Erlotinib (Tarceva ®)
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.
When erlotinib is used
Back to top
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:
the first treatment in this situation (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 previous chemotherapy.
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.
What erlotinib looks like
Back to top
Erlotinib is a white to yellowish tablet, coated with a film. It comes in three strengths: 25mg, 100mg and 150mg.
How erlotinib is given
Back to top
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.
Possible side effects of erlotinib
Back to top
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:
Use tepid water and mild, non-scented soap for bathing and washing.
Avoid skincare products that contain alcohol.
Don’t use anti-acne products. They can dry your skin and make your symptoms worse.
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. You can still go out in the sun, but should wear a sun cream with a high sun protection factor (SPF) 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.
Moisturise your skin regularly and after bathing. Your doctor or specialist nurse can advise you on which moisturisers are best.
Wear gloves when doing housework and gardening.
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.
Feeling sick (nausea) and being sick (vomiting)
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.
Changes in hair growth
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.
Sore mouth and ulcers
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.
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.
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.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even it they're not mentioned above.
Additional information about erlotinib
Back to top
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.
Non-cancer hospital admission
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.
Things to remember about erlotinib tablets
Back to top
It’s important to take your tablets at the right times, as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you’re taking a course of erlotinib tablets, which should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place, out of reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablets, let your doctor know. You may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take a double dose. Tell your doctor and keep to your regular dose schedule.
This section has been compiled using a number of sources, including:
British National Formulary. 2012. 63rd edition. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). website www.emc.medicines.org.uk (accessed October 2012).
National Institute for Health and Clinical Excellence (NICE). Erlotinib for the first-line treatment of locally advanced or metastatic EGFR-TK mutation-positive non-small-cell lung cancer (TA258). June 2012.
National Institute for Health and Clinical Excellence (NICE). Erlotinib for the treatment of non-small cell lung cancer (TA162). November 2008.
National Institute for Health and Clinical Excellence (NICE). Erlotinib monotherapy for maintenance treatment of non-small-cell lung cancer (TA227). June 2011.
Scottish Medicines Consortium (SMC). 220/05 Erlotinib (Tarceva). June 2006.
Scottish Medicines Consortium (SMC). 382/07 Erlotinib (Tarceva). July 2007.
Scottish Medicines Consortium (SMC).664/10 Erlotinib (Tarceva). January 2011.
Scottish Medicines Consortium (SMC).749/11 Erlotinib (Tarceva). January 2012.
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.