Encorafenib (Braftovi)

Encorafenib at a glance

Braftovi is the verified brand for encorafenib. It blocks an altered protein called BRAF, which can help cancer cells grow. A suitable tumour-test result is needed before treatment. Encorafenib is usually taken once daily, with or without food.

The starting dose depends on the combination. Common adult examples are 450 mg daily with binimetinib or 300 mg daily with cetuximab, sometimes with additional chemotherapy. These examples are not interchangeable prescriptions. Capsule strengths and reductions also vary by product and clinical circumstances.

Important precautions include skin surveillance, heart and eye monitoring, liver tests, hydration and interaction checks. The medicines prescribed alongside encorafenib change the risks, tests and pregnancy precautions. Keep an up-to-date list of every component of your plan.

How encorafenib works

BRAF is part of a pathway that transmits growth signals inside cells. Certain changes in the BRAF gene produce an overactive signal. Encorafenib inhibits this altered protein, aiming to slow cancer growth. It is a kinase inhibitor, a type of targeted therapy, rather than conventional chemotherapy or checkpoint immunotherapy.

Binimetinib blocks MEK, another protein in the same pathway. Cetuximab blocks a growth-signal receptor called EGFR on the cell surface. Depending on the clinical setting, blocking more than one point is necessary to use encorafenib effectively. Some plans also include fluorouracil-based chemotherapy, which adds its own safety requirements.

Targeting a protein does not mean that normal tissues are unaffected. Encorafenib can alter skin growth, heart electrical activity and other body functions. Conversely, having few side effects does not mean treatment is failing. Benefit is judged through clinical review and appropriate scans, not by how unwell the medicine makes you feel.

How the team decides whether it is suitable

The oncologist considers your diagnosis, the exact BRAF alteration, previous treatment, general health and applicable prescribing information. BRAF V600E and, in some settings, V600K are relevant. A report simply saying “BRAF change” may need further interpretation. Encorafenib is not suitable for every mutation or every cancer. Safety and effectiveness in children have not been established.

Testing may use tumour tissue or, in selected situations, circulating tumour DNA in a blood sample. A negative blood test may need follow-up tissue testing because a blood sample can miss an alteration. The team also checks tests needed for the proposed companion treatment.

Tell the team about fainting, an irregular heartbeat, long QT syndrome, heart failure, eye disease, bleeding, blood clots, liver or kidney problems, and previous cancers. Blood-salt abnormalities or medicines that affect heart rhythm can increase risk. Liver impairment may alter the dose: US and European recommendations differ, so the prescriber must follow the relevant product guidance.

Before treatment starts

Baseline blood tests usually include blood counts, liver and kidney function and blood salts such as potassium and magnesium. Pregnancy status should be checked if pregnancy is possible. A skin examination provides a starting point for detecting new lesions. Other examinations or scans may assess for additional cancers according to your history and the treatment guidance.

An electrocardiogram, or ECG, records the heart's electrical activity. It is particularly important when there are rhythm risk factors; European guidance recommends one before treatment. With binimetinib, a heart scan measures pumping function, and blood tests check creatine kinase, an enzyme that can rise with muscle injury. Eye symptoms and relevant eye history are reviewed.

Bring every medicine and supplement to the medication check, including occasional antibiotics, anti-sickness medicines, herbal products and contraception. Ask which symptoms mean you should call immediately and how to obtain advice outside clinic hours. Confirm your dose in milligrams, capsule strength and the exact number of capsules, rather than remembering only a tablet count.

How to take encorafenib

Daily routine and dose

Take the whole daily encorafenib dose at the prescribed time, usually once a day. Food is optional: no fasting window is required. Swallow capsules with water.

A 450 mg dose is six 75 mg capsules; a 300 mg dose is four 75 mg capsules. Current US information lists 75 mg capsules, while European information also describes 50 mg capsules. Your actual prescription may be lower because of side effects, interactions or liver function. Do not change the number yourself.

