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Patient information - Melanoma metastatic - Binimetinib and encorafenib

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It is important to understand that binimetinib and encorafenib are not traditional chemotherapy drugs and have a different way of working. They work by targeting the cancer cells to stop them growing and spreading. The treatment schedule below explains how the drugs for this treatment are given.

Binimetinib and encorafenib
This treatment is continuous. Your doctor will advise you how long to take the treatment for.
Day Treatment How it is given
Continuous
 		 Binimetinib 
(BIN-i-ME-ti-nib)

Take orally TWICE a day (3 x 15 mg tablets, morning and evening, about 12 hours apart) with a glass of water, with or without food. Swallow whole - do not break, crush or chew the tablets.

If you forget to take a dose, and if it is more than 6 hours before your next dose, take it as soon as you remember. If it is less than 6 hours before your next dose, skip that dose and take your normal dose the next time it is due. Do not take an extra dose.

If you vomit after taking your dose, do not take the same dose again. Take the next dose at the usual time.
Encorafenib 
(EN-koe-RAF-e-nib)

Take orally ONCE a day with a glass of water, with or without food. Swallow whole - do not break, crush or chew the capsules.

If you forget to take a dose, and if it is more than 12 hours before your next dose, take it as soon as you remember. If it is less than 12 hours before your next dose, skip that dose and take your normal dose the next time it is due. Do not take an extra dose.

If you vomit after taking your dose, do not take the same dose again. Take the next dose at the usual time.

Encorafenib capsules are available in two capsule strengths, 50 mg and 75 mg. It is important that you take the correct capsules and understand how to take them. Ask your doctor, nurse or pharmacist to complete the table below with the correct number of capsules for you.

Encorafenib Number of capsules
50 mg  
75 mg  
  • Tell your doctor if you have any heart, liver, kidney or eye problems.

Anticancer drugs (drugs used to treat cancer) can sometimes cause serious problems. It is important to get medical help immediately if you become unwell.

During treatment if you have any symptoms of a fever (e.g. chills, shivers, dizziness, weakness, or temperature of 38°C or higher):

  • stop taking the binimetinib tablets and encorafenib capsules immediately and contact your doctor or nurse for advice
  • start taking paracetamol 1 g every 6 hours 
  • stay well hydrated by drinking plenty of fluids
  • monitor your temperature 3 to 4 times a day
  • keep a record of your temperatures including the time and date
  • if your temperature continues to stay above 38°C despite stopping the medication, go to the nearest Emergency Department.

A short treatment break off binimetinib and encorafenib does not reduce the overall anti-cancer effect.

Emergency

IMMEDIATELY go to your nearest hospital Emergency Department, or contact your doctor or nurse if you have any of the following at any time:

Emergency contact details

Ask your doctor or nurse from your treating team who to contact if you have a problem

 

  • a temperature of 38ºC or higher, despite stopping the binimetinib and encorafenib
  • chills, sweats, shivers or shakes, despite stopping the binimetinib and encorafenib
  • shortness of breath
  • uncontrolled vomiting or diarrhoea
  • pain, tingling or discomfort in your chest or arms
  • severe abdominal pain
  • eye pain, swelling or redness or any vision changes
  • you become unwell.
Daytime:
Night/weekend:
Other instructions:

Changes to your dose or treatment delays

Sometimes a treatment may be started at a lower dose or the dose needs to be changed during treatment. There may also be times when your treatment is delayed. This can happen if your doctor thinks you are likely to have severe side effects, if you get severe side effects, if your blood counts are affected and causing delays in treatment, or if you are finding it hard to cope with the treatment. This is called a dose reduction, dose change or treatment delay. Your doctor will explain if you need any changes or delays to your treatment and the reason why.

Blood tests and monitoring 

You will need to have a blood test before you start treatment and regularly throughout your treatment. Your doctor or nurse will tell you when to have these blood tests.

Squamous cell carcinoma 

This treatment may occasionally cause a type of skin cancer called squamous cell carcinoma (SCC). This usually does not spread to other parts of your body. Your doctor or nurse should check your skin for any new skin cancers before you start taking this treatment and regularly while you are on this treatment. They may continue to check your skin for six months after your treatment has stopped. 

Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others.

The table below shows some of the side effects you may get with this treatment. You are unlikely to get all of those listed and you may also get some side effects that have not been listed.

Tell your doctor or nurse about any side effects that worry you. Follow the instructions below and those given to you by your doctor or nurse.

