Pronounced: en koe RAF e nib
Classification: Kinase Inhibitor
About: Encorafenib (Braftovi®)
Encorafenib is usually given in combination with another medication called binimetinib. It is used to treat melanoma with a BRAF V600E or V600K mutation, which is detected by testing a piece of the tumor. This article will focus on the side effects of taking encorafenib by itself, and together with binimetinib. If you are taking both medications, please see the article for binimetinib for more information.
A kinase is an enzyme that promotes cell growth. There are many types of kinases, which control different phases of cell growth. By blocking a particular enzyme from working, this medication can slow the growth of cancer cells.
Encorafenib works by targeting and blocking receptors found on cancer cells called BRAF V600E or V600K. In some cancers, this receptor is overactive, causing cells to grow and divide too fast. By inhibiting these, this medication can slow or stop tumor growth. Your oncology team will test your tumor for this abnormality, which must be present in order to receive the medication.
How to Take Encorafenib
Encorafenib is taken once a day, by mouth, in a capsule form. It can be taken with or without food. If you miss your dose and it is within 12 hours of your next dose, skip the missed dose and take your next dose as scheduled. If you vomit after taking this medication, do not take an extra dose. Instead, continue with your next dose as scheduled. Consult with your pharmacist or provider if you are having trouble swallowing the medication.
It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.
The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, verapamil, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil, among others. Be sure to tell your healthcare provider about all medications and supplements you take.
If at some point you stop taking encorafenib you should also stop taking binimetinib. Discuss with your provider if you stop taking any medication.
Storage and Handling
Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). Do not remove the dessicant from the bottle as this protects moisture from affecting the medication. This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Encorafenib is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment directly to your home.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending upon prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Encorafenib
There are a number of things you can do to manage the side effects of encorafenib. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
This medication can cause skin issues such as hyperkeratosis (thickening of the skin), dry skin, itching and rash. Use an alcohol free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your oncology care team can recommend a topical medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. Your care providers will frequently be checking your skin for any changes. It is important to notify your providers of any new or worsening changes to your skin.
Loss or Thinning of Scalp and Body Hair (Alopecia)
Your hair may become thin, brittle, or may fall out. This typically begins two to three weeks after treatment starts. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. The use of scarves, wigs, hats and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather or to protect you from the sun.
Hand Foot Syndrome
Hand foot syndrome (HFS) is a skin reaction that appears on the palms of the hands and/or the soles of the feet, as a result of certain chemotherapy agents being absorbed by the skin cells. HFS can begin as a mild tingling, numbness, pins-and-needles feeling, redness or pain or swelling of the hands and/or feet. This can then progress to painful swelling, blistering or peeling skin that can interfere with your ability to do normal activities. Be sure to let your oncology team know right away if you notice these symptoms, as they may need to adjust the chemotherapy dose or take a break to allow the skin to heal. Some tips to help prevent HFS include:
- Keep hands and feet clean and dry.
- Avoid tight shoes or socks.
- Avoid activities that put pressure on the palms or soles for 1 week after treatment.
- Apply an alcohol-free moisturizer liberally and often. (Avoid moisturizers with perfumes or scents)
- Avoid very hot water for baths and showers.
Muscle or Joint Pain/Aches and Headache
Your healthcare provider can recommend medications and other strategies to help relieve pain and to manage any swelling of joints.
When given in combination with binimetinib, these side effects may occur:
This medication can cause kidney problems, including an increased creatinine level, which your oncology care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite.
This medication can cause liver toxicity, which your oncology care team may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, 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 with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Nausea and/or Vomiting
Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. 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 saltines, or ginger ale to lessen symptoms.
Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
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 oncology care team 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.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.
High Blood Sugar
This medication can cause elevated blood sugar levels in patients with and without diabetes. Your oncology care 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.
Less common, but important side effects can include:
- Secondary Malignancies: There is a risk of developing a new primary skin cancer due to treatment with this medication, which can occur during and/or many years after treatment. You will have frequent skin checks and you should report any new changes in your skin to your provider.
- Bleeding: This medication can cause abnormal, serious bleeding. You should contact your provider if you cough up blood or blood clots, if you vomit and it looks like coffee grounds, you have bleeding with bowel movements, or red or black, tar-like stools.
- Eye Problems: If you have any change in vision such as blurred vision, loss of vision, see colored dots or halos, have eye pain, swelling or redness, you should contact your care provider.
- QT Prolongation: This medication can cause slow or abnormal heartbeats or an abnormal heart rhythm called QT prolongation. Notify your oncology care team right away if you feel abnormal heartbeats or if you feel dizzy or faint.
This medication may affect the reproductive system in men, resulting in sperm production becoming irregular or stopping permanently. You may want to consider sperm banking if you may wish to have a child in the future. Discuss these options with your oncology team.
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. Effective non-hormonal birth control is necessary during treatment and for at least 2 weeks after treatment. This medication makes hormonal birth control methods ineffective, such as birth control pills, patches, implants, shots and IUDs. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while taking this medication.