Gefitinib (Iressa ®)
Gefitinib, which is also known as Iressa ®, Is a drug that may be used to treat non-small cell lung cancer (NSCLC) or other types of cancer as part of a research trial.
The page describes gefitinib, how it's given and some of its possible side effects. It should ideally be read with our general information about your type of cancer.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Gefitinib 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.
Gefitinib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die.
Gefitinib is used to treat some people with non-small cell lung cancer (NSCLC).
It only works for NSCLCs that have changes called EGFR mutations on the surface of their cells. EGFR mutations are most likely to occur in NSCLC in:
people who have never smoked
people with adenocarcinoma (a specific type of NSCLC)
people of Asian origin.
Tests may be done to check the level of EGFR. These will help you and your doctors decide if you're likely to benefit from gefitinib. Testing can be done at the time the cancer is diagnosed, or samples of cancer cells from previous biopsies or surgery may be used.
The National Institute for Health and Clinical Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. It recommends gefitinib as a possible first treatment for people with NSCLC that is EGFR positive and has spread to surrounding tissues or other parts of the body (advanced or metastatic).
Recommendations on the use of new drugs within the NHS in Scotland are made by the Scottish Medicines Consortium (SMC). The SMC doesn’t currently recommend the use of gefitinib. As a result, it may not be available on the NHS in Scotland, 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.
If you live in Northern Ireland, speak to your cancer specialist about whether gefitinib is recommended to treat your type of cancer.
What gefitinib looks like
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Gefitinib is a brown, round tablet, coated with a film.
How gefitinib is given
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Gefitinib is taken as a tablet once a day. You should take the tablet at about the same time each day. It should be swallowed whole with a glass of water, and can be taken with or without food. If you have trouble swallowing tablets, the gefitinib can be put in a glass of water and left to dissolve. The tablet may take 20 minutes to completely dissolve and should be drunk straight away. The glass should be rinsed with more water and that should also be drunk.
Gefitinib is usually taken for as long as a person benefits from it.
Possible side effects of gefitinib
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Each person’s reaction to cancer 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've 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 most common side effect of gefitinib is an acne-like rash that mainly affects the head, chest and back. This usually begins 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.
Taking the following steps may help 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 containing alcohol.
Don’t use anti-acne products as they can dry your skin and make your symptoms worse.
Moisturise your skin regularly and after bathing. Your doctor or specialist nurse can advise you on which moisturisers are best.
Protect your hands and fingernails from detergents by wearing rubber gloves when washing dishes.
Protect your skin in the sun, as sunlight can make skin symptoms worse. During treatment with gefitinib, 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 you should wear a suncream with a high sun protection factor (SPF), and cover up with clothing and a hat. If you’re having radiotherapy, don't apply suncream to any skin in the area being treated.
Let your doctor know as soon as possible if you develop skin or nail changes. They can prescribe treatment to help. In people who have more severe side effects, treatment with gefitinib can be stopped for a few days to allow their skin to recover.
Gefitinib can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Loss of appetite
Some people lose their appetite while they’re having gefitinib. A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite and maintain your weight.
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.
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.
Treatment with gefitinib may cause changes in the way that your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems but your doctor will take regular blood samples to check your liver is working properly.
Your eyelashes may grow longer and more curly than usual. Men may notice they have less beard growth. You may notice 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. These changes are usually temporary and gradually improve once treatment is over.
If you notice any change to your vision or pain or redness of your eyes, let your doctor know immediately.
Let your doctor know if you have nosebleeds or notice blood in your urine while taking gefitinib.
This is an uncommon side effect that may affect about 1 in 100 people taking gefitinib. If you become breathless, if your breathing worsens or if you have a cough or fever, tell your doctor straight away. It may mean you have an inflammation of the lungs called 'interstitial lung disease', which is potentially very serious. If you're worried about this potential side effect, talk to your doctor or nurse.
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.
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Some medicines, including those you can buy in a shop or chemist, can be harmful to take while you are having gefitinib. Tell your doctor about any medicines you are 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 gefitinib on a developing baby. Therefore, it’s not advisable to become pregnant or father a child while taking this drug.
It’s not known whether gefitinib 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 treatment.
There is a potential risk that gefitinib 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 gefitinib 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 gefitinib tablets
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It’s important to take your tablets as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you are taking a course of gefitinib tablets, and that they 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 the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
If you are sick just after taking the tablets, tell your doctor as you may need to take another dose. Don't take another dose without telling your doctor first.
If you forget to take a tablet, take it as soon as you realise. However, if there’s less than 12 hours until the next scheduled dose, don’t take the missed dose. You should never take a double dose.
This information has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2012).
National Institute for Health and Clinical Excellence (NICE). Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer (TA129). July 2010.
Scottish Medicines Consortium (SMC). Advice on 615/10 - Gefitinib (Iressa) Resubmission. December 2010.
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.