What is erlotinib (Tarceva®)?

Erlotinib (Tarceva®) is used to treat non-small cell lung cancer (NSCLC) and pancreatic cancer. It may sometimes be used to treat other cancers. It is best to read this information with our general information about the type of cancer you have.

Erlotinib belongs to a group of targeted therapy drugs known as cancer growth inhibitors.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial. If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice.

How erlotinib works

Erlotinib blocks (inhibits) a protein called epidermal growth factor receptor (EGFR) that can cause the cancer to grow. Blocking this protein causes the cancer cells to die. This may shrink a cancer or stop it growing for a time.

When erlotinib is given

Non-small cell lung cancer (NSCLC)

Erlotinib can be used to treat non-small cell lung cancer (NSCLC) that has spread (metastatic cancer).

You may have a test to check if you are likely to benefit from erlotinib. This test is done on samples of cancer cells taken by biopsy or during surgery.

Pancreatic cancer

Erlotinib can also be used with the chemotherapy drug gemcitabine, to treat people with pancreatic cancer that has spread (metastatic cancer).

How erlotinib is given

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Erlotinib comes in tablets, which you can take at home. Your nurse or pharmacist will give you the tablets to take home.

Taking erlotinib

You take erlotinib tablets once a day. Swallow the tablets whole with a glass of water – do not crush or chew them. You take it at least one hour before or two hours after eating food. Take it at the same time every day. 

Do not eat grapefruit or drink grapefruit juice during treatment with erlotinib. It may increase the side effects of erlotinib.  

If you take any medicines to reduce stomach acid talk to your doctor first. These drugs may interfere with the way erlotinib works. Your doctor will advise you which medicines you can take and how to take them safely. 

Always take erlotinib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.

Other things to remember about your tablets:

  • If you forget to take the tablets, do not take a double dose. Keep to your regular schedule and tell your doctor or nurse.
  • If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose.
  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • If your treatment is stopped return any unused tablets to the pharmacist.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Skin changes

You may develop an acne-like rash on your face during the first two to three weeks of treatment. Your skin may also become dry, itchy and flaky. 

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. 

Rarely some people may get a severe skin reaction. Symptoms of this can include blistering and peeling skin, sores in your mouth and a high temperature. You must contact the hospital straight away if this happens as it may cause serious problems.

Here are some things you can do to look after your skin during treatment:

  • Wash with lukewarm water using mild, unperfumed, soap-free cleansers.
  • Moisturise your skin regularly with unperfumed moisturisers – ask your doctor or nurse what is best.
  • Do not use anti-acne products or any products containing alcohol on your skin.

During treatment with erlotinib, and for several months afterwards, you will be more sensitive to the sun. Wear a sun cream with a high sun protection factor (SPF) of at least 30 when outside. Cover up with clothing and a hat.

Nail changes

You may notice changes to your nails. They may become brittle and break easily. Wear gloves when washing dishes or using detergents to help protect your hands and nails. Dry your hands carefully after washing. If the area around your nails becomes red, hot or swollen, tell your doctor straight away.

Diarrhoea

This treatment may cause diarrhoea. Tell your cancer doctor or nurse straight away if you have diarrhoea. Your doctor or nurse may give you anti-diarrhoea drugs to take at home.

If you have diarrhoea:

  • follow any advice you have been given about taking anti-diarrhoea drugs
  • drink at least two litres (three and a half pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Contact the hospital straight away if:

  • you have diarrhoea at night
  • you have diarrhoea more than 4 times in a day
  • the anti-diarrhoea drugs do not work within 24 hours.

Some people may need to go to hospital to have fluids through a drip. Your doctor may ask you to stop taking your erlotinib tablets. When the diarrhoea is better, your doctor will tell you if you can start taking erlotinib again.

Tiredness

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection.

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Eye problems

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. Tell your doctor if you notice any changes.

Tell your doctor or nurse straight away if you have eyesight changes, or if your eyes become more painful or sensitive to light.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Feeling sick

You may feel sick during treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Mood changes

You may notice that you feel low or have changes in your mood. Talk to your doctor or nurse if you feel like this. It may help to talk to a family member or friend about how you are feeling.

Nosebleeds

Erlotinib can cause nosebleeds. These are usually mild and stop without needing treatment. Tell your doctor or nurse if you have nosebleeds.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks. Tell your doctor if you have these symptoms.

Breathing problems

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. You may have an inflammation of the lungs. This is a rare side effect. Your doctor can tell you more about this.

Effects on the liver

This treatment may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have regular blood tests to check how well your liver is working.

Less common and rare side effects

Tummy (abdominal) pain

Some people have pain or discomfort in their tummy during treatment with erlotinib. Tell your doctor 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
  • bleeding from the back passage
  • black stools
  • vomiting up blood (or vomit that looks like coffee grounds).

Hair changes

Changes to hair 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 may have some hair thinning or hair loss. 

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Smoking

Smoking reduces the level of erlotinib in the blood and may make it less effective. If you smoke, try to quit before you start treatment. Tell your doctor or pharmacist if you stop smoking during treatment.

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Problems with lactose

These tablets contain a type of sugar called lactose. If you have been told by a doctor that you cannot digest some sugars or are lactose intolerant, talk to your doctor before taking this drug.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.