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Erlotinib is also known as Tarceva ®. It can be used to treat people with advanced non-small cell lung cancer (NSCLC)| and people with pancreatic cancer|. It may also be used to treat other types of cancer as part of a research trial|.
Erlotinib is a type of treatment called a tyrosine kinase inhibitor. Kinases are important proteins in the body that regulate how the cells grow and divide.
Erlotinib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die.
Tests may be done to check the level of epidermal growth factor receptors (EGFR). These tests will show if you're likely to benefit from erlotinib. Tests can be done at the same time as diagnosis, or samples of cancer cells from previous biopsies or surgery may be used.
Non-small cell lung cancer (NSCLC)
Erlotinib is licensed to treat people with non-small cell lung cancer (NSCLC) that has spread to the surrounding tissues or other parts of the body (locally advanced or metastatic cancer). It can be used as:
Erlotinib is also licensed to be used in combination with the chemotherapy drug gemcitabine|, which is used to treat people with pancreatic cancer that has spread beyond the pancreas (metastatic cancer).
The National Institute for Health and Clinical Excellence (NICE|) gives advice on which new drugs and treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC|) makes recommendations on the use of new drugs within the NHS in Scotland.
NICE and the SMC have approved erlotinib as a first-line treatment for people with locally advanced or metastatic NSCLC. They have also approved elotinib as an alternative treatment to the chemotherapy drug docetaxel| for people with NSCLC whose cancer has come back after, or not responded to, at least one course of chemotherapy. Erlotinib is not recommended as a maintenance treatment.
NICE hasn't issued guidance on the use of erlotinib as a treatment for pancreatic cancer in the NHS in England and Wales. The SMC has advised that erlotinib, in combination with gemcitabine, is not recommended for the treatment of people with metastatic pancreatic cancer within NHS Scotland.
If you live in Northern Ireland, speak to your cancer specialist about whether erlotinib is recommended to treat your type of cancer.
If erlotinib isn’t recommended for you it may not be available on the NHS, although you may be given it as part of a clinical trial. We have more information on what you can do if a treatment isn't available|.
Erlotinib is a white to yellowish tablet, coated with a film. It comes in three strengths: 25mg, 100mg and 150mg.
Erlotinib is usually taken as a single dose each morning with a large glass of water, at least one hour before a meal or two hours afterwards.
Each person’s reaction to treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having this treatment.
We have outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
The side effects of erlotinib are generally mild and some of them can be reduced with medicines.
An acne-like rash that mainly affects the head, chest and back is the most common side effect of erlotinib. This usually develops during the first 2-3 weeks of treatment and goes away once treatment ends.
Your skin may also become dry and itchy or feel tender and peel. Some people find that the nails on their hands or feet become red, sore and brittle.
Tell your doctor if you develop these side effects, as they can prescribe medicines to help.
Taking the following steps may help to reduce the severity of skin changes, although they can’t prevent them altogether:
Let your doctor know as soon as possible if you develop skin or nail changes so they can prescribe treatment to help.
This is common but usually mild, and can generally be controlled with medicine. Tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea|. Let your doctor know if you develop any black, tarry-looking stools.
Feeling tired| is a common side effect of cancer treatment especially towards the end and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea| or vomiting. If the sickness isn't controlled, or if it continues tell your doctor as they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Some people develop sore, red eyes (conjunctivitis) or dry eyes while they are being treated with erlotinib. Your doctor can prescribe eye drops to help with this. Let your doctor know if you notice any changes to your eyes.
Your eyelashes may grow longer and more curly than usual. Men may have less beard growth. You may notice that your head and body hair is finer, curlier or more brittle. Some people have hair thinning or hair loss|. If this happens, it usually develops gradually. All of these changes are usually temporary and improve once treatment is over.
Your mouth may become sore| or dry, or you may notice small ulcers during this treatment. Some people find sucking on ice soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Some people lose their appetite| while they’re having erlotinib. A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite and maintain your weight.
This is an uncommon side effect that affects fewer than 1 in 100 people taking erlotinib. If you suddenly become breathless| or your breathing gets worse, possibly with a cough or high temperature, tell your doctor immediately. It may mean you have an inflammation of the lungs called interstitial lung disease.
This may make erlotinib less effective.
Erlotinib may interact with other medicines, including some that are used to treat stomach ulcers, indigestion and epilepsy. It may also interact with the herbal remedy St John's Wort. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies| and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of erlotinib on a developing baby. Therefore, it is not advisable to become pregnant or father a child while taking this drug.
It’s not known whether erlotinib is present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There is a potential risk that erlotinib may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having erlotinib treatment. You should tell them the name of your cancer specialist so that they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This section has been compiled using a number of sources, including:
With thanks to: Kavita Kantilal, Oncology Pharmacist; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices| network.
Content last reviewed: 1 January 2013
Next planned review: 2015
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© Macmillan Cancer Support 2013
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