Tarceva (Erlotinib)
برای این دارو، اطلاعات عمومی (فارسی) یافت نشد . برای افزودن اطلاعات فارسی به این دارو کلیک نمایید.
Tarceva (Erlotinib)

TARCEVA®
(erlotinib) Tablets, Oral

DRUG DESCRIPTION

TARCEVA (erlotinib), a kinase inhibitor, is a quinazolinamine with the chemical name N-(3-ethynylphenyl)-6,7-bis(2-methoxyethoxy)-4-quinazolinamine. TARCEVA contains erlotinib as the hydrochloride salt that has the following structural formula:

TARCEVA® (erlotinib) Structural Formula Illustration

Erlotinib hydrochloride has the molecular formula C22H23N3O4•HCl and a molecular weight of 429.90. The molecule has a pKa of 5.42 at 25oC. Erlotinib hydrochloride is very slightly soluble in water, slightly soluble in methanol and practically insoluble in acetonitrile, acetone, ethyl acetate and hexane.

Aqueous solubility of erlotinib hydrochloride is dependent on pH with increased solubility at a pH of less than 5 due to protonation of the secondary amine. Over the pH range of 1.4 to 9.6, maximal solubility of approximately 0.4 mg/mL occurs at a pH of approximately 2.

TARCEVA (erlotinib) tablets for oral administration are available in three dosage strengths containing erlotinib hydrochloride (27.3 mg, 109.3 mg and 163.9 mg) equivalent to 25 mg, 100 mg and 150 mg erlotinib and the following inactive ingredients: lactose monohydrate, hypromellose, hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, sodium lauryl sulfate and titanium dioxide. The tablets also contain trace amounts of color additives, including FD&C Yellow #6 (25 mg only) for product identification.

What are the possible side effects of erlotinib (Tarceva)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking erlotinib and call your doctor at once if you have a serious side effect such as:

  • new or worsening lung problems such as chest pain, dry cough with fever, wheezing, rapid breathing, feeling short of breath;
  • chest pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
  • sudden numbness or weakness, sudden severe headache, or problems with vision, speech, or...

Read All Potential Side Effects and See Pictures of Tarceva »

What are the precautions when taking erlotinib (Tarceva)?

Before taking erlotinib, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney problems, stomach/intestinal disease (such as ulcers, diverticulosis).

Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports to lower the chance of getting cut, bruised or injured.

This medicine may increase your risk of stomach bleeding. Limit alcoholic beverages.

Sunlight may worsen any skin reactions that may occur while you...

Read All Potential Precautions of Tarceva »

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

INDICATIONS

Non-Small Cell Lung Cancer (NSCLC)

TARCEVA (erlotinib) monotherapy is indicated for the maintenance treatment of patients with locally advanced or metastatic non-small cell lung cancer whose disease has not progressed after four cycles of platinum-based first-line chemotherapy [see Clinical Studies].

TARCEVA (erlotinib) monotherapy is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen [see Clinical Studies].

Results from two, multicenter, placebo-controlled, randomized, Phase 3 trials conducted in first-line patients with locally advanced or metastatic NSCLC showed no clinical benefit with the concurrent administration of TARCEVA (erlotinib) with platinum-based chemotherapy [carboplatin and paclitaxel or gemcitabine and cisplatin] and its use is not recommended in that setting [see Clinical Studies].

Pancreatic Cancer

TARCEVA (erlotinib) in combination with gemcitabine is indicated for the first-line treatment of patients with locally advanced, unresectable or metastatic pancreatic cancer [see Clinical Studies].

DOSAGE AND ADMINISTRATION

NSCLC

The recommended daily dose of TARCEVA (erlotinib) for NSCLC is 150 mg taken on an empty stomach at least one hour before or two hours after the ingestion of food. Treatment should continue until disease progression or unacceptable toxicity occurs. There is no evidence that treatment beyond progression is beneficial.

Pancreatic Cancer

The recommended daily dose of TARCEVA (erlotinib) for pancreatic cancer is 100 mg taken on an empty stomach at least one hour before or two hours after the ingestion of food, in combination with gemcitabine [see Clinical Studies or the gemcitabine package insert]. Treatment should continue until disease progression or unacceptable toxicity occurs.

Dose Modifications

In patients who develop an acute onset of new or progressive pulmonary symptoms, such as dyspnea, cough or fever, treatment with TARCEVA (erlotinib) should be interrupted pending diagnostic evaluation. If Interstitial Lung Disease (ILD) is diagnosed, TARCEVA (erlotinib) should be discontinued and appropriate treatment instituted as necessary [see WARNINGS AND PRECAUTIONS]. Discontinue TARCEVA (erlotinib) for hepatic failure or gastrointestinal perforation. Interrupt or discontinue TARCEVA (erlotinib) in patients with dehydration who are at risk for renal failure, in patients with severe bullous, blistering or exfoliative skin conditions, or in patients with acute /worsening ocular disorders [see WARNINGS AND PRECAUTIONS].

Diarrhea can usually be managed with loperamide. Patients with severe diarrhea who are unresponsive to loperamide or who become dehydrated may require dose reduction or temporary interruption of therapy. Patients with severe skin reactions may also require dose reduction or temporary interruption of therapy.

When dose reduction is necessary, the TARCEVA (erlotinib) dose should be reduced in 50 mg decrements.

In patients who are taking TARCEVA (erlotinib) with a strong CYP3A4 inhibitor such as, but not limited to, atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin (TAO), voriconazole, or grapefruit or grapefruit juice, a dose reduction should be considered if severe adverse reactions occur. Similarly, in patients who are taking TARCEVA (erlotinib) with an inhibitor of both CYP3A4 and CYP1A2 like ciprofloxacin, a dose reduction of TARCEVA (erlotinib) should be considered if severe adverse reactions occur [see DRUG INTERACTIONS].

