Pemigatinib

Pemigatinib is a drug treatment for bile duct cancer. It is also known as Pemazyre.

Bile duct cancer is also known as cholangiocarcinoma.

What is pemigatinib?

Pemigatinib is a type of targeted cancer drug. It is a treatment for bile duct cancer that has come back or spread to other parts of the body. This is advanced bile duct cancer.

You might have pemigatinib if your cancer has a change in a gene  called Fibroblast Growth Factor Receptor 2 (FGFR2). Your doctor will test the cancer for this before you start this drug.

How does pemigatinib work?

Pemigatinib is a type of targeted cancer drug called tyrosine kinase inhibitor (TKI).

TKIs block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells. Blocking tyrosine kinases stops the cell from growing and dividing.

How do you have pemigatinib?

You take pemigatinib as tablets. You swallow them whole with a glass of water. You may take them with or without food. You should not open, crush or chew the tablets.

You should take the tablets at the same time, every day.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

How often do you have pemigatinib?

You usually take pemigatinib once a day for 14 days. You then have a rest of 7 days to allow your body to recover. Then you start taking pemigatinib every day again for 14 days and then a 7 days break.

You continue taking pemigatinib in this way for as long as the treatment is helping you. And the side effects aren’t too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of pemigatinib?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Low levels of sodium in your blood

Sodium is a salt and symptoms of low sodium include:

• headaches
• feeling or being sick
• confusion
• restlessness
• seizures

Your sodium levels will most likely go back to normal when you finish treatment. You have regular blood tests during treatment to check this.

High or low levels of phosphate in your blood

Blood tests may show that you have high or low levels of phosphate in your blood. This can cause muscle cramps, bone weakness and confusion.

Phosphate is a mineral. It is in many foods such as meat, fish, eggs and cheese. Your doctor might ask you to follow a low or high phosphate diet depending on your levels.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Dry eyes

This drug can cause dry eyes. Speak to your nurse or pharmacist about having eye drops to help with this. 

Feeling sick

Feeling sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as directed by your doctor or pharmacist, even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Mouth sores, ulcers and a dry mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

A dry mouth is also called xerostomia (pronounced zero-stow-mee-a). Talk to your healthcare team if you have this. They can give you artificial saliva to help with a dry mouth. It can also help to drink plenty of fluids.

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Dry skin and nail changes

Moisturising your skin regularly helps to reduce skin dryness. Your doctor or nurse will tell you what lotions, creams or gels to use. 

Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment

Hair loss

Your hair may thin but you’re unlikely to lose all your hair. This usually starts after your first or second cycle of treatment. It is almost always temporary and your hair will grow back when you finish your treatment.

Joint pain

You might have joint pain. Speak to your doctor or nurse about what painkillers you can take to help with this.

Fatigue

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

High levels of creatinine in your blood

Your blood tests might show that you have high levels of a substance called creatinine.

Creatinine is a waste product made by the muscles. The kidneys remove this from our blood and get rid of it in our urine. You have blood tests to check the levels of creatinine.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• blurred vision and loss of vision
• a build up of fluid under the coloured layer of the eye (retina). This can be serious and cause a break in the retina
• inflammation of a part of the eye called cornea
• changes to your eyelashes. They may become long and grow inwards towards the eye

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

You should not eat grapefruit or drink grapefruit juice when you are taking this drug because it can react with the drug.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.