Tarceva-Erlotnib

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Description

Your chemotherapy treatment is called erlotinib (er-LA-tin-nib) or Tarceva® (tar-SEA-va). It is commonly used to treat non-small lung cancer and has also been used to treat other diseases. Erlotinib is a new kind of anti-cancer drug called a tyrosine kinase inhibitor. This drug prevents cancer cells from dividing and growing, and can eventually cause the cancer cells to shrink and die.

What Do I Need to Know Before Starting Treatment?

Be sure to tell your healthcare provider about any prescription or over-the-counter products you are taking, including dietary supplements, vitamins, herbal medicines and homeopathic remedies. Use an effective birth control method while you are taking these drugs. Erlotinib can cause harm to a fetus, so be sure to tell your healthcare provider right away if you or your partner becomes pregnant. Avoid breastfeeding during treatment. It is not known if erlotinib passes into breast milk. Some chemotherapy drugs can cause sterility. Talk with your healthcare provider about your options if you want to have children in the future. Do not get any immunizations or vaccinations while taking chemotherapy drugs without the approval of your healthcare provider. Chemotherapy can sometimes cause changes in the amount of electrolytes in your body, such as sodium, potassium and magnesium. Your healthcare provider will check your blood for these changes and will treat any problems that are found.

What Do I Need to Know Before Starting Erlotinib?

Erlotinib commonly causes a mild to moderate rash or dry skin that affects skin areas above the waist. Typically, the rash develops about eight to ten days after the start of treatment. Tell your healthcare provider if your rash is severe. In rare cases, erlotinib can cause Stevens-Johnson syndrome or toxic epidermal necrolysis, two serious skin conditions. Tell your healthcare provider immediately if you develop a rash that looks like pimples or blisters on the skin, in the mouth or on the genitals or if you develop swelling around the eyes. Erlotinib can cause gastrointestinal perforation (holes in the stomach, intestines or colon) that must be repaired through surgery. You may be at higher risk for this side effect if you have peptic ulcers, diverticulitis or if you are taking an NSAID such as ibuprofen. Call your healthcare provider right away if you have abdominal pain with nausea, vomiting, blood in your stool, constipation or fever. In rare cases, erlotinib can cause a serious lung disease called interstitial lung disease. Tell your healthcare provider if you suddenly have shortness of breath, a cough or a fever. The skin conditions, gastrointestinal perforation and lung disease caused by erlotinib can be severe and life- threatening. Erlotinib can cause eye problems, such as conjunctivitis, keratitis (inflammation of the cornea) and ulcers on the cornea. These side effects can cause vision problems. Tell your healthcare provider immediately if you have eye pain during treatment. Erlotinib can cause problems with liver and kidney function. In rare cases, erlotinib can cause liver or kidney failure. Your healthcare provider will check your kidneys and liver regularly to make sure they are working properly. Your treatment can interact with other substances, including:
  • Rifabutin (Mycobutin®), rifampin (Rifadin®) or isoniazid
  • Phenytoin (Dilantin®), carbamazepine (Tegretol®) or phenobarbital (Luminal® or Solfoton®)
  • Fluconazole (Diflucan®), itraconazole (Sporanox®), ketoconazole (Nizoral®), voriconazole (Vfend®) or posaconazole (Noxafil®)
  • Steroids, such as dexamethasone
  • Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen or naproxen
  • St. John’s wort
  • Clarithromycin (Biaxin®), erythromycin (E-mycin®) or telithromycin (Ketek®)
  • Grapefruit, grapefruit juice or starfruit
  • Drugs used to treat HIV, such as atazanavir (Reyataz®), indinavir (Crixivan®), nelfinavir (Viracept®), ritonavir (Norvir®) or saquinavir (Invirase®)
  • Nefazodone
  • Omeprazole (Prilosec®), cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®) or nizatidine (Axid®)
  • Warfarin (Coumadin®)
  • Tobacco
Please note this list is a summary and does not contain all possible drug interactions. Contact your healthcare provider if you are taking any medications that can interact with your treatment. You should not take this treatment if you are allergic to erlotinib or any of its components.

How Is the Treatment Given?

Erlotinib is usually taken once a day. You should take erlotinib one hour before a meal or two hours after a meal. Do not take erlotinib with food. Try to take erlotinib at around the same time every day. If you miss a dose, skip it and take the next dose as scheduled. Do not take two doses of erlotinib at the same time. It is important to take erlotinib exactly as prescribed. Do not stop the medicine or change the dose on your own without talking with your healthcare provider. Store erlotinib at room temperature away from children and pets. If you take too much erlotinib, contact your healthcare provider, local poison control center or emergency room right away. Do not share erlotinib with others. Sharing this medication with anyone else could be harmful.

When Should I Call My Healthcare Provider?

Call your healthcare provider right away if you have any of the following symptoms:
  • Shaking chills or fever of 100.5 degrees F or higher
  • Unusual bleeding, easy bruising or pinpoint red spots on your skin
  • Vomiting that is severe or that lasts several hours
  • Painful or frequent urination or blood in your urine
  • Diarrhea that causes an additional four bowel movements a day, diarrhea that lasts more than one day, diarrhea at night or diarrhea with fever, cramps or bloody stools
  • Irregular or rapid heartbeat, chest pain, chest tightness or shortness of breath
  • Dizziness or feeling lightheaded
  • Inability to eat or weight loss
 

What Are the Possible Side Effects?