Pre-treatment with the CYP3A4 inducer rifampicin decreased erlotinib AUC by about 2/3 to 4/5. Use of alternative treatments lacking CYP3A4 inducing activity is strongly recommended. If an alternative treatment is unavailable, an increase in the dose of TARCEVA (erlotinib) should be considered as tolerated at two week intervals while monitoring the patient's safety. The maximum dose of TARCEVA (erlotinib) studied in combination with rifampicin is 450 mg. If the TARCEVA (erlotinib) dose is adjusted upward, the dose will need to be reduced immediately to the indicated starting dose upon discontinuation of rifampicin or other inducers. Other CYP3A4 inducers include, but are not limited to rifabutin, rifapentine, phenytoin, carbamazepine, phenobarbital and St. John's Wort. These too should be avoided if possible [see DRUG INTERACTIONS].

Cigarette smoking has been shown to reduce erlotinib exposure. Patients should be advised to stop smoking. If a patient continues to smoke, a cautious increase in the dose of TARCEVA (erlotinib) , not exceeding 300 mg may be considered, while monitoring the patient's safety. However, efficacy and long-term safety ( > 14 days) of a dose higher than the recommended starting doses have not been established in patients who continue to smoke cigarettes. If the TARCEVA (erlotinib) dose is adjusted upward, the dose should be reduced immediately to the indicated starting dose upon cessation of smoking [see CLINICAL PHARMACOLOGY].

Erlotinib is eliminated by hepatic metabolism and biliary excretion. Although erlotinib exposure was similar in patients with moderately impaired hepatic function (Child-Pugh B), patients with hepatic impairment (total bilirubin > ULN or Child-Pugh A, B and C) should be closely monitored during therapy with TARCEVA [see WARNINGS AND PRECAUTIONS]. Treatment with TARCEVA (erlotinib) should be used with extra caution in patients with total bilirubin > 3 x ULN. TARCEVA (erlotinib) dosing should be interrupted or discontinued if changes in liver function are severe such as doubling of total bilirubin and/or tripling of transaminases in the setting of pretreatment values outside normal range. In the setting of worsening liver function tests, before they become severe, dose interruption and/or dose reduction with frequent liver function test monitoring should be considered. TARCEVA (erlotinib) dosing should be interrupted or discontinued if total bilirubin is > 3 x ULN and/or transaminases are > 5 x ULN in the setting of normal pretreatment values [see WARNINGS AND PRECAUTIONS, ADVERSE REACTIONS and Use in Specific Populations].

HOW SUPPLIED

Dosage Forms And Strengths

25 mg tablets

White film-coated tablets for daily oral administration. Round, biconvex face and straight sides, white film-coated, printed in orange with a “T” and “25” on one side and plain on the other side.

100 mg tablets

White film-coated tablets for daily oral administration. Round, biconvex face and straight sides, white film-coated, printed in gray with “T” and “100” on one side and plain on the other side.

150 mg tablets

White film-coated tablets for daily oral administration. Round, biconvex face and straight sides, white film-coated, printed in maroon with “T” and “150” on one side and plain on the other side.

Storage And Handling

25 mg Tablets

Round, biconvex face and straight sides, white film-coated, printed in orange with a “T” and “25” on one side and plain on the other side; supplied in: Bottles of 30: NDC 50242-062-01

100 mg Tablets

Round, biconvex face and straight sides, white film-coated, printed in gray with “T” and “100” on one side and plain on the other side; supplied in: Bottles of 30: NDC 50242-063-01

150 mg Tablets

Round, biconvex face and straight sides, white film-coated, printed in maroon with “T” and “150” on one side and plain on the other side; supplied in: Bottles of 30: NDC 50242-064-01

Store at 25°C (77°F); excursions permitted to 15° – 30°C (59° – 86°F). See USP Controlled Room Temperature.

Manufactured for: OSI Pharmaceuticals Inc., Melville, NY 11747. Manufactured by: Schwarz Pharma Manufacturing, Seymour, IN 47274. Distributed by: Genentech USA, Inc. 1 DNA Way, South San Francisco, CA 94080-4990. For further information please call 1-877-TARCEVA (erlotinib) (1-877-827-2382).

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

SIDE EFFECTS

Because clinical trials are conducted under widely varying conditions, adverse reactions rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Safety evaluation of TARCEVA (erlotinib) is based on more than 1200 cancer patients who received TARCEVA (erlotinib) as monotherapy, more than 300 patients who received TARCEVA (erlotinib) 100 or 150 mg plus gemcitabine, and 1228 patients who received TARCEVA (erlotinib) concurrently with other chemotherapies.

There have been reports of serious events, including fatalities, in patients receiving TARCEVA (erlotinib) for treatment of NSCLC, pancreatic cancer or other advanced solid tumors [see WARNINGS AND PRECAUTIONS and DOSAGE AND ADMINISTRATION].

Clinical Trial Experience

Non-Small Cell Lung Cancer

Maintenance Study

Adverse reactions, regardless of causality, that occurred in at least 3% of patients treated with single-agent TARCEVA (erlotinib) at 150 mg and at least 3% more often than in the placebo group in the randomized maintenance trial are summarized by NCI-CTC (version 3.0) Grade in Table 1.

The most common adverse reactions in patients receiving single-agent TARCEVA (erlotinib) 150 mg were rash and diarrhea. Grade 3/4 rash and diarrhea occurred in 6.0% and 1.8%, respectively, in TARCEVA (erlotinib) -treated patients. Rash and diarrhea resulted in study discontinuation in 1.2% and 0.5% of TARCEVA (erlotinib) -treated patients, respectively. Dose reduction or interruption for rash and diarrhea was needed in 5.1% and 2.8% of patients, respectively. In TARCEVA (erlotinib) -treated patients who developed rash, the onset was within two weeks in 66% and within one month in 81%.

