Fruquintinib

Symptoms of drug allergy including one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Increase in blood pressure 

• If your blood pressure is very high, you may have headache, dizziness or blurry eyesight.

• Inform your doctor if you have such symptoms of increase in blood pressure frequently.
• If you have been prescribed with high blood pressure medications, continue to take your medications regularly as instructed.
• Your doctor may adjust your blood pressure medications if needed.
• If you have a blood pressure monitoring machine at home, measure your blood pressure at the same time(s) every day and record it in a book. Bring it for your future appointments.

Hand-foot syndrome. This may occur during treatment.

• Palms of the hand and soles of the feet may become numb, sore, swollen, red or painful.
• Nail beds may darken.
• Skin may become dry or itchy.

• Moisturize these areas daily. Wear socks or soft bedroom slippers at home to avoid slipping.
• Avoid tight-fitting shoes.
• Apply sunscreen with an SPF (sun protection factor) of at least 30.
• Inform your doctor if blisters, severe pain or ulcers affect your normal daily activities.

Decreased level of magnesium, calcium and potassium in the blood

Magnesium, calcium and potassium are types of electrolytes (mineral) needed by the body.

If your electrolyte levels are too low, you may experience symptoms such as: 

• Muscle cramps
• Numbness and tingling of hands and feet
• Abnormal heart rhythms
• Seizures (in rare cases)

• You may need to do blood tests to check the magnesium, calcium and potassium levels in your blood and take supplements if required.
• Seek medical attention if any of the symptoms becomes severe.

Thyroid problems

Fruquintinib can sometimes affect the thyroid gland, making it less active or more active (less commonly). 

You may experience extreme tiredness, abnormal intolerance of cold or heat, feeling irritable, unusual weight gain or loss.

• Your doctor will check how your thyroid is working with regular blood tests.
• Abnormal thyroid hormone levels can be treated with medication. 

Diarrhoea (loose and frequent stools)

• Drink plenty of clear fluids (at least 2 litres or 8 cups every day) unless instructed otherwise by your doctor.
• Eat food that is gentler on the stomach such as porridge or soup.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.
• Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed.
• Proceed to the A&E Department immediately if you have very bad diarrhoea (for example increase in bowel movement of more than 4 times per day) that does not improve even after taking anti-diarrhoeal medications.

Mouth ulcers or sores

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce chances of infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot lesser because of mouth pain.

Slow wound healing

• Wounds may take longer to heal while you are being treated with Fruquintinib. 

• If you have any surgery or dental procedures planned, inform your doctor. You may need to stop Fruquintinib for a period of time before surgery and resume only after the wound has fully healed.

Decrease in platelet count. Low platelet levels can increase your chance of bleeding. 

• To reduce risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have:
  • Bruising without a cause or bruises that get larger in size
  • Black, sticky stools
  • Blood in the urine
  • Coughing out blood or vomit that looks like coffee grounds
  • Bleeding which does not stop

Proteinuria (leakage of protein in your urine)

Symptoms include frothy urine, leg swelling and/or weight gain.

• Proceed to the A&E department immediately if:
  • You are not able to pass urine or passing a lot lesser urine than usual.
  • There is blood in the urine.
  • Sudden swelling of both feet or a big weight gain.
• Inform your doctor if you have any bubbles in the urine.

• Proceed to the A&E department immediately if you experience any:
  • Dark or tea-coloured urine
  • Pale or light-coloured stools
  • Yellowing of skin or eyes
  • Nausea, vomiting with loss of appetite
  • Severe abdominal pain

• Do not drive or operate machinery if you are feeling tired.
• Eat well and get enough sleep. Prioritize tasks to ensure you make the best use of your energy.
• Simple exercise such as walking can help to boost your energy.
• Avoid alcohol as this may cause you to feel more tired and drowsy.

Abnormal blood clot 

This may occur in the one of the legs or arms (deep vein thrombosis) or lungs (pulmonary embolism).

Symptoms may include:

• Warmth, pain of redness with swelling on the arm of leg
• Sudden onset of cough, chest pain or shortness of breath

• Proceed to the A&E department immediately if you develop any of these symptoms. 

• You may have your cholesterol level checked before starting Fruquintinib, and periodically after starting Fruquintinib.
• Your doctor may prescribe medications to control your cholesterol levels if required.

• Please proceed to the A&E department immediately if you experience sudden onset of severe headache, eyesight changes, slurred speech and loss of coordination, weakness or numbness in arm or leg.

If you need to go to the hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment.

Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.

It is normal to feel fearful or worried about your condition.

Do not be afraid to talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.