Erlotinib (Tarceva ®)
Erlotinib is used to treat non-small cell lung cancer (NSCLC) that has spread to surrounding tissues (locally advanced) or other parts of the body (metastatic). It can also treat metastatic pancreatic cancer.
Erlotinib is a type of treatment called a tyrosine kinase inhibitor. Kinases are proteins in the body that regulate how cells grow and divide.
Erlotinib blocks (inhibits) signals within the cancer cells and stops the action of a protein called epidermal growth factor receptor (EGFR). Blocking the signals causes the cells to die.
Tests may be done to check the level of 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.
It’s best to read this information with our general information about the type of cancer you have. During treatment, you will see a cancer doctor and a cancer nurse. This is who we mean when we mention doctor or nurse in this information. You'll see your doctor and nurse regularly while you’re having erlotinib. This information may help you discuss any questions about your treatment and its side effects with them.
When erlotinib is used
Back to top
Non-small cell lung cancer (NSCLC)
Erlotinib can be used 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:
the first treatment (called first-line treatment)
a maintenance treatment for people whose disease is stable after at least four cycles of chemotherapy
a treatment for people whose cancer has come back after chemotherapy.
Erlotinib can also be used in combination with the chemotherapy drug gemcitabine, to treat people with pancreatic cancer that has spread (metastatic cancer).
Erlotinib may only be available in some situations. Your cancer doctor can tell you if it's appropriate for you. Some people may have it as part of a clinical trial. If a drug isn’t available on the NHS, there may be different ways you can still to have it. Your cancer doctor can give you advice. We have further information on What to do if a treatment isn’t available.
Taking erlotinib tablets
Back to top
You take erlotinib as a tablet once a day. Take it at the same time every day. Swallow the tablet whole with a glass of water – don’t crush or chew it. You can take it at least one hour before or two hours after food.
Always take erlotinib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.
There are some important things to remember when taking your tablets:
If you forget to take a tablet, don’t take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Keep tablets in the original package, away from heat and direct sunlight.
Keep them safe and out of the reach of children.
Get a new prescription before you run out of tablets and make sure you have enough for holidays.
Return any unused tablets to the pharmacist if your treatment is stopped.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose.
Possible side effects of erlotinib
Back to top
We have included the most common likely side effects of erlotinib here. We haven’t included all the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.
If you have chemotherapy or radiotherapy along with erlotinib, some side effects may be worse. You may also have side effects not listed here. We have more information about chemotherapy.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you.
Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve. Always tell your doctor or nurse about the side effects you have.
Serious and life threatening side effects
Sometimes cancer drugs can result in very severe reactions, which rarely may be life threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about erlotinib
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information, you can visit the electronic medicines compendium (eMC)
Common side effects of erlotinib
Back to top
These side effects may affect more than 1 in 10 people (more than 10%).
You may develop an acne-like rash on your face during the first two to three weeks of treatment. This goes away once treatment ends.
Your skin may also become dry, itchy and flaky. 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 give treatments to help. Very rarely, people may have a very severe skin reaction. The symptoms can include large blisters, peeling skin and sores in your mouth. You may also have a fever (high temperature). You must contact the hospital straight away if this happens as it may cause very serious problems.
Always tell your doctor or nurse about any skin changes. They can give you advice and prescribe creams for your skin or medicines to help. If you have severe skin problems they may lengthen the time in between your treatments or lower the dose. If you have severe skin problems, your doctor may need to stop the treatment.
Here are some things you can do to reduce skin changes, although they can’t prevent them altogether:
Wash with tepid water using mild, unperfumed, soap-free cleansers.
Avoid skincare products that contain alcohol.
Moisturise your skin regularly with unperfumed moisturisers – ask your doctor or nurse what’s best.
Don’t use anti-acne products or any products containing alcohol on your skin.
Wear gloves when doing housework and gardening.
Sunlight can make skin symptoms worse. During treatment with erlotinib, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily than normal. Wear a sun cream with a high sun protection factor (SPF) of at least 30 when outside, and cover up with clothing and a hat. If you're having radiotherapy, don't apply sunscreen to any skin in the area being treated.
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. It's important to drink plenty of fluids if you have diarrhoea. Tell your doctor if it's severe or continues. You may need to come into hospital to have a drip (infusion) and other treatments.
Feeling tired is a common side effect of cancer treatment, especially towards the end of treatment 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.
You may notice that you feel a bit low or have changes in your mood. Talk to your doctor or nurse if you feel like this. It might help to talk to a family member or friend about how you are feeling.
Your doctor can prescribe effective anti-sickness drugs to prevent or reduce sickness 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 work better for you.
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.
If your eyes become more painful with any changes to your vision or sensitivity to light it is very important to tell your doctor or nurse straight away.
Bruising and bleeding
Erlotinib can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Sore mouth and ulcers
Your mouth may become sore or dry, or you may notice small mouth ulcers during this treatment. 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. They can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Loss of appetite
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.
Always tell your doctor if you notice wheezing or a cough, or if you feel short of breath.
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 is a rare side effect. Your doctor can tell you more about this.
Less common and rare side effects of erlotinib
Back to top
These side effects affect fewer than 1 in 10 people (under 10%).
Risk of infection
When taking erlotinib you may be at more risk of infection. Tell your doctor if you notice any signs of infection such as a high temperature, feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Abdominal (tummy) pain
Some people have pain or discomfort in their tummy during treatment with erlotinib. Let your doctor know if this happens to you.
Very rarely, erlotinib can cause a hole (perforation) in the small bowel. Contact your doctor immediately if you have severe pain in the tummy or signs of bleeding such as bleeding from the back passage, black stools or vomiting up blood (or vomit that looks like coffee grounds).
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
These are less common than skin changes, but sometimes develop after three months or more. Your eyelashes may grow longer and curlier. 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.
Other information about erlotinib
Back to top
Smoking 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.
Erlotinib may cause bleeding problems. Tell your doctor if you take any medicines that may affect bleeding, such as aspirin or warfarin.
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.
Doctors don’t yet know how erlotinib may affect the fertility of men and women. If you are worried about this, talk to your doctor before treatment starts.
Your doctor will advise you not to become pregnant or father a child while taking erlotinib as not enough is known about its effect on the developing baby. It’s important to use effective contraception while having this drug. You can discuss this with your doctor or specialist nurse.
Doctors do not know whether erlotinib may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
Medical or dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking erlotinib. Tell them the name of your cancer doctor so they can ask for advice.
Always tell your dentist you are taking erlotinib.
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 page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a healthcare professional.
Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to grow.
You could help us too when you join our Cancer Voices Network - find out more.