Table 1: NSCLC Maintenance Study: Adverse Reactions Occurring More Frequently ( ≥ 3%) in the Single-Agent TARCEVA (erlotinib) Group than in the Placebo Group and in ≥ 3% of Patients in the TARCEVA (erlotinib) Group.

NCI-CTC Grade TARCEVA
N = 433
PLACEBO
N = 445
Any Grade Grade 3 Grade 4 Any Grade Grade 3 Grade 4
MedDRA Preferred Term % % % % % %
Rash 49.2 6.0 0 5.8 0 0
Diarrhea 20.3 1.8 0 4.5 0 0
Fatigue 9.0 1.8 0 5.8 1.1 0
Anorexia 9.2 < 1 0 4.9 < 1 0
Pruritus 7.4 < 1 0 2.7 0 0
Acne 6.2 < 1 0 0 0 0
Dermatitis Acneiform 4.6 < 1 0 1.1 0 0
Dry Skin 4.4 0 0 < 1 0 0
Weight Decreased 3.9 < 1 0 < 1 0 0
Paronychia 3.9 < 1 0 0 0 0

Liver function test abnormalities (including elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin) were observed in patients receiving single-agent TARCEVA (erlotinib) 150 mg in the Maintenance study. Grade 2 ( > 2.5 – 5.0 x ULN) ALT elevations occurred in 2% and 1%, and Grade 3 ( > 5.0 – 20.0 x ULN) ALT elevations were observed in 1% and 0% of TARCEVA (erlotinib) and placebo treated patients, respectively. The TARCEVA (erlotinib) treatment group had Grade 2 ( > 1.5-3.0 x ULN) bilirubin elevations in 4% and Grade 3 ( > 3.0-10.0 x ULN) in < 1% compared with < 1% for both Grades 2 and 3 in the placebo group. TARCEVA (erlotinib) dosing should be interrupted or discontinued if changes in liver function are severe [see DOSAGE AND ADMINISTRATION].

Second/Third Line Study

Adverse reactions, regardless of causality, that occurred in at least 10% of patients treated with single-agent TARCEVA (erlotinib) at 150 mg and at least 3% more often than in the placebo group in the randomized trial of patients with NSCLC are summarized by NCI-CTC (version 2.0) Grade in Table 2.

The most common adverse reactions in this patient population were rash and diarrhea. Grade 3/4 rash and diarrhea occurred in 9% and 6%, respectively, in TARCEVA (erlotinib) -treated patients. Rash and diarrhea each resulted in study discontinuation in 1% of TARCEVA (erlotinib) -treated patients. Six percent and 1% of patients needed dose reduction for rash and diarrhea, respectively. The median time to onset of rash was 8 days, and the median time to onset of diarrhea was 12 days.

Table 2: NSCLC 2nd/3rd Line Study: Adverse Reactions Occurring More Frequently ( ≥ 3%) in the Single-agent TARCEVA (erlotinib) 150 mg Group than in the Placebo Group and in ≥ 10% of Patients in the TARCEVA (erlotinib) Group.

NCI-CTC Grade TARCEVA 150 mg
N = 485
Placebo
N = 242
Any Grade Grade 3 Grade 4 Any Grade Grade 3 Grade 4
MedDRA Preferred Term % % % % % %
Rash 75 8 < 1 17 0 0
Diarrhea 54 6 < 1 18 < 1 0
Anorexia 52 8 1 38 5 < 1
Fatigue 52 14 4 45 16 4
Dyspnea 41 17 11 35 15 11
Cough 33 4 0 29 2 0
Nausea 33 3 0 24 2 0
Infection 24 4 0 15 2 0
Vomiting 23 2 < 1 19 2 0
Stomatitis 17 < 1 0 3 0 0
Pruritus 13 < 1 0 5 0 0
Dry skin 12 0 0 4 0 0
Conjunctivitis 12 < 1 0 2 < 1 0
Keratoconjunctivitis sicca 12 0 0 3 0 0
Abdominal pain 11 2 < 1 7 1 < 1

Liver function test abnormalities (including elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin) were observed in patients receiving single-agent TARCEVA (erlotinib) 150 mg. These elevations were mainly transient or associated with liver metastases. Grade 2 ( > 2.5 – 5.0 x ULN) ALT elevations occurred in 4% and < 1% of TARCEVA (erlotinib) and placebo treated patients, respectively. Grade 3 ( > 5.0 – 20.0 x ULN) elevations were not observed in TARCEVA (erlotinib) -treated patients. TARCEVA (erlotinib) dosing should be interrupted or discontinued if changes in liver function are severe [see DOSAGE AND ADMINISTRATION].

Pancreatic Cancer

Adverse reactions, regardless of causality, that occurred in at least 10% of patients treated with TARCEVA (erlotinib) 100 mg plus gemcitabine in the randomized trial of patients with pancreatic cancer are summarized by NCI-CTC (version 2.0) Grade in Table 3.

The most common adverse reactions in pancreatic cancer patients receiving TARCEVA (erlotinib) 100 mg plus gemcitabine were fatigue, rash, nausea, anorexia and diarrhea. In the TARCEVA (erlotinib) plus gemcitabine arm, Grade 3/4 rash and diarrhea were each reported in 5% of TARCEVA (erlotinib) plus gemcitabine-treated patients. The median time to onset of rash and diarrhea was 10 days and 15 days, respectively. Rash and diarrhea each resulted in dose reductions in 2% of patients, and resulted in study discontinuation in up to 1% of patients receiving TARCEVA (erlotinib) plus gemcitabine. The 150 mg cohort was associated with a higher rate of certain class-specific adverse reactions including rash and required more frequent dose reduction or interruption.