Binimetinib is usually taken twice daily, whereas encorafenib is once daily. Cetuximab is given by intravenous infusion on its own appointment schedule. If chemotherapy is included, its clinic days and any infusion-pump arrangements are separate from the daily capsule routine. Ask for one written calendar showing which treatment happens when.

Missed doses and vomiting

If you forget encorafenib, take it only if there are more than 12 hours before the next scheduled dose. If 12 hours or less remain, skip the forgotten dose. Take the next dose at the usual time and never double up.

If you vomit after taking encorafenib, do not take a replacement dose. Continue with the next scheduled dose unless the team advises a pause. Repeated vomiting, inability to drink or much less urine needs prompt advice. If you take an extra dose accidentally, contact the treating service immediately.

The companion medicine may have a different missed-dose rule. In particular, binimetinib's rule uses six hours before the next dose. Do not apply encorafenib's 12-hour rule to every medicine in the combination.

Swallowing difficulties

Tell the pharmacist if capsules are difficult to swallow. European Braftovi instructions permit opening the capsules and mixing their contents into about 20 mL of apple sauce, then taking the mixture immediately. The pharmacist should confirm that this method is suitable for your dispensed product and demonstrate how to take the complete dose.

The current US label does not provide that preparation method. Do not improvise by crushing capsules, mixing into other foods or putting the contents through a feeding tube. Feeding-tube use needs a specific pharmacy assessment rather than assuming that an apple-sauce method can be adapted.

Treatment pauses and storage

If a companion medicine is paused or stopped, contact the oncology team before continuing encorafenib as usual. The encorafenib dose may need reduction or treatment may need to stop. Continuing the full dose alone can increase certain skin problems, and the intended combination is no longer being given. Never restart after a medical pause without the agreed instructions.

Keep capsules in their original packaging and protect them from moisture. US bottles should remain tightly closed with the drying packet inside, stored at 20–25°C (68–77°F); European packs should be stored below 30°C (86°F). Follow the label for your supply, particularly during travel or hot weather. Keep medicines out of children's reach and return unused capsules to the pharmacy.

Monitoring and checking whether treatment is working

Blood tests and symptom reviews continue throughout treatment. US guidance specifies liver tests before treatment and monthly; European guidance specifies at least monthly for the first six months and then as clinically indicated. Kidney function and blood salts need attention, especially with vomiting, diarrhoea or dehydration.

ECGs may be repeated to look for QT prolongation, a delay in the heart's electrical recovery. European guidance recommends checks at about one month and then approximately every three months, with extra testing when needed. Blood salts that affect rhythm should be corrected. With binimetinib, heart scans are performed before treatment, after one month and then every two to three months under US guidance, or approximately every three months under European guidance.

Eye assessments are performed regularly and whenever vision changes. With binimetinib, creatine kinase and creatinine are checked before treatment and periodically afterwards to look for muscle and kidney injury. Cetuximab adds blood-salt monitoring; US guidance recommends weekly checks during treatment and for at least eight weeks after it ends.

Skin examinations are recommended before treatment, every two months during it and for up to six months afterwards. Scans and clinical review assess whether the cancer is responding or remaining controlled. Do not wait for a booked appointment to report a concerning symptom.

Common side effects and practical management

Nausea, bowel changes and appetite

Nausea, vomiting, abdominal discomfort and diarrhoea can occur; constipation is also possible. The pattern depends partly on your accompanying treatment. Use the anti-sickness or bowel medicines prescribed for your regimen. Avoid adding a different anti-sickness product without checking, because some affect heart rhythm.

Take small, frequent drinks if you feel nauseated. Report persistent diarrhoea or vomiting, difficulty drinking, dizziness on standing or reduced urine promptly. Dehydration can affect kidney function and blood salts. Severe abdominal pain, bloody diarrhoea or a swollen abdomen needs urgent assessment rather than routine home treatment.

Small meals may be easier when appetite is reduced. Ask for dietetic support if your weight is falling or symptoms prevent eating.

