Crizotinib (XALKORi)

Non-small cell lung cancer (ALK or ROS1-positive), advanced or metastatic

Non-small cell lung cancer (ALK or ROS1-positive), advanced or metastatic

• Oral: 250 mg twice daily continuously until disease progression or unacceptable toxicity

Available as 200 mg and 250 mg hard gelatin capsules. Capsules should NOT be opened. Store at room temperature.

Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a Anaplastic Lymphoma Kinase(ALK) Inhibitor and a ROS-1 inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 6 hours of the missed dose. If it is over 6 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Vision disorders, Diarrhea, Nausea, Vomiting.

Less Common: Neutropenia, Bradycardia, Hepatic failure, ALT increase, AST increase, Neuropathy, QT prolongation, Pneumonitis.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, alkaline phosphatase, ALT, total bilirubin, LDH, calcium, magnesium, sodium, potassium, ECG, C-reactive protein and albumin (optional, and results do not have to be available to proceed with first treatment).

During treatment: CBC & differential, platelets, alkaline phosphatase, ALT, total bilirubin and LDH should be checked every two weeks during cycle 1 and cycle 2 and at each subsequent visit thereafter.

If clinically indicated: Blood pressure, electrolytes, chest x-ray, ECG.

• May increase the risk for QT interval prolongation. Avoid concurrent therapy with drugs associated with QTc prolongation and/or Torsades de pointes, if possible. If unavoidable, monitor for QT prolongation or cardiac arrhythmias.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Fatalities due to crizotinib-induced hepatotoxicity have occurred with crizotinib.
• Interstitial lung disease (ILD)/Pneumonitis: Crizotinib has been associated with severe, life-threatening, or fatal treatment-related ILD/pneumonitis. These cases generally occurred within 2 months after the initiation of treatment. Patients should be regularly monitored for pulmonary symptoms indicative of ILD/pneumonitis.
• Vision disorder, most commonly visual impairment, photopsia, vision blurred, and vitreous floaters, was experienced by 63% of patients treated with Crizotinib. 95% of these patients had Grade 1 visual adverse reactions. Ophthalmological evaluation should be considered if vision disorder persists or worsens in severity.

BC Cancer. BC Cancer Drug Manual. Crizotinib. Vancouver, British Columbia: BC Cancer Agency. Available at :http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Crizotinib_monograph.pdf. Updated August 1, 2020. Accessed January 22, 2024.

Lexicomp. Crizotinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/3517168?cesid=3c3zjY15LvW&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dcrizotinib%26t%3Dname%26acs%3Dtrue%26acq%3Dcrizontinib. Updated January 24, 2024. Accessed January 28, 2024.

Cancer Care Ontario. Crizotinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44286. Updated December 2020. Accessed January 22, 2024.Pfizer Canada Inc. XALKORI® Product monograph. Kirkland, Quebec. Updated April 17, 2023.