Table 3: Adverse Reactions Occurring in ≥ 10% of TARCEVA (erlotinib) -treated Pancreatic Cancer Patients: 100 mg cohort

NCI-CTC Grade TARCEVA + Gemcitabine 1000 mg/m² IV
N=259
Placebo + Gemcitabine1000 mg/m² IV
N=256
Any Grade Grade 3 Grade 4 Any Grade Grade 3 Grade 4
MedDRA Preferred Term % % % % % %
Fatigue 73 14 2 70 13 2
Rash 69 5 0 30 1 0
Nausea 60 7 0 58 7 0
Anorexia 52 6 < 1 52 5 < 1
Diarrhea 48 5 < 1 36 2 0
Abdominal pain 46 9 < 1 45 12 < 1
Vomiting 42 7 < 1 41 4 < 1
Weight decreased 39 2 0 29 < 1 0
Infection* 39 13 3 30 9 2
Edema 37 3 < 1 36 2 < 1
Pyrexia 36 3 0 30 4 0
Constipation 31 3 1 34 5 1
Bone pain 25 4 < 1 23 2 0
Dyspnea 24 5 < 1 23 5 0
Stomatitis 22 < 1 0 12 0 0
Myalgia 21 1 0 20 < 1 0
Depression 19 2 0 14 < 1 0
Dyspepsia 17 < 1 0 13 < 1 0
Cough 16 0 0 11 0 0
Dizziness 15 < 1 0 13 0 < 1
Headache 15 < 1 0 10 0 0
Insomnia 15 < 1 0 16 < 1 0
Alopecia 14 0 0 11 0 0
Anxiety 13 1 0 11 < 1 0
Neuropathy 13 1 < 1 10 < 1 0
Flatulence 13 0 0 9 < 1 0
Rigors 12 0 0 9 0 0
*Includes all MedDRA preferred terms in the Infections and Infestations System Organ Class

In the pancreatic carcinoma trial, 10 patients in the TARCEVA (erlotinib) /gemcitabine group developed deep venous thrombosis (incidence: 3.9%). In comparison, 3 patients in the placebo/gemcitabine group developed deep venous thrombosis (incidence 1.2%). The overall incidence of grade 3 or 4 thrombotic events, including deep venous thrombosis, was similar in the two treatment arms: 11% for TARCEVA (erlotinib) plus gemcitabine and 9% for placebo plus gemcitabine.

No differences in Grade 3 or Grade 4 hematologic laboratory toxicities were detected between the TARCEVA (erlotinib) plus gemcitabine group compared to the placebo plus gemcitabine group.

Severe adverse reactions ( ≥ grade 3 NCI-CTC) in the TARCEVA (erlotinib) plus gemcitabine group with incidences < 5% included syncope, arrhythmias, ileus, pancreatitis, hemolytic anemia including microangiopathic hemolytic anemia with thrombocytopenia, myocardial infarction/ischemia, cerebrovascular accidents including cerebral hemorrhage, and renal insufficiency [see WARNINGS AND PRECAUTIONS].

Liver function test abnormalities (including elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin) have been observed following the administration of TARCEVA (erlotinib) plus gemcitabine in patients with pancreatic cancer. Table 4 displays the most severe NCI-CTC grade of liver function abnormalities that developed. TARCEVA (erlotinib) dosing should be interrupted or discontinued if changes in liver function are severe [see DOSAGE AND ADMINISTRATION].

Table 4 :Liver Function Test Abnormalities (most severe NCI-CTC grade) in Pancreatic Cancer Patients: 100 mg Cohort

NCI-CTC Grade TARCEVA (erlotinib) + Gemcitabine 1000 mg/m² IV
N = 259
Placebo + Gemcitabine 1000 mg/m² IV
N = 256
Grade 2 Grade 3 Grade 4 Grade 2 Grade 3 Grade 4
Bilirubin 17 % 10% < 1% 11% 10% 3%
ALT 31% 13% < 1% 22% 9% 0%
AST 24% 10% < 1% 19% 9% 0%

NSCLC and Pancreatic Indications: Low Frequency Adverse Reactions

Gastrointestinal Disorders

Gastrointestinal perforations have been reported [see WARNINGS AND PRECAUTIONS].

During the NSCLC and the combination pancreatic cancer trials, infrequent cases of gastrointestinal bleeding have been reported, some associated with concomitant warfarin or NSAID administration [see WARNINGS AND PRECAUTIONS]. These adverse reactions were reported as peptic ulcer bleeding (gastritis, gastroduodenal ulcers), hematemesis, hematochezia, melena and hemorrhage from possible colitis.

Renal Disorders

Cases of acute renal failure or renal insufficiency, including fatalities, with or without hypokalemia have been reported [see WARNINGS AND PRECAUTIONS].

Hepatic Disorders

Hepatic failure has been reported in patients treated with single-agent TARCEVA (erlotinib) or TARCEVA (erlotinib) combined with chemotherapy [see WARNINGS AND PRECAUTIONS].

Ocular Disorders

Corneal ulcerations or perforations have been reported in patients receiving TARCEVA (erlotinib) treatment. Abnormal eyelash growth including in-growing eyelashes, excessive growth and thickening of the eyelashes have been reported [see WARNINGS AND PRECAUTIONS] and are risk factors for corneal ulceration/perforation.