Skin, hair and nails

Dry skin, itching, rash, thicker patches and soreness of the hands or feet may occur. Cetuximab can add an acne-like rash and nail problems. Report early changes so the team can choose appropriate creams or medicines. Do not use harsh acne treatments on a treatment-related rash without advice.

Moisturiser, gentle washing, comfortable footwear and protection from strong sunlight can help. Hair thinning or loss is possible, and additional chemotherapy may change its likelihood. A new mole, wart-like growth or non-healing sore must be examined even if it is painless.

Tiredness, pain and other changes

Fatigue, headache and muscle or joint aches can affect daily activities. Balance manageable activity with rest and discuss persistent pain before taking extra painkillers. Unusual severe muscle pain, weakness or dark urine can signal a different problem and needs urgent advice.

Numbness or tingling may be more relevant when certain chemotherapy partners are included. Report symptoms that interfere with walking, buttons, eating or sleep. Keep track of when they began so the team can judge which medicine may need adjustment.

Less common but important side effects

Heart rhythm and pumping problems

Encorafenib can prolong the QT interval and occasionally lead to a dangerous abnormal rhythm. Warning symptoms include palpitations, marked dizziness or fainting. Vomiting, diarrhoea and cetuximab-related low magnesium can increase concern by disturbing blood salts. Fainting or collapse with a fast or irregular heartbeat needs emergency care.

The combination with binimetinib can reduce heart pumping strength. Report new breathlessness, swollen ankles, rapid weight gain or unusual exhaustion promptly. Severe breathlessness or chest pain needs emergency assessment. Heart tests help guide treatment changes.

Eye inflammation and retinal changes

Uveitis means inflammation inside the eye. It can cause pain, redness, light sensitivity or blurred vision. With binimetinib, fluid can collect beneath the retina, or a retinal vein can become blocked. Report new visual symptoms immediately; sudden loss of vision is an emergency.

Do not wait to see whether symptoms disappear or arrange only a routine optician appointment. Specialist eye assessment may be needed urgently, and the decision about holding one or both medicines depends on the cause. Do not restart a paused drug simply because the eye feels more comfortable.

Bleeding, clots and lung problems

Serious bleeding, including bleeding inside the bowel or brain, can occur. Vomiting blood, black tar-like stools, coughing blood or a sudden severe headache requires immediate medical assessment. Heavy bleeding, collapse or stroke-like symptoms needs emergency care. Tell the team about blood thinners and aspirin-containing medicines.

Binimetinib-containing treatment can cause blood clots. One painful swollen arm or leg needs urgent advice; sudden chest pain or breathlessness may indicate a clot in the lungs and requires emergency assessment. New or worsening cough and breathlessness can also reflect lung inflammation associated with partner medicines. The team needs to investigate rather than assume these symptoms are fatigue.

Liver, kidney and muscle injury

Liver changes may first appear on blood tests. Yellow skin or eyes, dark urine, persistent nausea or unusual upper-abdominal discomfort should be reported promptly. Kidney injury can follow dehydration or other treatment effects; markedly reduced urine or inability to keep fluids down requires urgent advice.

Rhabdomyolysis is muscle breakdown that can damage the kidneys and has been reported with binimetinib. Severe muscle pain or weakness, especially with dark urine, needs immediate assessment. Creatine kinase can rise even before obvious symptoms, which is why the blood tests matter.

New cancers and tumour lysis syndrome

New skin cancers and cancers outside the skin can develop during BRAF-inhibitor treatment. Skin surveillance is designed to find changes promptly; a skin lesion can sometimes be removed while treatment continues. Report unexplained lumps, changing moles, persistent sores or new unusual symptoms.

Tumour lysis syndrome occurs when rapid cancer-cell breakdown releases substances into the blood, disrupting salts and kidney function. It has been reported with encorafenib and binimetinib. Higher-risk patients may need closer blood testing and preventive hydration. Severe weakness, cramps, confusion, palpitations or reduced urine needs urgent assessment.

