Lapatinib (Tyverb ®)
Lapatinib, which is also known as Tyverb ®, is a drug that’s mainly used to treat women with advanced breast cancer. It may be used to treat other types of cancer as part of a research trial.
This section aims to give a balanced summary of the information that is available so far. 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.
Lapatinib 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.
Lapatinib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die. Lapatinib stops the action of two proteins:
erbB1, also known as epidermal growth factor receptor (EGFR)
erbB2, also known as HER2.
Tests may be done to check the level of EGFR or HER2. These will tell if you’re likely to benefit from lapatinib. Testing can be done at the same time as diagnosis, or samples of cancer cells from previous biopsies or surgery may be used.
When lapatinib is used
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Lapatinib is mainly used to treat people with HER2 positive breast cancer that has spread to other parts of the body (advanced or metastatic breast cancer).
It is either given with a chemotherapy tablet called capecitabine (Xeloda ®) or in combination with a type of hormonal therapy.
The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or 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. Neither NICE nor the SMC recommend the use of lapatinib.
As a result, lapatinib may not be available on the NHS, although you could 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 lapatinib looks like
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Lapatinib is available as 250mg oval, yellow tablets.
How lapatinib is given
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Lapatinib should be taken with a glass of water, either an hour before or after food. It should not be taken with grapefruit or grapefruit juice. It should be taken at the same time each day, so if you start taking it an hour before food you should continue to take it before food, rather than sometimes taking it after food.
Possible side effects of lapatinib
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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 being treated with lapatinib.
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 lapatinib are generally mild, but because it’s given with other cancer treatments, you may also get side effects associated with these other treatments.
This is the most common side effect of lapatinib and develops about one week after treatment. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
You may develop an acne-like rash that mainly affects the head, chest and back. This usually begins during the first 2-3 weeks of treatment and may gradually fade over the following weeks, even if you continue to have treatment. Your skin may also become dry and itchy or feel tender and peel. Let your doctor know if you develop these side effects as they can prescribe medicines to help.
Taking the following steps when taking lapatinib may help reduce the severity of skin changes, although it may not prevent them completely:
Use tepid water and mild, non-scented soap for bathing and washing.
Avoid skincare products that contain alcohol.
Don’t use anti-acne products on your skin. Although the rash can look like acne, it isn’t. Anti-acne products can dry your skin and make symptoms worse.
Apply sunscreen with high protection against UVA rays and with sun protection factor (SPF) of at least 30 before going outdoors. Sunlight can make skin symptoms worse.
Moisturise your skin regularly and after bathing. Your doctor or specialist nurse can advise you on which moisturisers are best.
Feeling tired is a common side effect, 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.
Feeling sick (nausea) or 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; 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.
Indigestion and heartburn
This is a common side effect, which can usually be relieved by taking an antacid. You should take the antacid at least an hour before or after taking lapatinib. Let your doctor or nurse know if you have any indigestion that isn’t relieved.
Stomach cramps and bloating
Let your doctor know if you get any stomach cramps or bloating as they can prescribe medicines that will help relieve this.
Loss of appetite
Some people lose their appetite. This can be mild and may only last a few days. If it doesn’t improve, you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
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.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Muscle and joint pains
You may have joint or muscle pains, especially in your back. Let your doctor know if you develop these as they can prescribe painkillers.
Some people find that lapatinib causes headaches. Let your doctor or nurse know if you’re affected by this as they can give you painkillers to relieve this.
Some people find that they have trouble sleeping while taking lapatinib. Using relaxation techniques or CDs may help. If you still have trouble sleeping, talk to your doctor about night sedation.
Your liver may be temporarily affected
Rarely, lapatinib may cause temporary changes to the way your liver works. The changes are unlikely to cause you any harm, but your doctor will monitor this carefully.
Changes in the way your heart works
Lapatinib may cause changes in the muscle of the heart. This can affect how the heart works. Tests to monitor how well your heart is working may be carried out before and during treatment.
It's important to let your doctors know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Additional information about lapatinib
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Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you’re taking lapatinib. 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 taking this drug. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while taking lapatinib, as it may harm the developing baby. It’s important to use effective contraception while taking this drug, and for at least a few months afterwards.
It’s not known whether lapatinib 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 lapatinib may be present in breast milk so women are advised not to breastfeed while taking imatinib 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 are having lapatinib treatment. You should tell them the name of your cancer specialist so that they can ask 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 lapatinib tablets
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It's important to take your tablets as directed by your doctor, nurse or pharmacist.
Always tell any doctors treating you for non-cancerous conditions that you’re taking a course of imatinib tablets that 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 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, nurse or pharmacist first.
If you forget to take a tablet, don't take a double dose. Inform your doctor and keep to your regular dose schedule.
If your doctor decides to stop the treatment, return any remaining tablets to the hospital pharmacist. Don't flush them down the toilet or throw them away.
This information has been compiled using information from a number of reliable sources, including:
British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Breast cancer (metastatic hormone-receptor) - lapatinib and trastuzumab (with aromatase inhibitor)(TA257). National Institute for Health and Clinical Excellence (NICE). June 2012.
electronic Medicines Compendium (eMC). Tyverb - Summary of Product Characteristics (SPC). (accessed October 2012).
With thanks to: Professor Stephen Johnston, Consultant Medical Oncologist; and the people affected by cancer who reviewed this edition.
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