How it is administered

Crizotinib is taken by mouth, usually as a capsule or oral pellets.

• For adults with ALK- or ROS1-positive metastatic non-small cell lung cancer (NSCLC) or ALK-positive inflammatory myofibroblastic tumor (IMT), the typical dose is 250 mg twice daily.
• For pediatric patients and young adults with relapsed or refractory, systemic ALK-positive anaplastic large cell lymphoma (ALCL) or ALK-positive IMT, the dose is based on body surface area (280 mg/m² twice daily).

Capsules should be swallowed whole and not chewed, crushed, or split. Oral pellets are administered by opening the shell and placing the pellets directly in the mouth or with a dosing aid, followed by water to ensure all pellets are swallowed.

How it works

Crizotinib is a targeted therapy known as a kinase inhibitor. It blocks specific proteins called receptor tyrosine kinases, including ALK (anaplastic lymphoma kinase), ROS1, and c-Met. These proteins can become abnormally active in certain cancers, including some blood cancers like ALK-positive anaplastic large cell lymphoma (ALCL).

By inhibiting these proteins, crizotinib disrupts the signals that tell cancer cells to grow and survive. In ALK-positive ALCL, the presence of abnormal ALK fusion proteins leads to uncontrolled cell growth. Crizotinib binds to these proteins and shuts down their activity, which can slow or stop the growth of cancer cells and may lead to tumor shrinkage.

Crizotinib has shown effectiveness in both adults and children with ALK-positive cancers, including certain blood cancers. Its targeted action means it is most effective in patients whose tumors have specific genetic changes (ALK or ROS1 positivity), which should be confirmed with appropriate testing before starting treatment.

Who Should take it

Crizotinib is indicated for:

• Pediatric patients (1 year and older) and young adults with relapsed or refractory, systemic ALK-positive anaplastic large cell lymphoma (ALCL).
• Adult and pediatric patients (1 year and older) with unresectable, recurrent, or refractory ALK-positive inflammatory myofibroblastic tumor (IMT).
• Adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are ALK- or ROS1-positive.

For blood cancers, crizotinib is specifically used in ALK-positive ALCL, a type of peripheral T-cell lymphoma. Before starting crizotinib, your doctor will test your cancer cells to confirm the presence of ALK gene changes. Crizotinib is generally used when the disease has come back (relapsed) or has not responded to previous treatments (refractory).

Who should not take it

There are no absolute contraindications listed for crizotinib, but certain patients should use caution or may not be suitable for this medication:

• Patients with a history of severe allergic reactions to crizotinib or any of its ingredients should not take it.
• Pregnant women should avoid crizotinib, as it can harm an unborn baby. Effective contraception is recommended during treatment and for a period after the last dose.
• Breastfeeding is not recommended during treatment and for 45 days after the last dose.
• Patients with severe liver or kidney impairment may require dose adjustments or may not be suitable candidates, depending on their overall health and organ function.

Crizotinib should be used with caution in patients with a history of heart rhythm problems, severe visual disorders, or lung inflammation. Always discuss your full medical history with your doctor before starting crizotinib.

Commonly used with

Crizotinib is often used as a single agent for ALK-positive ALCL and IMT, especially in relapsed or refractory cases. In some clinical settings, it may be used in combination with supportive medications such as antiemetics (to prevent nausea and vomiting) and antidiarrheal agents.

It is important to avoid combining crizotinib with certain other medications, especially those that strongly affect liver enzymes (CYP3A inhibitors or inducers), or those that can prolong the QT interval or cause bradycardia.

Commonly tested with

Crizotinib has been studied as a single agent in ALK-positive ALCL and IMT. In some pediatric studies, it has been evaluated in combination with chemotherapy, but its safety and effectiveness in combination with chemotherapy for newly diagnosed ALCL have not been established.

Before starting crizotinib, your doctor may order tests to check for ALK gene changes in your cancer, as well as baseline liver function, heart rhythm, and eye exams. Regular monitoring is recommended during treatment.