Xalkori: Side effects, dosage, uses, and more

Xalkori (generic name: crizotinib) is a targeted cancer therapymeaning it’s designed to home in on
specific genetic “on switches” that help certain cancers grow. If chemotherapy is the sledgehammer,
Xalkori is more like a key that fits a particular lock… except the lock is on a cancer cell, and your
oncology team is the one holding the key ring.

Important: This article is for educational purposes only and is not medical advice.
Xalkori is a prescription medicine used under the supervision of an oncology team. Always follow your
prescriber’s instructions, and ask them before changing how you take any medication.

What is Xalkori?

Xalkori is a kinase inhibitor (a type of targeted therapy). It’s used when a tumor has certain genetic
changesmost commonly involving the ALK gene (anaplastic lymphoma kinase) or the ROS1 gene. Those gene
changes can act like a stuck accelerator pedal for cancer growth. Xalkori helps slow that down by blocking
the signals.

Uses of Xalkori (what it treats)

Xalkori is used for specific cancers that test positive for certain biomarkers (tumor genetic changes).
In the U.S., Xalkori is used for:

• Metastatic non-small cell lung cancer (NSCLC) when the tumor is ALK-positive or
  ROS1-positive.
• Relapsed or refractory systemic anaplastic large cell lymphoma (ALCL) that is
  ALK-positive in pediatric patients (age 1+) and young adults.
• Inflammatory myofibroblastic tumor (IMT) that is ALK-positive in
  adults and pediatric patients (age 1+), when the disease is unresectable,
  recurrent, or refractory.

Why biomarker testing matters

Xalkori isn’t a “one-size-fits-all” drug. It’s prescribed when testing shows the tumor has an ALK or ROS1
alteration that Xalkori can target. Practically speaking, that means your care team may order tumor testing
(or blood-based testing in some situations) before deciding whether Xalkori makes sense.

How Xalkori works

Some cancers grow because certain proteins keep telling cells to divide. In ALK-positive or ROS1-positive tumors,
those signals can be unusually active due to gene rearrangements or fusions. Xalkori blocks ALK and ROS1 signaling
pathways, which may help slow tumor growth or shrink tumors in cancers driven by those targets.

Dosage and how to take Xalkori

Xalkori dosing depends on the condition being treated, your age/body size, and sometimes your kidney or liver
function. Your oncology team may also adjust the dose if side effects become difficult or unsafe.

Typical adult dosage for NSCLC (and adult IMT)

For many adults with ALK- or ROS1-positive metastatic NSCLC, the commonly prescribed dose is
250 mg by mouth twice daily. Adults with ALK-positive IMT may also be treated with an adult dose
regimen determined by the prescriber.

Pediatric and young adult dosing for ALCL (and pediatric IMT)

For pediatric patients and certain young adults (for ALK-positive ALCL) and for pediatric patients (for ALK-positive IMT),
dosing is typically based on body surface area (BSA). In other words: your care team calculates it,
and the dose can vary by height and weight. If you’re a caregiver, don’t be surprised if the “mg” number looks different
than what adults takethis is normal for oncology medications in children.

Capsules vs oral pellets

Xalkori comes as capsules, and in some cases oral pellets may be used (for example, for people who can’t swallow capsules).
Your pharmacist and oncology team will tell you which form you’re using and exactly how to take it.

How to take it (the practical rules)

• Take Xalkori twice daily at about the same times each day (your team may suggest morning/evening).
• With or without food is usually acceptable unless your clinician instructs otherwise.
• Swallow capsules wholedon’t crush, chew, split, or open them.
• If you miss a dose: take it unless your next dose is due within about 6 hours.
  If the next dose is soon, skip the missed dose and return to your usual schedule.
• If you vomit after a dose: do not take an extra dosetake your next dose at the
  regular scheduled time.

Dose adjustments (kidneys, liver, and interactions)

Your care team may adjust Xalkori if you have moderate or severe liver impairment,
severe kidney impairment, or if you must take certain interacting medications (especially strong CYP3A
inhibitors). This is one of those “don’t DIY it” momentsdose changes should only be made by your prescriber.

Side effects of Xalkori

Like most cancer therapies, Xalkori can cause side effects. Some are common and manageable; others are less common but
serious and require urgent medical attention. The key is knowing what to expect, what to report, and what to treat as an emergency.

