Erlotinib (TARCEVA)

Non-small cell lung cancer – advanced or metastatic, with EGFR mutations

Non-small cell lung cancer – advanced or metastatic, with EGFR mutations

• Oral: 150 mg daily continuously until disease progression or unacceptable toxicity

Available as 25 mg, 100 mg or 150 mg film-coated tablets. Tablets should NOT be crushed or broken. Store at room temperature. Tablets contain lactose.

EGFR (epidermal growth factor receptor) inhibitor

Take at least one hour before or two hours after a meal

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Fatigue, Rash, Anorexia, Diarrhea, Dyspnea.

Less Common: INR elevations, bleeding events, Gastrointestinal hemorrhage or perforation, Increases in liver transaminases, Conjunctivitis, Dry eyes, Interstitial lung disease.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: alkaline phosphatase, ALT, total bilirubin, LDH, chest X-ray.

During treatment: alkaline phosphatase, ALT, bilirubin, LDH should be checked two weeks after starting and at every visit.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Avoid concurrent therapy with proton pump inhibitors, H2 receptor antagonists, and short acting antacids.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Monitor for ILD (interstitial lung disease), which can be fatal.
• Avoid in pregnancy and lactation.
• Cigarette smoking can decrease erlotinib levels.
• Diarrhea commonly occurs. Severe diarrhea can result in dehydration, electrolyte imbalance, and renal insufficiency. Manage with loperamide.
• Rash is very common, patients should minimize sun exposure and use sunscreen.

BC Cancer. BC Cancer Drug Manual. Erlotinib. Vancouver, British Columbia: BC Cancer Agency. Available at http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Erlotinib_monograph_1July2014.pdf. Updated July 1, 2012. Accessed January 22, 2024.

Lexicomp. Erlotinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6841?cesid=8LpqzfjlZv7&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Derlotinib%26t%3Dname%26acs%3Dfalse%26acq%3Derlotinib. Updated January 16, 2024. Accessed January 22, 2024.

Cancer Care Ontario. Erlotinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44041. Updated October 2022. Accessed January 22, 2024.

Hoffmann-La Roche Ltd. TARCEVA® Product Information. Mississauga, Ontario: Hoffmann-La Roche Ltd. Updated September 23, 2021.