Nintedanib (Vargatef®) is used to treat a type of non-small cell lung cancer called adenocarcinoma.
Nintedanib (Vargatef®) is used to treat a type of non-small cell lung cancer called adenocarcinoma that has spread, or come back, after chemotherapy. It is given with a chemotherapy drug called docetaxel.
Nintedanib belongs to a group of targeted therapy drugs known as cancer growth inhibitors. It is a multi-tyrosine kinase inhibitor (TKI). Kinases are proteins that control how cells grow and divide. Nintedanib blocks different proteins (kinases) from sending signals to the cancer cells to grow. This causes the cancer cells to die.
Nintedanib is also an angiogenesis inhibitor drug. It stops the cancer cells from developing new blood vessels.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Nintedanib is given as capsules you take at home. You start taking nintedanib the day after you have the chemotherapy drug docetaxel. Docetaxel is given as a drip (infusion) into a vein.
During treatment you usually see a cancer doctor, a cancer nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
You will have regular blood samples taken throughout your treatment. These allow your doctor to check:
- the levels of different blood cells (blood count) in your body
- how your liver and kidneys are working.
The nurse or pharmacist will give you the nintedanib capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.
Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they have been explained to you.
Your course of treatment
When you have nintedanib and docetaxel you usually have it as a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you.
You start taking nintedanib the day after you have had docetaxel. You do not have nintedanib and docetaxel on the same day.
You usually take nintedanib for 20 days and then have docetaxel again. This is called a cycle of treatment. Each cycle lasts 21 days (3 weeks). Your doctor will talk to you about how many cycles of treatment you can have.
Your doctor may talk to you about continuing nintedanib after finishing treatment with docetaxel. In this situation, you usually take nintedanib every day for as long as it keeps the cancer under control.
Taking nintedanib capsules
You take nintedanib twice a day with food. They must be swallowed whole with a glass of water. They should not be chewed, opened or crushed. Take them about 12 hours apart and at the same time every day.
Always take nintedanib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.
If you forget a dose, just take the next dose at the usual time. Never take a double dose to make up for the one you missed.
Your doctor may ask you to stop taking nintedanib, or take a lower dose, because of side effects. Always follow your doctor’s advice carefully.
Other things to remember about your capsules:
- Do not take nintedanib if you are allergic to peanut or soya.
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
- If your treatment is stopped, return any unused capsules to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
If you have chemotherapy along with nintedanib, some side effects may be worse. You may also have side effects not listed here. We have more information about chemotherapy.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
You will have regular blood tests during treatment. If needed, your doctor may reduce or delay your treatment for a short time, until your cell count increases.
This treatment may cause diarrhoea. Diarrhoea usually means that you have to open your bowels more often than you normally do. The bowel movements are also looser than normal. If you have a stoma, it will be more active than usual.
Your hospital team may give you anti-diarrhoea drugs to take at home.
If you have diarrhoea or a mild increase in stoma activity:
- follow any advice from your cancer team about taking anti-diarrhoea drugs
- drink at least 2 litres (31/2 pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
Contact the hospital straight away if:
- you have diarrhoea at night
- you have diarrhoea more than 4 times in a day
- you have a moderate or severe increase in stoma activity
- the anti-diarrhoea drugs do not work within 24 hours.
You may need to go to hospital to have fluids through a drip.
Your doctor may ask you to stop taking nintedanib. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes your doctor may reduce the dose.
Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
If you have diarrhoea or feel sick, it can be difficult to drink enough. This can make you dehydrated. It can also affect the levels of minerals and salts in your body, for example, sodium, potassium and calcium. Your doctor will take regular blood tests to check these.
It is important that you drink around 2 litres (3½ pints) of fluids every day while having treatment with nintedanib.
Let your doctor or nurse know if you have any signs of dehydration, such as:
- feeling dizzy or tired
- passing small amounts of urine (pee)
- having a dry mouth and eyes.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes. But for some people they may never go away. Talk to your doctor if you are worried about this.
You may get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help. Tell them if the pain does not improve or gets worse.
Rarely, nintedanib can cause a hole (perforation) in the small bowel. Tell your doctor immediately if you have sudden or severe pain in your tummy or signs of bleeding. Signs of bleeding from the bowel include:
- vomiting up blood
- vomit that looks like coffee grounds
- bleeding from the back passage
- black poo (stool).
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
This treatment may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. This treatment can cause a rash, which may be itchy.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Some people have hair thinning or hair loss. Hair changes are usually temporary and improve gradually once treatment is over.
Changes in the way the liver works
Nintedanib may affect how your liver works. This is usually mild and goes back to normal after treatment. The drug may cause the skin and whites of your eyes to become yellow (jaundiced). Tell your nurse or doctor if you notice this.
You will have blood tests to check how well your liver is working.
Effects on the kidneys
This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.
It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.
This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Effects on the heart
In some people, nintedanib may cause heart problems.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor.
High blood pressure
Slow wound healing
Wounds may take longer to heal while you are being treated with nintedanib. If you have any wounds which are not healing or look infected, speak to your doctor straight away.
If you have any surgery planned, nintedanib will be stopped before the operation and not started again until the wound is fully healed.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for at least 3 months after treatment finishes. It is best to use a barrier form of contraception as a second form of contraception, as it is not known if nintedanib affects contraceptives. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.