NCI-CTC Grade 3 conjunctivitis and keratitis have been reported infrequently in patients receiving TARCEVA (erlotinib) therapy in the NSCLC and pancreatic cancer clinical trials. [see PATIENT INFORMATION].

Skin, Hair, and Nail Disorders

Bullous, blistering and exfoliative skin conditions have been reported including cases suggestive of Stevens-Johnson syndrome/Toxic epidermal necrolysis [seeWARNINGS AND PRECAUTIONS].

In patients who develop skin rash, the appearance of the rash is typically erythematous and maculopapular and it may resemble acne with follicular pustules, but is histopathologically different. This skin reaction commonly occurs on the face, upper chest and back, but may be more generalized or severe (NCI-CTC Grade 3 or 4) with desquamation. Skin reactions may occur or worsen in sun exposed areas; therefore, the use of sunscreen or avoidance of sun exposure is recommended. Associated symptoms may include itching, tenderness and/or burning. Also, hyperpigmentation or dry skin with or without digital skin fissures may occur.

Hair and nail disorders including alopecia, hirsutism, eyelash/eyebrow (see above) changes, paronychia and brittle and loose nails have been reported.

Other Disorders

Epistaxis was also reported in both the single-agent NSCLC and the pancreatic cancer clinical trials.

In general, no notable differences in the safety of TARCEVA (erlotinib) monotherapy or in combination with gemcitabine could be discerned between females or males and between patients younger or older than the age of 65 years [see Use in Specific Populations]. The safety of TARCEVA (erlotinib) appears similar in Caucasian and Asian patients.

Post-marketing Experience

The following adverse reactions have been identified during post approval use of TARCEVA (erlotinib) . Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Skin and subcutaneous tissue disorders

Hair and nail changes, mostly non-serious e.g. hirsutism, eyelash/eyebrow changes, paronychia and brittle and loose nails. Bullous, blistering and exfoliative skin conditions have been reported including cases suggested of Stevens-Johnson syndrome/Toxic epidermal necrolysis [seeWARNINGS AND PRECAUTIONS].

Gastrointestinal Disorders

Gastrointestinal perforations [seeWARNINGS AND PRECAUTIONS].

Hepatic Disorders

Hepatic failure has been reported in patients treated with single-agent TARCEVA (erlotinib) or TARCEVA (erlotinib) combined with chemotherapy [seeWARNINGS AND PRECAUTIONS].

Read the Tarceva (erlotinib) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

Erlotinib is metabolized predominantly by CYP3A4, and inhibitors of CYP3A4 would be expected to increase exposure. Co-treatment with the potent CYP3A4 inhibitor ketoconazole increases erlotinib AUC by 2/3. When TARCEVA (erlotinib) was co-administered with ciprofloxacin, an inhibitor of both CYP3A4 and CYP1A2, the erlotinib exposure [AUC] and maximum concentration [Cmax] increased by 39% and 17% respectively. Caution should be used when administering or taking TARCEVA (erlotinib) with ketoconazole and other strong CYP3A4 inhibitors such as, but not limited to, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin (TAO), voriconazole and grapefruit or grapefruit juice [see DOSAGE AND ADMINISTRATION].

Pre-treatment with the CYP3A4 inducer rifampicin for 7 days prior to TARCEVA decreased erlotinib AUC by about 2/3 to 4/5, which is equivalent to a dose of about 30 to 50 mg in NSCLC patients. In a separate study, treatment with rifampicin for 11 days, with co-administration of a single 450 mg dose of TARCEVA on day 8 resulted in a mean erlotinib exposure (AUC) that was 57.6% of that observed following a single 150 mg TARCEVA (erlotinib) dose in the absence of rifampicin treatment [see Dose Modifications]. Use of alternative treatments lacking CYP3A4 inducing activity is strongly recommended. If an alternative treatment is unavailable, adjusting the starting dose should be considered. If the TARCEVA (erlotinib) dose is adjusted upward, the dose will need to be reduced immediately to the indicated starting dose upon discontinuation of rifampicin or other inducers. Other CYP3A4 inducers include, but are not limited to, rifabutin, rifapentine, phenytoin, carbamazepine, phenobarbital and St. John's Wort [see DOSAGE AND ADMINISTRATION].

Cigarette smoking has been shown to reduce erlotinib AUC. Patients should be advised to stop smoking; however, if they continue to smoke, a cautious increase in the dose of TARCEVA (erlotinib) may be considered, while monitoring the patient's safety. If the TARCEVA (erlotinib) dose is adjusted upward, the dose should be reduced immediately to the indicated starting dose upon cessation of smoking [see DOSAGE AND ADMINISTRATION and CLINICAL PHARMACOLOGY].

Pretreatment and co-administration of TARCEVA (erlotinib) decreased the AUC of CYP3A4 substrate, midazolam, by 24%. The mechanism is not clear.

In a study, there were no significant effects of gemcitabine on the pharmacokinetics of erlotinib nor were there significant effects of erlotinib on the pharmacokinetics of gemcitabine.

Drugs that alter the pH of the upper GI tract may alter the solubility of erlotinib and reduce its bioavailability. Increasing the dose of TARCEVA (erlotinib) when coadministered with such agents is not likely to compensate for the loss of exposure. Co-administration of TARCEVA (erlotinib) with omeprazole, a proton pump inhibitor, decreased the erlotinib AUC by 46%. Since proton pump inhibitors affect pH of the upper GI tract for an extended period, separation of doses may not eliminate the interaction. The concomitant use of proton pump inhibitors with TARCEVA (erlotinib) should be avoided if possible. Co-administration of TARCEVA (erlotinib) with 300 mg ranitidine, an H2 receptor antagonist, decreased erlotinib AUC by 33%. When TARCEVA (erlotinib) was administered with ranitidine 150 mg twice daily (at least 10 h after the previous ranitidine evening dose and 2 h before the ranitidine morning dose), the erlotinib AUC decreased by 15%. If patients need to be treated with an H2-receptor antagonist such as ranitidine, it should be used in a staggered manner. TARCEVA (erlotinib) must be taken once a day, 10 hours after the H2-receptor antagonist dosing and at least 2 hours before the next dose of H2-receptor antagonist. Although the effect of antacids on erlotinib pharmacokinetics has not been evaluated, the antacid dose and the TARCEVA (erlotinib) dose should be separated by several hours, if an antacid is necessary. [see CLINICAL PHARMACOLOGY].

