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Treatment Name: Erlotinib (Tarceva®)

Erlotinib (Tarceva®) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

How does erlotinib work?
Erlotinib is designed to bind to the epidermal growth factor receptor (EGFR) on the surface of lung cancer cells. When this happens, erlotinib blocks the signal that tells the cancer cells to grow and divide. The EGFR receptor is normally found on the surface of healthy cells, but can be found in a much higher amounts on the surface of cancer cells. Testing may be done prior to starting erlotinib to determine if you have a genetic mutation in EGFR that predicts a positive response to erlotinib.

Goals of therapy:
Erlotinib is taken to slow the progression and to stop the spreading of the disease. Erlotinib is not usually taken with the goal of cure. Erlotinib may be given as the initial choice of therapy, after other chemotherapy regimens have failed to control the cancer, or right after the completion of chemotherapy as a “maintenance” regimen.

Schedule

  • Usual starting dose: 150 mg oral tablet by mouth once Daily

Erlotinib is usually taken at home. Erlotinib is taken continuously as long as the drug is working and no unacceptable side effects are experienced.

Side Effects

In clinical studies, the most commonly reported side effects with erlotinib are shown here. Side effects sometimes have percentage ranges [example 76 – 80%] because they differed between in clinical studies:

  • Rash (76 - 80%)
  • Fatigue (57 - 79%)
  • Diarrhea (57%)
  • Nausea (40%)
  • Infection (34%)
  • Decreased appetite (31 - 69%)
  • Eye toxicity (28%)
  • Vomiting (25%)
  • Mouth sores (19%)
  • Hair loss or hair thinning, not complete hair loss (14%)
  • Anemia [low red blood cells] (12%)
  • Joint pain (11%)
  • Nerve pain (9%)
  • Dehydration (7%)
  • Liver injury (6%)
  • Lung toxicity (1 - 3%)

Roughly 6% of patients discontinue erlotinib due to unacceptable side effects.

Side effect videos Side Effect Videos
Fatigue Fatigue DiarrheaDiarrheaNausea and VomitingNausea and VomitingAnemiaAnemiaPainPain

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and every 6 to 8 weeks during treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. You may have an eye exam before starting treatment then again in 4 to 8 weeks to check for any eye toxicities.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue erlotinib as planned, or delay or switch therapy.

ChemoExperts Tips

  • It is extremely important to tell your doctor if you are actively smoking while on therapy with erlotinib. Smoking may cause erlotinib to be metabolized at a higher rate than normal, possibly decreasing its effectiveness. Typically, patient who continue to smoke have their doses increased every 2 weeks, if no side effects are experienced, to a maximum of 300 mg per day. If you decide to quit smoking after your dose is increased, notify your doctor immediately
  • Development of a skin rash is common while on erlotinib; however, development of skin rashes may be linked with better disease response from erlotinib. Mild skin rashes can be treated with over-the-counter lotions or topical steroids. More severe rashes can be treated with oral or topical antibiotics or oral steroids that are prescribed by your doctor. Tell your doctor about any skin reactions that you have
  • Erlotinib may decrease in effectiveness if taken with medicines for heartburn or those that reduce stomach acid. Talk with your doctor or pharmacist about how best to take these two medicines when they are both needed
  • If you are going to the hospital or the emergency room, be sure to bring your supply of erlotinib with you. Many hospitals don’t carry this medication and your supply may need to be used if you are admitted to the hospital and your doctors want to continue erlotinib during your stay.
  • Erlotinib has numerous drug-drug interactions. A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Erlotinib (Tarceva®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Erlotinib (Tarceva®). Depending upon your income, they may be able to help cover the cost of:

  • Erlotinib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Erlotinib (Tarceva®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Erlotinib (Tarceva®)

Individual Drug Label Information

Erlotinib (Tarceva®)

  • Erlotinib is a oral tablet that comes in 25 mg, 100 mg, and 150 mg 
  • Erlotinib should be taken on an empty stomach, at least 1 hour before a meal or two hours after a meal. Food increases absorption so it is best to take on an empty stomach to avoid an increase in side effects. Erlotinib can be taken at any time of the day as long as it is taken at the same time each day 
  • If you miss a dose, take the dose as soon as you remember if it’s the same day. If it is the next day, take your regular dose as scheduled. Do not double your dose to make up for the missed dose 
  • Erlotinib should be stored at room temperature in a cool, dry place 
  • Dosage adjustments may be required for smoking, drug interactions, and severe side effects 
  • May interact with over-the-counter medicines taken for heartburn or those that reduce stomach acid. It is recommended that short-acting antacids (example: Tums®) be considered instead of proton pump inhibitors (example: omeprazole (Prilosec®) or H2-antagonists (famotidine, ranitidine). Tums® should not be taken within 2 hours of erlotinib 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions 
  • May interact with grapefruit and grapefruit juice causing increased blood levels of erlotinib. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment 
  • Avoid smoking and therapy with St. Johns Wort as it will decrease blood levels of erlotinib and could decrease its effectiveness 
  • Avoid during pregnancy. Contact your doctor immediately if you think you may have become pregnant 
General Erlotinib (Tarceva) Side Effects  
  • May cause severe diarrhea leading to dehydration. Diarrhea often responds to over-the-counter medications such as loperamide (Imodium®) 
  • Skin rashes are common and can be treated with either prescription or over-the-counter medications 
  • Can cause decreased tear production, abnormal eyelash growth, or more serious eye toxicities. You may have an eye exam before starting treatment then again in a few weeks after starting treatment 
  • Can cause an opening in the wall of your stomach or intestines. Seek help immediately if you experience sever abdominal pain with fever, nausea, or vomiting 
  • May cause you to bleed more easily if you are on warfarin, enoxaparin, or other blood thinners
  • Rare but serious lung toxicities have been reported 
  • Fatigue is commonly reported with erlotinib 
  • Nausea and vomiting may occur 
  • May decreased your appetite 
  • Can cause liver injury 
  • May cause mouth pain and sores 
  • May cause joint and/or nerve pain 
  • Click on the erlotinib (Tarceva) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemia

See DailyMed package insert.

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References

Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al. Erlotinib in previously treated non–small-cell lung cancer. New Engl J Med. 2005;353:123-132.

Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13:239-246.

Created: March 12, 2016 Updated: August 31, 2016

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is Maintenance therapy?

Maintenance therapy is the phase of treatment that follows the successful completion of a prior chemotherapy regimen. The purpose of maintenance therapy is to target any remaining cancer cells that may be present, but cannot be seen with imaging or blood tests. Maintenance chemotherapy agents are typically well tolerated and can be given over an extended period of time.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al. Erlotinib in previously treated non–small-cell lung cancer. New Engl J Med. 2005;353:123-132.

Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13:239-246.