Common side effects (often manageable)

Many adults taking Xalkori for NSCLC report side effects like:

• Vision changes (blurred vision, “floaters,” flashes, light sensitivity)
• Nausea, diarrhea, or vomiting
• Swelling (edema), often in hands/feet/face
• Constipation
• Fatigue and dizziness
• Decreased appetite and taste changes
• Upper respiratory infections (colds)
• Numbness/tingling (neuropathy)
• Elevated liver enzymes on blood tests (may not cause symptoms at first)

In pediatric/young adult ALCL (and pediatric IMT), gastrointestinal symptoms can be especially prominent, including
severe nausea, vomiting, diarrhea, and mouth sores (stomatitis).

Serious side effects and safety warnings (call your care team right away)

Xalkori has several important safety warnings. Your oncology team typically monitors for these with labs,
check-ins, and sometimes ECGs (heart rhythm tests).

1) Liver toxicity (hepatotoxicity)

Xalkori can cause liver injury, including rare cases of fatal hepatotoxicity. Your care team will
monitor liver blood testsoften more frequently early in treatment. Contact your prescriber promptly if you notice
possible liver-related symptoms, such as yellowing of skin/eyes (jaundice), dark urine, severe fatigue, or right-upper
abdominal pain.

2) Lung inflammation (ILD/pneumonitis)

Xalkori can cause interstitial lung disease (ILD) or pneumonitis, which can be life-threatening.
Seek medical attention for new or worsening shortness of breath, cough, fever, or chest discomfortespecially if
symptoms appear relatively suddenly or worsen quickly.

3) Heart effects: QT prolongation and bradycardia

Xalkori may affect the electrical system of the heart in two main ways:

• QT interval prolongation (changes in heart rhythm risk). Your team may monitor with ECGs and electrolytes,
  particularly if you have risk factors or take other QT-prolonging medications.
• Bradycardia (slow heart rate), which can sometimes cause dizziness, fainting (syncope), or low blood pressure.
  Your clinician may recommend monitoring heart rate and blood pressure and avoiding certain “slow-the-heart” medications
  when possible.

4) Vision problems (sometimes early, sometimes annoying, rarely severe)

Visual disturbances are common with Xalkori and may happen early in treatment (some people notice changes within the first week).
In rare cases, severe visual loss has occurred. Report any new or worsening vision symptoms promptlyespecially partial vision loss,
significant visual field changes, or anything that makes you feel unsafe driving or walking unaided.

5) Severe GI toxicity (especially in pediatric and young adult patients)

For younger patients (and sometimes adults), nausea, vomiting, diarrhea, and mouth sores can become severe.
Clinicians often use standard anti-nausea and anti-diarrheal medications, hydration plans, and nutritional support.
If symptoms are persistent, escalating, or causing dehydration, call your care team quickly.

6) Low blood counts and lab abnormalities

Xalkori can affect lab results, including liver enzymes and, in some patients, blood counts. Depending on the indication and your
health status, your team may monitor for neutropenia (low neutrophils), thrombocytopenia (low platelets), and other abnormalities.

Drug interactions, foods to avoid, and supplements

Xalkori is processed in the body through pathways that can be strongly influenced by other drugs and even certain foods.
Always give your oncology team a complete medication listprescriptions, OTC meds, vitamins, and supplements.

Major interaction categories

• Strong CYP3A inhibitors may raise Xalkori levels and increase side effect risk (examples often include certain
  antifungals and some antibiotics). If one is unavoidable, your prescriber may adjust the Xalkori dose.
• Strong CYP3A inducers may lower Xalkori levels and reduce effectiveness (some anti-seizure drugs and rifampin
  are common examples).
• Medications that prolong the QT interval may increase rhythm risk when combined.
• Medications that slow heart rate (like some beta-blockers or certain calcium channel blockers) can increase
  bradycardia risk.
• Grapefruit or grapefruit juice is typically avoided because it can increase drug levels.

Precautions: pregnancy, breastfeeding, and fertility

Xalkori can cause fetal harm. If pregnancy is possible, discuss contraception before starting treatment.
Your team may recommend specific timing for contraception during treatment and for a period after the last dose.
Breastfeeding is generally not recommended during treatment; ask your care team for personalized guidance.

Monitoring while on Xalkori

Many people take Xalkori long-term when it is effective and tolerated. Monitoring is a huge part of making that possible.
Depending on your situation, your clinician may recommend:

• Liver function tests (often more frequently early in treatment)
• ECGs and electrolytes if you have QT risk factors or symptoms
• Heart rate and blood pressure checks if bradycardia is a concern
• Eye evaluations if you develop significant vision symptoms
• Symptom tracking for cough/shortness of breath (ILD/pneumonitis red flags)

FAQs

Can I drive on Xalkori?