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

WARNINGS

Included as part of the PRECAUTIONS section.

PRECAUTIONS

Pulmonary Toxicity

There have been reports of serious Interstitial Lung Disease (ILD)-like events, including fatalities, in patients receiving TARCEVA (erlotinib) for treatment of NSCLC, pancreatic cancer or other advanced solid tumors. In the randomized single-agent NSCLC studies [see Clinical Studies], the incidence of serious ILD-like events in the TARCEVA (erlotinib) treated patients versus placebo treated patients was 0.7% versus 0% in the maintenance study and 0.8% for both groups in the 2nd and 3rd line study. In the pancreatic cancer study - in combination with gemcitabine – [see Clinical Studies], the incidence of ILD-like events was 2.5% in the TARCEVA (erlotinib) plus gemcitabine group vs. 0.4% in the placebo plus gemcitabine group.

The overall incidence of ILD-like events in approximately 32,000 TARCEVA (erlotinib) -treated patients from all studies (including uncontrolled studies and studies with concurrent chemotherapy) was approximately 1.1%.

Reported diagnoses in patients suspected of having ILD-like events included pneumonitis, radiation pneumonitis, hypersensitivity pneumonitis, interstitial pneumonia, interstitial lung disease, obliterative bronchiolitis, pulmonary fibrosis, Acute Respiratory Distress Syndrome and lung infiltration. Symptoms started from 5 days to more than 9 months (median 39 days) after initiating TARCEVA (erlotinib) therapy. In the lung cancer trials most of the cases were associated with confounding or contributing factors such as concomitant/prior chemotherapy, prior radiotherapy, pre-existing parenchymal lung disease, metastatic lung disease, or pulmonary infections.

In the event of an acute onset of new or progressive unexplained pulmonary symptoms such as dyspnea, cough, and fever, TARCEVA (erlotinib) therapy should be interrupted pending diagnostic evaluation. If ILD is diagnosed, TARCEVA (erlotinib) should be discontinued and appropriate treatment instituted as needed [see DOSAGE AND ADMINISTRATION].

Renal Failure

Cases of hepatorenal syndrome, acute renal failure (including fatalities), and renal insufficiency have been reported. Some were secondary to baseline hepatic impairment while others were associated with severe dehydration due to diarrhea, vomiting, and/or anorexia or concurrent chemotherapy use. In the event of dehydration, particularly in patients with contributing risk factors for renal failure (eg, pre-existing renal disease, medical conditions or medications that may lead to renal disease, or other predisposing conditions including advanced age), TARCEVA (erlotinib) therapy should be interrupted and appropriate measures should be taken to intensively rehydrate the patient. Periodic monitoring of renal function and serum electrolytes is recommended in patients at risk of dehydration [see ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION].

Hepatotoxicity

Cases of hepatic failure and hepatorenal syndrome (including fatalities) have been reported during use of TARCEVA (erlotinib) , particularly in patients with baseline hepatic impairment. Therefore, periodic liver function testing (transaminases, bilirubin, and alkaline phosphatase) is recommended. In the setting of worsening liver function tests, dose interruption and/or dose reduction with frequent liver function test monitoring should be considered. TARCEVA (erlotinib) dosing should be interrupted or discontinued if total bilirubin is > 3 x ULN and/or transaminases are > 5 x ULN in the setting of normal pretreatment values [see ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION].

Patients with Hepatic Impairment

In a pharmacokinetic study in patients with moderate hepatic impairment (Child-Pugh B) associated with significant liver tumor burden, 10 out of 15 patients died on treatment or within 30 days of the last TARCEVA (erlotinib) dose. One patient died from hepatorenal syndrome, 1 patient died from rapidly progressing liver failure and the remaining 8 patients died from progressive disease. Six out of the 10 patients who died had baseline total bilirubin > 3 x ULN suggesting severe hepatic impairment. Treatment with TARCEVA (erlotinib) should be used with extra caution in patients with total bilirubin > 3 x ULN. Patients with hepatic impairment (total bilirubin > ULN or Child-Pugh A, B and C) should be closely monitored during therapy with TARCEVA (erlotinib) . TARCEVA (erlotinib) dosing should be interrupted or discontinued if changes in liver function are severe such as doubling of total bilirubin and/or tripling of transaminases in the setting of pretreatment values outside normal range [see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION].

Gastrointestinal Perforation

Gastrointestinal perforation (including fatalities) have been reported in patients receiving TARCEVA (erlotinib) . Patients receiving concomitant anti-angiogenic agents, corticosteroids, NSAIDs, and/or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease are at increased risk. [see ADVERSE REACTIONS]. Permanently discontinue TARCEVA (erlotinib) in patients who develop gastrointestinal perforation.

Bullous and Exfoliative Skin Disorders

Bullous, blistering and exfoliative skin conditions have been reported including cases suggestive of Stevens-Johnson syndrome/Toxic epidermal necrolysis, which in some cases were fatal [see ADVERSE REACTIONS]. Interrupt or discontinue TARCEVA (erlotinib) treatment if the patient develops severe bullous, blistering or exfoliating conditions.

