Erlotinib (Tarceva)

• What erlotinib is
• How you take erlotinib
• Common side effects
• Rare side effects
• Important points to remember

Erlotinib is also known by its brand name, Tarceva (tar-see-vah). It is a type of biological therapy called a tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that cells use to signal to each other to grow. They act as chemical messengers.

Erlotinib blocks tyrosine kinase within cells from sending growth signals. So the cancer cells don’t grow.

Erlotinib is a treatment for

• Pancreatic cancer that has spread - alongside the chemotherapy drug gemcitabine
• Advanced non small cell lung cancer for people who have already had chemotherapy which is no longer working

Erlotinib is a tablet. You take it once a day, at least 1 hour before eating, or 2 hours after eating. You usually carry on taking it for as long as it is still working.

Some drugs may increase the harmful effects of this drug, including antibiotics and antifungal medicines. Avoid grapefruit and grapefruit juice as they can increase the side effects. Some drugs can reduce how well erlotinib works. These include

• Some antibiotics
• Anti epileptic medicines
• Indigestion medicines
• St John's Wort
• Smoking

You should let your doctor, nurse or pharmacist know about any other drugs or complementary medicines you are taking.

The side effects of erlotinib are listed below. Remember most people don’t have all of them.

Many people have one or more of the following side effects

• Skin changes occur in about 3 in 4 people (75%) - you may have a rash, blistering, or red, dry, skin, which usually starts within 10 days of starting erlotinib. If it is severe your doctors may reduce the dose or stop treatment.
• Itching affects just over 1 in 10 people (13%)
• Diarrhoea affects up to 1 in 2 people (50%), but is usually mild - do tell your doctor or nurse as you can have medicines to stop it
• Loss of appetite happens in about 1 in 2 people who take this drug (50%)
• Fatigue happens in up to 1 in 2 people (50%)
• Sickness affects just over 3 in 10 (33%) people, but is usually well controlled with anti sickness drugs
• Sore, red eyes (conjunctivitis) or dry eyes affect up to1 in 4 people (25%) - eye drops can help
• A sore mouth occurs in 1 in 5 people (20%)
• Low mood, including anxiety and depression, affects about 1 in 10 people (10%) who have erlotinib combined with gemcitabine
• Loss of fertility - you may not be able to get pregnant or father a child after treatment with this drug. It is important to talk to your doctor about your fertility before starting treatment
• We don’t know whether erlotinib can harm a developing baby - do talk to your doctor about contraception before having treatment if there is any chance you or your partner could become pregnant

A few people may have some of the following effects

• Severe lung problems occur in fewer than 1 in 100 (1%) people - if you have a cough, high temperature and are short of breath contact your treatment centre urgently.
• An effect on the liver, which is unlikely to cause symptoms, and usually goes back to normal after the treatment ends - you will have regular blood tests to check how your liver is working and may stop treatment if tests show that your liver is being affected by the drug
• Brittle or loose nails occur in fewer than 1 in 10 people (10%)
• A hole in the bowel wall has occurred but this is very rare and usually happens if people are also having steroids, non steroidal antiinflammatory drugs or taxane-based chemotherapy. People who have had peptic ulcers or diverticular disease are more likelyto have this problem.
• Abnormal eyelash growth, eye pain or ulcers on the surface of the eye occur but this is rare. If it is severe your doctors may reduce the dose or stop treatment.

Not everyone will get these side effects. You may have none or several. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. The side effects depend on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we tell you to contact your doctor, it is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together. Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your specialist, clinic or ward nurse should give you a phone number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.