Drug Action
Cobimetinib is a mitogen-activated protein kinase (MAPK) inhibitor.
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Drug reference
Cobimetinib is a mitogen-activated protein kinase (MAPK) inhibitor.
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Treatment of BRAF V600 mutation-positive unresectable or metastatic melanoma (in combination with vemurafenib) (specialist use only) ▶BY MOUTH ▶Adult: 60 mg once daily for 21 days; subsequent cycles repeated after a 7-day interval, for dose adjustment due to side-effects—consult product literature
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Left ventricular dysfunction. risk factors for bleeding
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NICE decisions ▶Cobimetinib in combination with vemurafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma (October 2016) NICE TA414 Cobimetinib (Cotellic ®) in combination with vemurafenib (Zelboraf ®) is not recommended within its marketing authorisation for treating unresectable or metastatic melanoma with a BRAF V600 mutation. Patients currently receiving cobimetinib may continue without change to prior funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta414
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: cobimetinib
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▶Common or very common Anaemia. basal cell carcinoma. chills. dehydration. diarrhoea. electrolyte imbalance. fever. haemorrhage. hyperglycaemia. hypertension. nausea. photosensitivity reaction. pneumonitis. serous retinopathy. skin reactions. vision disorders. vomiting ▶Uncommon Rhabdomyolysis
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Manufacturer advises use of two effective contraceptive methods during treatment and for at least 3 months after stopping treatment.
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Manufacturer advises avoid unless essential—toxicity in animal studies. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid—no information available.
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Manufacturer advises caution.
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Manufacturer advises caution in severe impairment—limited information available.
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▶Creatine kinase elevation Manufacturer advises baseline creatine kinase and creatinine levels should be measured before starting treatment, and then at monthly intervals during treatment or as clinically indicated—consult product literature if elevated. ▶Left ventricular function Manufacturer advises ejection fraction should be evaluated before initiation of treatment, then after the first month of treatment and at least every 3 months thereafter (or as clinically indicated) until treatment discontinuation. ▶Liver function Manufacturer advises liver function should be evaluated before initiation of treatment and monthly thereafter (or more frequently as clinically indicated). ▶Visual disturbances Manufacturer advises assess for new or worsening visual disturbances at each visit; if symptoms of new or worsening visual disturbances are identified, an ophthalmologic examination is recommended. Immune system and malignant disease
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Cotellic (Roche Products Ltd) A Cobimetinib (as Cobimetinib hemifumarate) 20 mg Cotellic 20mg tablets | 63 tablet P £4,275.67
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Vomiting Manufacturer advises if vomiting occurs after taking tablets, no additional dose should be taken on that day and the next dose should be taken at the usual time. Missed doses Manufacturer advises if a dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time. Driving and skilled tasks Manufacturer advises patients should be counselled on the effects on driving and performance of skilled tasks—increased risk of visual disturbances.
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60 mg once daily for 21 days; subsequent cycles
First-line fragment. Read the complete Indications and Dose section above.
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