All drugs can cause side effects, but every person reacts differently to each drug. The following chart lists the possible side effects that can occur with your treatment, how to recognize and minimize symptoms and possible treatments. The side effects are grouped by how often the side effect occurs: Common (occurs in more than 25 percent of patients), Less Common (occurs in 5 to 25 percent of patients) or Rare (occurs in less than 5 percent of patients).
Side Effect How to Minimize Side Effect Possible Treatments
Rash (Common. Symptoms are generally mild to moderate but can be severe.)
  • Usually mild and short-lived
  • Generally appears on the arms and trunk (occasionally on the face)
  • May be itchy
  • May appear as a flat, discolored area on the skin or as a small raised bump
  • Avoid prolonged exposure to heat.
  • Use creams or moisturizers regularly. Try wearing cotton gloves on your hands.
  • Avoid using perfume, cologne or aftershave since these products can be irritating to the skin.
  • Your healthcare provider may prescribe creams (mild steroids, antihistamines or antibiotics) to help treat the rash.
  • The rash may improve on its own without any treatment.
Nausea/Vomiting (Common. Symptoms are generally mild to moderate.)
  • Feeling queasy or sick to your stomach
  • Eat small, frequent meals and bland foods— such as bananas, rice, applesauce and toast.
  • Eat food cold or at room temperature so the smell of food will not bother you.
  • Avoid fried, spicy or fatty foods.
  • Eat and drink slowly.
  • Drink plenty of liquids during the day, but to avoid bloating, drink small amounts of liquid during meals.
  • You will be given medicine to help reduce nausea and vomiting.
 
Diarrhea (Common. Symptoms are generally mild to moderate.)
  • Loose or watery stools several times a day
  • Abdominal cramping, gas and bloating
  • Eat small, frequent meals and bland foods— such as bananas, rice, applesauce and toast.
  • Avoid caffeine; alcohol; raw fruits and vegetables; raw eggs; undercooked meats; spicy, fatty and greasy foods; milk and dairy products; foods that cause gas, such as beans and other legumes; high fiber and high- fat foods; foods left un-refrigerated for more than two hours (one hour for egg dishes andcream or mayonnaise-based foods); bulk laxatives; and stool softeners.
  • Drink eight to ten glasses of clear liquids every day.
  • Your healthcare provider may prescribe medicine to help treat diarrhea.
Anorexia or Appetite Loss (Common. Weight loss is generally mild to moderate.)
  • Not having an appetite
  • Feeling too nauseous to eat
  • Metallic or medicinal taste
  • Change in taste causing dislike for certain foods
  • Try eating six to eight small meals or snacks each day instead of three larger meals.
  • Vary your diet and try new foods and recipes.
  • Take a walk before meals, when possible. This may make you feel hungrier.
  • Eat with friends or family. When eating alone, listen to the radio or watch TV.
  • Cook dinners ahead of time and freeze them in small portions so that cooking smells are minimized.
  • Let others help with food, but ask that foods be prepared in small portions that can be frozen. And don’t hesitate to let them know which foods to avoid.
  • Add mild spices to change flavor.
  • It might be helpful to have a program, such as Meals on Wheels, deliver food to you.
Mouth Sores and Pain (Less Common. Symptoms are generally mild.)
  • Pain, swelling or redness of the mouth, tongue and throat
  • “Coated tongue”
  • Difficulty talking, swallowing or eating
  • Bleeding ulcers and infection
  • Brush teeth two to four times a day using a soft bristle brush and fluoride toothpaste.
  • Use non-waxed dental floss daily.
  • Ask your healthcare provider to recommend a mouthwash that does not contain alcohol.
  • Sip water during the day and use sugar-free candy or gum to keep your mouth wet.
  • Eat food cold or at room temperature.
  • Eat soft or pureed food.
  • Avoid food that is acidic, spicy, salty, dry or rough, such as toast.
  • You may be given medicine to help treat pain.
  • You may be given medicine to treat fungal or viral infections.
Risk of Infection (Less Common)
  • Fever and chills
  • Painful urination
  • Sore throat and cough
  • Nasal congestion
  • Swelling or redness of the skin at the site of a wound
 
  • Wash your hands often.
  • Brush and floss your teeth daily.
  • Clean cuts right away with warm water, soap and antiseptic.
  • When your white blood cell count is low, stay away from crowds and people with colds or other illnesses.
  • You may be given medicine to increase your white blood cell count.
  • You may be given an antibiotic to treat or prevent infection.
  • Your healthcare provider may decrease your dose or delay further treatment.
 

What Are the Other Possible Side Effects?

The chart below lists additional side effects found with this treatment. It does not list all possible side effects. For more information, talk with your healthcare provider. Common Side Effects
  • Fatigue (can be severe)
  • Shortness of breath or cough
  • Conjunctivitis
 

Less Common Side Effects

  • Stomach pain
  • Itchy, dry skin
  • Dehydration
 

Rare Side Effects

  • Allergic reactions
  • Severe high blood pressure
  • Pneumonia