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Care During Chemotherapy and Beyond

Cobimetinib

(koe bi ME ti nib)

Trade name: Cotellic™

Cobimetinib is the generic name for the trade name drug Cotellic™. In some cases, health care professionals may use the trade name Cotellic™ when referring to the generic drug name cobimetinib.

Drug type: Cobimetinib is a targeted therapy. It is an oral MEK kinase inhibitor - (For more detail see "How this drug works," below.)

What Cobimetinib Is Used For:

  • For the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation, in combination with vemurafenib. The cancer must be BRAF V600E- or BRAF V600L-positive as indicated by an FDA-approved test.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Cobimetinib Is Given:

  • Cobimetinib is a pill, taken by mouth, once daily. It can be taken with or without food.
  • Cobimetinib is usually taken once faily for 21 days followed by a 7-day rest period (no drug) for a 28-day cycle.
  • Take cobimetinib exactly as prescribed.
  • Swalow cobimetinib tablets whole. Do not crush or dissolve tablet.
  • Do not change your dose or stop cobimetinib unless your health care provider tells you to.
  • If you miss a dose, skip the missed dose and take your next dose at your regular time.
  • Do not take more than 1 dose of cobimetinib at one time. Call your health care provider righ away if you take too much.

The amount of cobimetinib that you will receive depends on many factors, your general health or other health problems, and the type of cancer or condition being treated. Higher doses do not give better response and may cause increased toxicity. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of cobimetinib:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration
  • Side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occuring in greater than 30%) for patients taking cobimetinib:

These side effects are less common side effects (occuring in about 10-29%) of patients receiving cobimetinib:

Not all side effects are listed above. Some that are rare (occuring in less tahn 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4° F (38° or higher, chills)

Always inform your health care provider if you experience any unusual symptoms.

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • diarrhhea (4-6 episodes in a 24-hour period)
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness
  • Any sudden change in eyesight (blurred or distorted vision, halos, partly missing vision)
  • Sudden onset of shortness of breath, accompanied by cough and/or fever
  • Skin or the whites of your eyes turn yellow
  • Urine turns dark or brown (tea color)
  • Muscle aches, spasms or weakness
  • Decrease appetite
  • Stomach pain
  • Bleed or bruise more easily than normal
  • Red or black stools that look like tar
  • Blood in urine
  • Headache, dizziness or feeling weak
  • Unusual vaginal bleeding
  • Increased heartbeat
  • Persistent coughing or wheezing
  • Shortness or breath
  • Swelling of your ankles or feet
  • Thickened, dry, wrinkled skin
  • Change in color or size of a mole
  • Any skin change, irritation, itching or rash
  • Report a new wart, skin sore or reddish bump that bleeds or does not heal or a change in size or color of a mole

Always inform your health care provider if you experience any unusual symptoms

Precautions:

  • Before starting cobimetinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Cobimetinib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus
  • For both men and women: Do not conceive a child (get pregnant) while taking cobimetinib. Barrier methods of contraception, such as condoms, are recommended during treatment and for 2 weeks following the final dose of cobimetinib. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking this medication.
  • You should not drink grapefruit juice or eat grapefruit during your treatment with cobimetinib as it is taken with vemurafenic and it may make the amount of vemurafenic in your blood increase to a harmful level.

Self-Care Tips:

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
  • Avoid sun exposure. When you go outside wear clothes that protect your skin, including your head, face, hands, arms, and legs. Use lip balm and wear SPF 30 (or higher) sun block.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plent of rest.
  • Maintain good nutrition.
  • Cobimetinib can cause visual changes, dizziness and tiredness. If you have any of these symptoms, use caution when driving a car, using machinery, or anything that requires you to be alert and make sure your provider is aware.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and testing while taking cobimetinib:

You will be checked regularly by your health care professional while you are taking cobimetinib to monitor side effects and check your response to therapy. Blood work will be done periodically to check your blood counts to monitor your liver, muscle and bone health as well as your electrolytes. You will also have periodic skin checks.

How Cobimetinib Works:

Targeted therapy is the result of many years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little but differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Cobimetinib is a targeted therapy that targets MEK proteins (kinase) within the cancer cell.

The BRAF gene plays an important role in bot normal and cancer cells. This gene leads to the production of BRAF protein. This protein is normally part of a chain of molecules including MEK that relay signals that tells cells how to grow and divide. A change in the BRAF gene (called a mutation) can alter the way that the BRAF protein works. Instead of waiting for its turn to signal a cell to divide or grow, the BRAF protein is out of control and signals all of the time, this out of control BRAF signaling may drive the uncontrolled growth of cancer cells. Cobimetinib targets the downstream MEK proteins that are stimulated by changed BRAF proteins and may slow down the growth of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

References:

Cobimetinib. Lexicomp Online® [updated November 10, 2015; cited 2015 December 2nd]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; December 2nd, 2015.

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