Treatment Name: Erlotinib (Tarceva®)
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 lung 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.
- 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.
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.
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.
- 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:
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.
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®)