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Erlotinib (Tarceva)

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This page tells you about the biological therapy erlotinib and its possible side effects. There is information about

 

What erlotinib is

Erlotinib is also known by its brand name, Tarceva (pronounced tar-see-vah). It is a treatment for

 

How erlotinib works

Erlotinib is a type of biological therapy called a tyrosine kinase inhibitor (TKI). It works by blocking particular proteins on cancer cells that encourage the cancer to grow. Erlotinib blocks proteins called epidermal growth factor receptors (EGFR). Cancers that have these receptors are called EGFR positive. For lung cancer, doctors check your cancer cells to see if they have the receptors before you have this treatment.

Erlotinib may shrink the cancer or stop it growing for a time.

 

How you take erlotinib

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.

It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

The side effects of erlotinib are listed below. Remember that you are likely to only to have a few of them. You can use the links (underlined) to find out more about each side effect. Where there is no link, please see our cancer drugs side effect section or use the search box at the top of the page. The side effects may be different if you are also taking other cancer drug treatments.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • 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
  • Sensitivity of the skin to sunlight – cover up with clothing and use sunscreen if you need to go out into the sun
  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Itching affects just over 1 in 10 people (13%)
  • Diarrhoea affects up to 1 in 2 people (50%) but is usually mild – tell your doctor or nurse if it is not controlled as they can prescribe medicines to stop it
  • Loss of appetite and weight loss happen in about 1 in 2 people (50%)
  • Tiredness and weakness (fatigue) happens in up to 1 in 2 people (50%)
  • Feeling sick affects just over 3 in 10 (33%) people – it is usually well controlled with anti sickness medicines. Let your doctor or nurse know if it is not controlled
  • Headaches
  • Numbness in the hands and feet – tell your doctor or nurse if you have this
  • Sore, red eyes or dry eyes affect up to 1 in 4 people (25%) – eye drops can help. Let your doctor or nurse know straight away if you have sudden or worsening eye redness or pain, watery eyes, or blurred vision and sensitivity to light
  • A sore mouth occurs in 1 in 5 people (20%)
  • Sadness, anxiety and depression affect about 1 in 10 people (10%)
  • Breathlessness and a cough due to lung inflammation
  • Stomach pain, indigestion and wind (flatulence)
  • Liver changes that are very mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your liver is working
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
  • Hair loss – hair growth on the head may be thinner or hair may be lost completely
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these effects.

  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia). Let your doctor or nurse know straight away if you have this
  • Swelling and inflammation around the fingernails
  • Bleeding from the stomach or bowel – people who have had peptic ulcers or diverticular disease are more likely to have this problem. Let your doctor or nurse know straight away if you have sudden, sharp tummy (abdominal)  pain, vomiting, or blood in your poo (faeces)
 

Rare side effects

Fewer than 1 in 100 people have these.

  • 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
  • Brittle or loose nails
  • Ingrowing eyelashes or loner and thicker eyelashes
  • Increased eyebrow growth – the hairs may be curlier than usual or grow in a different direction to usual
  • Increased hair on the face and body
 

Important points to remember

You will not get all the effects mentioned above. Any that occur may be mild. 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

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines and foods

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together. Some drugs or therapies can reduce how well erlotinib works. Some drugs may increase the harmful effects of the drug, including antibiotics and anti fungal medicines. 

Avoid grapefruit and grapefruit juice because they can increase the side effects. 

Stopping smoking

You are advised to stop smoking during treatment with erlotinib as it could lower the amount of the drug in your blood.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 2 weeks afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drug may come through in the breast milk.

 

Immunisations

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about erlotinib

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 26 August 2014