Encorafenib + binimetinib (Braftovi and Mektovi)

Encorafenib + binimetinib at a glance

Encorafenib and binimetinib are targeted medicines used together for selected cancers with a BRAF gene change. Encorafenib, known as Braftovi, blocks BRAF; binimetinib, known as Mektovi, blocks MEK. Both are taken by mouth. Their schedules differ: encorafenib is usually once daily and binimetinib twice daily. This guide concerns this two-drug combination, not encorafenib combined with other medicines.

Taking treatment at home still requires regular cancer-clinic care. Blood tests, heart checks, skin assessment and reporting new symptoms all help keep treatment safe. Keep a current prescription list and the cancer team's 24-hour telephone number nearby. Eye changes, severe muscle symptoms, bleeding and breathlessness deserve particularly prompt attention.

How encorafenib + binimetinib works

BRAF and MEK are parts of a signalling pathway that helps cells grow and divide. Certain BRAF changes can keep this pathway active when it should be regulated. Encorafenib blocks altered BRAF and binimetinib blocks a later step, MEK. Using the pair can interrupt growth signalling more effectively in the cancers for which the combination is appropriate.

These drugs are not immune checkpoint inhibitors. They can affect healthy tissues as well as cancer, so targeted treatment can still produce important side effects. The aim may be to shrink cancer or keep it controlled. Your team will judge benefit through symptoms, examination and scans, rather than how many side effects you experience.

How the team decides whether it is suitable

A laboratory test must confirm an appropriate BRAF change. The evidence and regulatory wording differ by cancer: BRAF V600E and V600K are relevant in melanoma, whereas the lung-cancer indication concerns BRAF V600E. Ask the team to explain the exact result on your report. A different BRAF change, or a BRAF result in another cancer, does not automatically establish suitability.

The team also considers prior treatment, heart function, eye or retinal disease, liver and kidney function, blood pressure, clotting or bleeding history, and other medicines. Availability, approvals and treatment pathways differ between countries. This guide does not establish an Indian licence or funding entitlement, and it does not describe the separate encorafenib combinations used in colorectal cancer.

Before treatment starts

Expect a review of your medical history and a complete medicine list, including supplements, traditional remedies and medicines used only occasionally. Tell the team if you have had fainting, an abnormal heart rhythm, heart failure, a blood clot, retinal vein blockage, eye inflammation, muscle disease or liver problems. Pregnancy testing and fertility discussion are arranged when relevant.

Baseline tests usually include blood counts, liver and kidney function, electrolytes and creatine kinase, also called CK, which can rise with muscle injury. Heart pumping function is assessed with an echocardiogram or similar test. An ECG may be needed to assess the heart's electrical rhythm. The team examines the skin and records existing symptoms.

Before going home, check that you can distinguish the capsule from the tablet and understand the number required for each dose. Ask what to do if one medicine is unavailable, a dose is missed, or swallowing becomes difficult. Agree how to obtain the next supply and whom to contact between scheduled appointments.

How to take encorafenib + binimetinib

Daily schedule and food

Encorafenib is usually taken once daily and binimetinib twice daily, approximately 12 hours apart. A usual adult starting regimen for this pair is encorafenib 450 mg daily with binimetinib 45 mg twice daily, but the prescription can be reduced or adjusted. Your written instructions determine the number of capsules or tablets. Do not transfer the dose from another encorafenib regimen.

Both medicines can be taken with or without food. Swallow them with water at consistent times. If taking them with food helps your routine, that is generally acceptable. Avoid grapefruit and grapefruit juice because they can change encorafenib exposure. Tell the pharmacist about swallowing difficulty before opening or dispersing anything.

Swallowing difficulties and missed doses

Specialist preparation methods exist for some products, but instructions vary between sources and formulations. A pharmacist must confirm whether your exact capsule may be opened or tablet dispersed, the liquid or food to use, and how promptly to take it. Do not improvise a feeding-tube method or crush tablets on advice intended for another brand.

Skip a missed encorafenib dose if the next dose is within 12 hours. For binimetinib, the cutoff is six hours. Never take two doses together to compensate. If you vomit after taking either medicine, do not replace that dose. Repeated vomiting or uncertainty about the timing should prompt a call to the team.

Storage and supply

Keep medicines in their original packaging, following the pack's temperature and moisture instructions. Protect them from children and pets. Do not share them. In hot weather, ask the pharmacy how to transport and store the supply safely; a parked car or sunny windowsill is unsuitable. Return unwanted medicine using the pharmacy's disposal arrangements.

Monitoring and checking response

Regular tests check liver function, kidney function, blood chemistry and muscle enzymes. The US binimetinib label specifies liver tests before treatment and monthly during treatment, with additional checks when needed. Blood pressure and symptoms are reviewed. Heart pumping function is commonly reassessed about one month after starting and then every two to three months, with additional tests if needed. Skin checks continue during treatment and may continue for months afterwards. The exact schedule is personalised.

Tell the team about exercise-related muscle soreness before a CK test, but never assume a raised result is harmless. Likewise, a scan showing stable cancer does not remove the need for safety monitoring. Keep a short record of bowel frequency, nausea, new visual symptoms, muscle weakness and doses taken. Record the date a symptom began and how it affects normal activities.

Common side effects and practical care

Nausea, diarrhoea and appetite

Nausea, vomiting, diarrhoea, abdominal discomfort and reduced appetite can occur. Use prescribed anti-sickness medicine and ask for help if it is ineffective. Small, frequent meals may be easier than large ones. With diarrhoea, drink regularly unless you have a fluid restriction and record the number of stools compared with your usual pattern.