Early (onset days to weeks)

Fever

  • You may get: 
    • a fever
    • chills or sweating 
    • muscle pain
    • headaches. 
  • You may also feel:
    • dizzy or tired.
  • Fever usually occurs within the first few weeks of treatment, but can occur at any time.
  • These symptoms are caused by your treatment.
  • Buy a digital thermometer and take your temperature if you feel unwell.
  •  ​You can take paracetamol if needed.
  • Stop taking your treatment and tell your doctor or nurse as soon as possible if you notice any of the symptoms listed above, or have a temperature of 38°C or higher.
  • Go to the nearest hospital Emergency Department if your temperature continues to stay above 38°C despite stopping the treatment.​

Nausea and vomiting

  • You may feel sick (nausea) or be sick (vomit).
  • Take your anti-sickness medication as directed even if you don’t feel sick.
  • Drink plenty of fluids (unless you are fluid restricted).
  • Eat small meals more frequently.
  • Try food that does not require much preparation.
  • Try bland foods like dry biscuits or toast.
  • Gentle exercise may help with nausea.
  • Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment. 
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have uncontrolled vomiting or feel dizzy or light-headed.

Diarrhoea

  • You may get bowel motions (stools, poo) that are more frequent or more liquid.
  • You may also get bloating, cramping or pain.
  • Take your antidiarrhoeal medication as directed by your doctor.
  • Drink plenty of fluids (unless you are fluid restricted).
  • Eat and drink small amounts more often.
  • Avoid spicy foods, dairy products, high fibre foods, and coffee.
  • Ask your doctor or nurse for eviQ patient information - Diarrhoea during cancer treatment. 
  • Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if your diarrhoea is not controlled, you have 4 or more loose bowel motions per day, and if you feel dizzy or light-headed.

Headache

  • You can take paracetamol if you have a headache.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get a very bad headache that is not helped by pain medication.

Tiredness and lack of energy (fatigue)

  • You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.
  • Do not drive or operate machinery if you are feeling tired.
  • Nap for short periods (only 1 hour at a time)
  • Prioritise your tasks to ensure the best use of your energy.
  • Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).
  • Try some gentle exercise daily.
  • Allow your friends and family to help.
  • Tell your doctor or nurse if you get any of the symptoms listed above.

Joint and muscle pain and stiffness

  • You may get muscle, joint or general body pain and stiffness.
  • Applying a heat pack to affected areas may help.
  • Talk to your doctor or nurse about other ways to manage these symptoms. You may need medication to help with any pain.

Skin changes

  • You may notice skin changes like:
    • dry skin or redness
    • changes to sunspots or moles
    • new sunspots or moles
    • thickening of skin on palms of hands or soles of feet.
  • Moisturise your skin with a gentle non-perfumed moisturising cream like sorbolene or aqueous cream.
  • Use a soap-free wash.
  • Avoid direct sunlight.
  • Protect your skin from the sun by wearing sun-protective clothing, a wide-brimmed hat, sunglasses and sunscreen of SPF 30 or higher.
  • Tell your doctor or nurse if you notice skin changes or have symptoms that cause discomfort or pain.

Liver problems

  • You may get: 
    • yellowing of your skin or eyes
    • itchy skin 
    • pain or tenderness in your stomach
    • nausea and vomiting
    •  loss of appetite
  • You will have regular blood tests to check how well your liver is working.
  • Tell your doctor or nurse as soon as possible if you notice that your urine is a dark colour, the whites of your eyes look yellow, or if you have stomach pain.

Eye problems

  • You may get:
    • eye pain or irritation
    • red or swollen eyes
    • blurred vision
    • floating spots
    • changes in your eyesight.
  • Protect your eyes from the weather (sun and wind) by wearing sunglasses, especially if you have lost your eyelashes.
  • Tell your doctor or nurse immediately if you get any of the symptoms listed above.

Appetite loss (anorexia)

  • You may not feel like eating.
  • Try to avoid drinking fluids at meal times.
  • Try to eat small meals or snacks regularly throughout the day.
  • Try to eat food that is high in protein and calories.
  • If you are worried about how much food you can eat, or if you are losing weight, ask to speak to a dietitian.

Late (onset weeks to months)

Heart problems

  • You may get:
    • chest pain or tightness
    • shortness of breath 
    • swelling of your ankles 
    •  an abnormal heartbeat.
  • Heart problems can occur months to years after treatment.
  • Tell your doctor if you have a history of heart problems or high blood pressure.
  • Before or during treatment, you may be asked to have a test to see how well your heart is working.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.

High blood pressure (hypertension)

  • You may not have any signs or symptoms if you have high blood pressure. 
  • If it is severe you may get headaches, shortness of breath or feel dizzy. 
  • Your blood pressure will be taken regularly during your treatment.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the signs or symptoms listed above. 