Myocardial Infarction/Ischemia

In the pancreatic carcinoma trial, six patients (incidence of 2.3%) in the TARCEVA (erlotinib) /gemcitabine group developed myocardial infarction/ischemia. One of these patients died due to myocardial infarction. In comparison, 3 patients in the placebo/gemcitabine group developed myocardial infarction (incidence 1.2%) and one died due to myocardial infarction.

Cerebrovascular Accident

In the pancreatic carcinoma trial, six patients in the TARCEVA (erlotinib) /gemcitabine group developed cerebrovascular accidents (incidence: 2.3%). One of these was hemorrhagic and was the only fatal event. In comparison, in the placebo/gemcitabine group there were no cerebrovascular accidents.

Microangiopathic Hemolytic Anemia with Thrombocytopenia

In the pancreatic carcinoma trial, two patients in the TARCEVA (erlotinib) /gemcitabine group developed microangiopathic hemolytic anemia with thrombocytopenia (incidence: 0.8%). Both patients received TARCEVA (erlotinib) and gemcitabine concurrently. In comparison, in the placebo/gemcitabine group there were no cases of microangiopathic hemolytic anemia with thrombocytopenia.

Ocular Disorders

Corneal perforation or ulceration have been reported during use of TARCEVA (erlotinib) . Other ocular disorders including abnormal eyelash growth, keratoconjunctivitis sicca or keratitis have been observed with TARCEVA (erlotinib) treatment and are known risk factors for corneal ulceration/perforation [see ADVERSE REACTIONS]. Interrupt or discontinue TARCEVA (erlotinib) therapy if patients present with acute/worsening ocular disorders such as eye pain.

Elevated International Normalized Ratio and Potential Bleeding

International Normalized Ratio (INR) elevations and infrequent reports of bleeding events, including gastrointestinal and non-gastrointestinal bleeding, have been reported in clinical studies, some associated with concomitant warfarin administration. Patients taking warfarin or other coumarin-derivative anticoagulants should be monitored regularly for changes in prothrombin time or INR [see ADVERSE REACTIONS].

Use in Pregnancy

TARCEVA (erlotinib) can cause fetal harm when administered to a pregnant woman. Erlotinib administered to rabbits during organogenesis at doses that result in plasma drug concentrations of approximately 3 times those in humans at the recommended dose of 150 mg daily, was associated with embryofetal lethality and abortion. When erlotinib was administered to female rats prior to mating and through the first week of pregnancy, at doses 0.3 or 0.7 times the clinical dose of 150 mg, on a mg/m² basis, there was an increase in early resorptions that resulted in a decrease in the number of live fetuses [see Use in Specific Populations].

There are no adequate and well-controlled studies in pregnant women using TARCEVA (erlotinib) . Women of childbearing potential should be advised to avoid pregnancy while on TARCEVA (erlotinib) . Adequate contraceptive methods should be used during therapy, and for at least 2 weeks after completing therapy. If TARCEVA (erlotinib) is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

Erlotinib has not been tested for carcinogenicity.

Erlotinib has been tested for genotoxicity in a series of in vitro assays (bacterial mutation, human lymphocyte chromosome aberration, and mammalian cell mutation) and an in vivo mouse bone marrow micronucleus test and did not cause genetic damage.

Erlotinib did not impair fertility in either male or female rats.

Use In Specific Populations

Pregnancy

Pregnancy Category D [See ‘WARNINGS AND PRECAUTIONS' section]

TARCEVA (erlotinib) can cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised not to become pregnant while being treated with TARCEVA.

Erlotinib has been shown to cause maternal toxicity with associated embryofetal lethality and abortion in rabbits when given at doses that result in plasma drug concentrations of approximately 3 times those in humans (AUCs at 150 mg daily dose). When given during the period of organogenesis to achieve plasma drug concentrations approximately equal to those in humans, based on AUC, there was no increased incidence of embryofetal lethality or abortion in rabbits or rats. However, female rats treated with 30 mg/m²/day or 60 mg/m²/day (0.3 or 0.7 times the clinical dose, on a mg/m² basis) of erlotinib prior to mating through the first week of pregnancy had an increase in early resorptions that resulted in a decrease in the number of live fetuses.

No teratogenic effects were observed in rabbits or rats dosed with erlotinib during organogenesis at doses up to 600 mg/m²/day in the rabbit (3 times the plasma drug concentration seen in humans at 150 mg/day) and up to 60 mg/m²/day in the rat (0.7 times the clinical dose of 150 mg/day on a mg/m² basis).

Nursing Mothers

It is not known whether erlotinib is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from TARCEVA (erlotinib) , a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

The safety and effectiveness of TARCEVA (erlotinib) in pediatric patients have not been established.

Geriatric Use

Maintenance Study

Of the total number of patients participating in the randomized NSCLC Maintenance trial, 66% were less than 65 years of age, and 34% of patients were aged 65 years or older. The hazard ratio for overall survival was 0.78 (95% CI: 0.65, 0.95) in patients less than 65 years of age and 0.88 (95% CI: 0.68, 1.15) in patients who were 65 years or older.

Second/Third Line Study

Of the total number of patients participating in the randomized 2nd/3rd line NSCLC trial, 61% were less than 65 years of age, and 39% of patients were aged 65 years or older. The survival benefit was maintained across both age groups [OS HR = 0.75 (95% CI: 0.6, 0.9) in patients less than 65 years of age, and OS HR = 0.79 (95% CI: 0.6, 1.0) in patients who were 65 years or older].

