ERLOTINIB

Erlotinib is a targeted therapy. It is classified as an epidermal growth factor receptor (EGFR) inhibitor – protein-tyrosine kinase inhibitor

What erlotinib is used for?

• Treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC).
• Treatment of patients with locally advanced, unresectable, or metastatic pancreatic cancer.

Other off-label uses:

1. Chordoma
2. Biliary tract cancers
3. Head and neck cancers

How erlotinib is given?

Erlotinib is given in tablet form to be taken by mouth at least one hour before or two hours after eating. The tablets are supplied in 25mg, 100mg, and 150mg strengths. Additionally, erlotinib interacts with proton pump inhibitors like pantoprazole. As a result, a gap of 2 hours is given before the drug and PPI.

Side Effects

Important things to remember about the side effects of erlotinib:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.

The following side effects are common (occurring in greater than 30%) among patients taking erlotinib:

• Rash
• Diarrhea
• Poor appetite
• Fatigue
• Shortness of breath
• Cough
• Nausea and vomiting

The following side effects are less common (occurring in about 10-29%) among patients receiving erlotinib:

• Infection
• Mouth sores
• Itching
• Dry skin
• Eye irritation
• Abdominal pain

The following symptoms require medical attention but are not an emergency. Contact your doctor within 24 hours of noticing any of the following:

• Nausea (interferes with the ability to eat and is unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24-hour period).
• Diarrhea (4-6 episodes in a 24-hour period).
• Extreme fatigue (unable to carry on self-care activities).
• Mouth sores (painful redness, swelling, or ulcers).
• Eye irritation.
• Unable to eat or drink for 24 hours or have signs of dehydration, such as tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness.

Precautions

• Before starting erlotinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter (OTC), vitamins, herbal remedies, etc.).  Certain medications can interfere with the levels/effects of erlotinib.  It is important that your oncologist is aware of all medications.  Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor’s approval while taking erlotinib.
• Inform your healthcare professional if you are pregnant or may be pregnant before starting this treatment. Erlotinib belongs to pregnancy category D (it may be hazardous to the fetus), women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.
• For both men and women: Do not conceive a child (get pregnant) while taking erlotinib. Barrier methods of contraception, such as condoms, are recommended. Furthermore, discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breastfeed while taking this medication.

Self-Care Tips

• Erlotinib should be taken on an empty stomach, 1 hour before or 2 hours after eating.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection report fever or any other signs of infection immediately to your healthcare provider.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your healthcare team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.