Lung problems

  • Lung problems are rare, but can be serious. They may occur throughout treatment or after the completion of treatment. 
  • You may get:
    • shortness of breath
    • fever
    • dry cough
    • wheezing
    • fast heartbeat
    •  chest pain.
  • Your doctor will monitor how well your lungs are working during your treatment.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.

Hand-foot syndrome (palmar-plantar erythrodysaesthesia)

  • The palms of your hands and soles of your feet may become:
    • red and hot
    • swollen
    • painful and tender
    • blistered.
  • The skin in the area may also peel.
  • Moisturise your hands and feet daily with sorbolene or aqueous cream.
  • Keep your hands and feet clean and dry.
  • Avoid hot water, instead use lukewarm water to bathe.
  • Avoid direct sunlight.
  • Avoid unnecessary walking, jogging or exercise.
  • Wear cotton socks and avoid tight-fitting shoes.
  • Tell your doctor or nurse as soon as possible if you notice any skin changes on your hands or feet.

Hair thinning

  • Your hair may become dry and may break easily.
  • You may lose some of your hair.
  • Use a gentle shampoo and a soft hairbrush.
  • Take care with hair products like hairspray, hair dye, bleaches and perms.
  • Protect your scalp from the cold with a hat or scarf.
  • Protect your scalp from the sun with a hat and sunscreen of SPF 30 or higher.
  • Ask your doctor or nurse about the Look Good Feel Better program (www.lgfb.org.au)

Blood clot risk

  • Cancer and anticancer drugs can increase the risk of a blood clot (thrombosis).
  • Tell your doctor if you have a family history of blood clots.
  • A blood clot can cause pain, redness, swelling in your arms or legs, shortness of breath or chest pain.
  • If you have any of these symptoms go to your nearest hospital Emergency Department.

Medications

  • Before you start treatment, tell your doctor about any medications you are taking, including vitamins or herbal supplements.
  • Don’t stop or start any medications during treatment without talking to your doctor and pharmacist first.

Other medical and dental treatment

  • If you go to hospital or any other medical appointment (including dental appointments), always tell the person treating you that you are receiving anticancer drugs.
  • Before you have any dental treatment, talk to your doctor. 

Diet

  • While you are receiving this treatment it is important that you try to maintain a healthy diet.
  • Grapefruit and grapefruit juice can interact with your medication and should be avoided while you are on this treatment. 
  • Speak to your doctor or nurse about whether drinking alcohol is safe with your treatment.
  • If you have any concerns about recent weight loss or weight gain or questions about your diet, ask to speak to a dietitian.

Fertility

  • Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant or father a child.
  • Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you and/or your partner, discuss these with your doctor or nurse. 

Pregnancy and breastfeeding 

  • Some cancer treatments can be dangerous to unborn babies. Talk to your doctor or nurse if you think there is any chance that you could be pregnant.
  • Do not try to get pregnant or father a child during this treatment. Contraception should be used during treatment and after stopping treatment. Hormonal contraception (such as pills, injections or patches) may not work as well in women having this treatment, and non-hormonal methods of contraception should be used. Ask your doctor or nurse about what type of contraception you should use.
  • If you are planning pregnancy/fatherhood after completing this treatment, talk to your doctor. Some doctors advise waiting between 6 months and 2 years after treatment.
  • Do not breastfeed if you are on this treatment, as anti-cancer medications can also pass into breast milk.

Sex life and sexuality 

  • The desire to have sex may decrease as a result of this treatment or its side effects. 
  • Your emotions and the way you feel about yourself may also be affected by this treatment. 
  • It may help to discuss your concerns with your partner and doctor or nurse.

Quitting smoking

  • It is never too late to quit smoking. Quitting smoking is one of the best things you can do to help your treatment work better.
  • There are many effective tools to improve your chances of quitting.
  • Talk to your treating team for more information and referral to a smoking cessation support service.

Staying active

  • Research shows that exercise, no matter how small, has many benefits for people during and after cancer treatment.
  • Talk to your doctor before starting an exercise program. Your doctor can advise whether you need a modified exercise program.

For more information about cancer treatment, side effects and side effect management see our Patient and carers section. 

Telephone support

  • Call Cancer Council on 13 11 20 for cancer information and support

Melanoma information

General cancer information and support

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your treating team about any other questions you may have.

This document is a guide only and cannot cover every possible situation. The health professionals caring for you should always consider your individual situation when making decisions about your care. Contact your cancer clinic staff or doctor if you have any questions or concerns about your treatment, or you are having problems coping with side effects. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use of this document is subject to eviQ’s disclaimer available at www.eviQ.org.au

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https://www.eviq.org.au/pi/3600

05 Feb 2023