Contact the team early if symptoms persist or interfere with eating and drinking. Severe pain, blood in the stool, faintness or reduced urine needs urgent assessment rather than only an anti-diarrhoea medicine. Constipation can also occur, sometimes worsened by supportive medicines; ask for an appropriate bowel plan instead of alternating treatments without guidance.

Tiredness, aches and skin changes

Fatigue, joint pain, muscle aches, headache, dry skin, itching or rash can affect daily life. Balance activity with rest, use gentle skin care and tell the team about symptoms that limit walking, sleep or self-care. Comfortable shoes and moisturiser may help sore palms or soles, but painful cracking or worsening redness warrants review.

Swelling, especially in the legs, should be described rather than assumed to be an ordinary side effect. Note whether it affects one side or both and whether there is pain or breathlessness. These details help the team decide whether urgent assessment is necessary.

Important side effects to recognise

Eyes and vision

Binimetinib can cause fluid-related changes behind the retina and, rarely, blockage of a retinal vein. Eye inflammation can also occur with the combination. Blurred vision, altered colour vision, eye pain, halos, light sensitivity or a new dark patch in sight needs immediate contact with the team. Do not drive while vision is affected. Sudden major loss of vision requires emergency assessment.

Muscle injury, heart effects and clots

Severe muscle pain or weakness, especially with dark urine or reduced urine, may indicate muscle breakdown and kidney injury. Contact the team urgently. This is different from mild familiar aching after ordinary activity. Heart pumping weakness and electrical-rhythm changes are also possible. Report new breathlessness, palpitations, swollen ankles or fainting promptly.

A painful swollen leg can indicate a clot. Sudden chest pain, severe breathlessness, coughing blood or collapse needs emergency care. Do not massage a newly swollen painful leg or delay assessment because your next appointment is soon.

Bleeding, liver problems and lung inflammation

Significant bleeding, including internal bleeding, can occur. Vomiting blood, black tar-like stools, a severe unfamiliar headache or stroke-like symptoms need emergency care. Report unusual bruising or recurrent nosebleeds as well. Yellow eyes, very dark urine, persistent upper abdominal pain or marked loss of appetite can indicate liver problems.

Severe persistent abdominal pain, especially with vomiting, also needs urgent assessment because pancreatic or bowel inflammation can occur.

New cough, fever or breathlessness may reflect infection, lung inflammation or another serious condition. Fever should be reported using the team's advice-line threshold. A previous mild episode does not establish the cause of a new one.

New skin cancers

Some people develop new skin growths, including skin cancers, during BRAF-inhibitor treatment. Report a new wart-like growth, a sore that does not heal, or a changing mole. Regular examination helps identify changes early. A new skin lesion does not automatically mean the original cancer has spread, but it needs assessment.

Other medicines and vaccinations

Encorafenib has important interactions involving liver enzymes, particularly CYP3A4. Some antibiotics, antifungals, epilepsy medicines, HIV medicines and herbal products can raise or lower its level. Other medicines can increase the risk of abnormal heart rhythm. Your pharmacist should check the actual list, including nausea medicines and non-prescription products, before anything is changed. Avoid grapefruit.

Do not stop essential medicines independently. Tell any dentist, emergency clinician or new prescriber about this combination. Encorafenib can reduce the reliability of hormonal contraception. Discuss vaccine type and timing with the team, particularly if you also receive steroids or another treatment affecting immunity. A vaccination decision should consider your complete treatment plan rather than this drug pair in isolation.

Everyday life during treatment

A clear morning-and-evening chart can help because only one drug is taken twice daily. Ask a family member to check the chart with you if there are several strengths or a recent dose change. Cross out the old instructions when the team provides a new prescription. Keeping an old dose chart beside a new medicine pack can create avoidable confusion.

You may be able to continue work and gentle activity, adjusting to fatigue and symptoms. Avoid driving when dizzy or when vision changes. Discuss travel before booking, including access to urgent eye care, blood tests, storage and extra supply. Carry the medicines in their labelled packaging. Emotional strain and uncertainty about scans are also valid reasons to ask for support from the team or a counsellor.

Fertility, pregnancy and breastfeeding

These medicines can harm a developing baby. If you could become pregnant, discuss pregnancy prevention before treatment and contact the team promptly if pregnancy is possible. Encorafenib can make hormonal contraception less effective, so a reliable non-hormonal method is needed. For the combination, pregnancy prevention must cover the longer requirement: at least 30 days after the last binimetinib dose under US information, while also meeting the encorafenib interval. European information specifies at least one month after either medicine; use the later calendar date advised by your team. The team should document your exact end date.

Do not breastfeed during treatment. The US encorafenib label advises waiting two weeks after its last dose; binimetinib advises three days. Follow whichever interval is later for your actual stopping dates and any longer local instruction. Fertility can be affected, particularly male fertility with encorafenib. Ask about preservation options before starting if future parenthood matters to you.

After a pause or the end of treatment

The two medicines must be managed as a linked regimen. If binimetinib is paused, encorafenib may need a dose adjustment; if encorafenib is paused, binimetinib may also need to stop. These decisions depend on the problem and the label being followed. Do not continue an unchanged dose of one drug just because the other ran out or was held. Contact the team for a written plan.

A supervised pause or reduction can make continued treatment possible. Ask who will review the tests, what symptoms must improve and who will authorise restarting. Continue scheduled skin checks and other follow-up after stopping. Keep the final dose dates because contraception, breastfeeding and interaction advice may depend on them. Return unused medicines appropriately.

Frequently asked questions