients taking ceritinib have developed a severe lung condition called pneumonitis (an inflammation or swelling of the lung tissue). Notify your healthcare provider right away if you develop any new or worsening symptoms, including shortness of breath, trouble breathing, cough or fever.

Liver Toxicity

Ceritinib can cause liver toxicity, which your doctor may monitor for using blood tests called liver function tests. If you develop elevations in your liver function tests, your healthcare provider may need to lower your dose or stop the medication. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity.

Heart Problems

Ceritinib can cause slow or abnormal heartbeats or an abnormal heart rhythm called QT prolongation. Notify your healthcare provider right away if you feel abnormal heartbeats or if you feel dizzy or faint.

High Blood Sugar

This medication can cause elevated blood sugar levels in patients with and without diabetes. Your healthcare team will monitor your blood sugar. If you develop increased thirst, urination or hunger, blurry vision, headaches or your breath smells like fruit, notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.


News
Genetic Screening of Lung Cancers Aids Targeted Therapy

Aug 23, 2014 - Screening lung cancer patients for the presence of epidermal growth factor receptor gene mutations can help identify those who will benefit most from treatment with the tyrosine kinase inhibitor erlotinib, according to a study published online Aug. 19 in the New England Journal of Medicine.



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