Additional risks from accompanying treatment

Cetuximab may cause an infusion reaction, including a serious allergic reaction. Tell the nurse immediately about wheezing, throat tightness, dizziness, rash or facial swelling during an infusion. Symptoms after leaving hospital also need prompt assessment; severe breathing problems or swelling of the throat is an emergency.

Chemotherapy partners can add infection risk, low blood counts and other complications. Follow the separate fever and emergency instructions for the entire regimen. A problem attributed to a partner still matters when deciding whether encorafenib can safely continue.

Other medicines, supplements and vaccinations

Encorafenib interacts with CYP3A4, an enzyme that processes many medicines. Some antibiotics, antifungals, HIV medicines and heart medicines can raise encorafenib levels. Certain seizure medicines, rifampicin and St John's wort can lower them. Dose changes, a substitute medicine or extra monitoring may be needed. Do not manage an interaction by spacing the medicines a few hours apart unless specifically advised.

Encorafenib can also reduce the effect of other medicines, including hormonal contraception, or increase levels of certain drugs such as some statins. Medicines that prolong QT should be avoided or carefully reassessed by the treating team. Always check new prescriptions, over-the-counter products and herbal or Ayurvedic remedies before use.

Avoid grapefruit and grapefruit juice. There is no routine requirement to separate encorafenib from acid-reducing medicines; current US information found no clinically significant effect with a proton-pump inhibitor. Nevertheless, include heartburn medicines in the interaction review.

Ask the oncology team about vaccination timing, especially live vaccines and travel vaccines. Advice depends on accompanying treatment, blood counts and the vaccine involved. Do not apply a fixed waiting period after treatment without checking your plan.

Everyday life during treatment

Keep a dose record and share updated prescriptions with anyone helping you take medicines.

Drink regularly unless you have a fluid restriction. Work, activity and travel can often be adapted around symptoms and clinic appointments. Plan enough medicine, appropriate storage and access to medical help while away. Tell the team before a long trip or major change in time zone.

Do not drive or use machinery if vision changes, dizziness or tiredness make it unsafe. Tell dentists and other clinicians about your cancer treatment before procedures or new medicines. Discuss sexual comfort, contraception and emotional concerns openly; support with these issues is part of treatment.

Fertility, contraception, pregnancy and breastfeeding

Encorafenib can harm an unborn baby. Pregnancy testing is required before treatment if pregnancy is possible. Tell the team immediately if you become pregnant or think you might be. Encorafenib may affect male fertility; discuss preservation options before treatment if future parenthood matters to you. Other components may also affect fertility.

For women who could become pregnant, US encorafenib guidance specifies effective non-hormonal contraception during treatment and for two weeks after the last dose. European guidance specifies at least one month and an additional or alternative method if hormonal contraception is used, because it may be less reliable.

The companion medicine may require longer protection. US binimetinib guidance specifies 30 days after its last dose; European guidance specifies at least one month. US cetuximab guidance specifies two months after its last dose. Chemotherapy partners may require longer precautions for patients or partners. Obtain a written end date based on every medicine, rather than using the shortest interval.

Do not breastfeed during treatment. US encorafenib guidance continues the restriction for two weeks afterwards; US binimetinib requires three days, so the longer encorafenib interval still matters. Cetuximab requires two months after the final infusion in both US and European information. European encorafenib and binimetinib labels do not specify the same fixed post-treatment breastfeeding interval. Chemotherapy may add further restrictions. Confirm your personalised plan before resuming breastfeeding.

After treatment finishes

Keep follow-up scans, blood tests and skin checks. Monitoring for new skin cancers continues for up to six months after encorafenib stops. Report new symptoms during this period rather than assuming that treatment-related problems must have ended.

Continue contraception and breastfeeding precautions for the longest period required by your regimen. Cetuximab-related blood-salt monitoring may also continue after its last infusion. Tell other prescribers the stop date so that medicine interactions can be reassessed. Return unused capsules and clarify whether a break is temporary or permanent.

Frequently asked questions