Possibly, but be cautious. Dizziness, fatigue, and vision changes can affect safety. If you notice visual symptoms,
don’t try to “power through” behind the wheel. Your best move: pause, assess, and ask your care team what they recommend.

Should I take Xalkori with food?

Many people can take it with or without food. If nausea is an issue, your clinician may suggest taking it with a light snack
and using anti-nausea medication. Follow your prescriber’s instructions.

What if side effects are bothering me but not “emergency-level”?

Tell your team anyway. The most successful Xalkori stories often include two unglamorous heroes:
dose adjustments and supportive care (antiemetics, antidiarrheals, hydration, nutrition, sleep strategy).
You’re not “complaining”you’re giving your clinicians the info they need to keep you on treatment safely.

Real-world experiences and practical tips

Let’s talk about what the day-to-day can feel like, because “adverse reactions” is accurate… but also sounds like a robot reading
a spreadsheet. People’s experiences vary widely, but there are a few patterns that show up again and againespecially in patient
education materials and clinical practice.

Vision changes are one of the most uniquely “Xalkori” experiences. Some people describe brief flashes of light,
blurry moments, or a sense that the room lighting is playing tricks on themparticularly when moving from dark to bright environments.
It can be subtle, like a phone camera trying to focus, or more distracting. A common coping tip: avoid driving at night until you
know how your eyes react, keep pathways well-lit at home, and report new symptoms early instead of waiting for them to “sort themselves out.”
The good news is that many vision effects are mild; the important part is not ignoring significant changes.

Stomach and bowel side effectsnausea, diarrhea, constipationoften feel like an annoying side quest you didn’t sign up for.
People frequently find that small, steady meals beat big, heavy ones. Hydration is surprisingly powerful: it helps with dizziness,
supports kidney function, and can reduce the “dragged-through-the-desert” vibe that sometimes comes with diarrhea or poor appetite.
If you’re dealing with nausea, ask about anti-nausea medications early. Many patients report that once nausea becomes severe,
it’s harder to catch uplike trying to mop up after the sink has already overflowed.

Swelling (edema) can be another common experience. Some notice puffiness in feet, ankles, hands, or around the eyes.
Practically, people often manage this with gentle movement (short walks if approved by the care team), elevating legs when resting,
and discussing salt intake if recommended. The key is distinguishing “puffy but okay” from swelling that’s sudden, painful, or paired
with shortness of breaththose need prompt medical attention.

Fatigue is a frequent companion on targeted therapy. Patients often describe it as different from being “sleepy.”
It can feel more like your battery charges to 60% and then politely refuses to go higher. Helpful strategies can include planning
activities around your best hours, simplifying the day (yes, paper plates count as a medical intervention), and building in short rest breaks.
Many people also find that light activityagain, only if your clinician approveshelps prevent fatigue from turning into complete inertia.

For caregivers and families, one of the most useful “experience-based” tips is to keep a simple symptom log:
what happened, when it started, how long it lasted, and what helped. This can make clinic visits far more productive, because you’re not trying to
remember whether the dizziness started before or after the dose change three Tuesdays ago. It also helps your team decide whether you need labs,
an ECG, an eye exam, supportive medications, or a dose adjustment.

Finally, many people emphasize the emotional side: targeted therapy can be a marathon, not a sprint. Some days you feel normal and almost forget you’re
on treatment, and other days you feel like you’ve been personally victimized by your own digestive system. Both can be true. If you’re struggling,
ask about supportive resourcesoncology social workers, counseling, nutrition support, and symptom management services. Getting help is not a sign
that the treatment is “failing”it’s a strategy for staying on therapy safely and maintaining quality of life.

Conclusion

Xalkori is an established targeted therapy for specific ALK- or ROS1-driven cancers, including certain types of metastatic NSCLC, pediatric/young adult
ALK-positive systemic ALCL, and ALK-positive IMT. Its benefits can be significant when the tumor biology matches the drug’s targetbut it also comes with
side effects that deserve respect (and a solid relationship with your care team). The goal is not to “tough it out.” The goal is to treat effectively,
monitor wisely, and adjust when needed so you can stay safe while the therapy does its job.

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