First-Line Pancreatic Cancer

In the pancreatic cancer study, 52 % of patients were younger than 65 years of age and 48 % were 65 years of age or older. There were no clinically relevant survival differences between the age groups [OS HR = 0.78 (95% CI: 0.6, 1.0) in patients less than 65 years of age, and OS HR = 0.94 (95% CI: 0.7, 1.2) in patients who were 65 years or older]. No meaningful differences in safety or pharmacokinetics were observed between younger and older patients in these studies. Therefore, no dosage adjustments are recommended in elderly patients.

Gender

Maintenance Study

Of the total number of patients participating in the randomized Maintenance trial, 73% were males and 27% females. There were no clinically relevant differences in safety and efficacy based on gender [OS HR = 0.88 (96% CI: 0.74, 1.05) in males and OS HR = 0.64 (95% CI: 0.46, 0.91) in females].

Second/Third Line Study

Of the total number of patients participating in the randomized 2nd/3rd line NSCLC trial, 65% were males and 35% females. There were no clinically relevant differences in safety and efficacy based on gender [OS HR = 0.76 (95% CI: 0.6, 0.9) in males and OS HR = 0.80 (95% CI: 0.6, 1.1) in females].

First Line Pancreatic Cancer

In the pancreatic cancer study, 51% of patients were males and 49% females. There were no clinically relevant differences in safety and efficacy based on gender [OS HR = 0.74 (95% CI: 0.6, 0.9) in males and OS HR = 1.0 (95% CI: 0.8, 1.3) in females].

Race

Maintenance Study

In the randomized Maintenance trial, 84% of all patients were Caucasian and 15% were Asian. There were no clinically relevant differences in safety and efficacy based on race [OS HR = 0.86 (95% CI: 0.73, 1.01) in Caucasians and OS HR = 0.66 (95% CI: 0.42, 1.05) in Asians].

Second/Third Line Study

In the randomized 2nd/3rd line NSCLC trial, 78% of all patients were Caucasian and 13% were Asian. There were no clinically relevant differences in safety and efficacy based on race [OS HR = 0.79 (95% CI: 0.6, 1.0) in Caucasians and OS HR = 0.61 (95% CI: 0.4, 1.0) in Asians].

First-Line Pancreatic Cancer

In the pancreatic cancer study, 86% of all patients were Caucasian and 8% were Asian. There were no clinically relevant differences in safety and efficacy based on race [OS HR = 0.88 (95% CI: 0.7, 1.1) in Caucasians and OS HR = 0.61 (95% CI: 0.3, 1.3) in Asians].

Patients with Hepatic Impairment

Patients with hepatic impairment (total bilirubin > ULN or Child Pugh A, B and C) should be closely monitored during therapy with TARCEVA (erlotinib) . Treatment with TARCEVA (erlotinib) should be used with extra caution in patients with total bilirubin > 3 x ULN [see WARNINGS AND PRECAUTIONS, ADVERSE REACTIONS, and DOSAGE AND ADMINISTRATION].

In vitro and in vivo evidence suggest that erlotinib is cleared primarily by the liver. However, erlotinib exposure was similar in patients with moderately impaired hepatic function (Child-Pugh B) compared with patients with adequate hepatic function including patients with primary liver cancer or hepatic metastases [see DOSAGE AND ADMINISTRATION and CLINICAL PHARMACOLOGY].

Patients with Renal Impairment

Less than 9% of a single dose is excreted in the urine. No clinical studies have been conducted in patients with compromised renal function.

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

OVERDOSE

Single oral doses of TARCEVA (erlotinib) up to 1,000 mg in healthy subjects and weekly doses up to 1,600 mg in cancer patients have been tolerated. Repeated twice-daily doses of 200 mg single-agent TARCEVA (erlotinib) in healthy subjects were poorly tolerated after only a few days of dosing. Based on the data from these studies, an unacceptable incidence of severe adverse reactions, such as diarrhea, rash, and liver transaminase elevation, may occur above the recommended dose [see DOSAGE AND ADMINISTRATION]. In case of suspected overdose, TARCEVA (erlotinib) should be withheld and symptomatic treatment instituted.

CONTRAINDICATIONS

None

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

CLINICAL PHARMACOLOGY

Mechanism of Action

The mechanism of clinical antitumor action of erlotinib is not fully characterized. Erlotinib inhibits the intracellular phosphorylation of tyrosine kinase associated with the epidermal growth factor receptor (EGFR). Specificity of inhibition with regard to other tyrosine kinase receptors has not been fully characterized. EGFR is expressed on the cell surface of normal cells and cancer cells.

Pharmacokinetics

Absorption and Distribution:

Erlotinib is about 60% absorbed after oral administration and its bioavailability is substantially increased by food to almost 100%. Peak plasma levels occur 4 hours after dosing. The solubility of erlotinib is pH dependent. Erlotinib solubility decreases as pH increases. Co-administration of TARCEVA (erlotinib) with omeprazole, a proton pump inhibitor, decreased the erlotinib exposure [AUC] and maximum concentration [Cmax] by 46% and 61% respectively. When TARCEVA (erlotinib) was administered 2 hours following a 300 mg dose of ranitidine, an H2 receptor antagonist, the erlotinib AUC was reduced by 33% and Cmax by 54%. When TARCEVA (erlotinib) was administered with ranitidine 150 mg twice daily (at least 10 h after the previous ranitidine evening dose and 2 h before the ranitidine morning dose), the erlotinib AUC and Cmax decreased by 15% and 17% respectively [see DRUG INTERACTIONS].

Following absorption, erlotinib is approximately 93% protein bound to plasma albumin and alpha-1 acid glycoprotein (AAG). Erlotinib has an apparent volume of distribution of 232 liters.

Metabolism and Excretion:

A population pharmacokinetic analysis in 591 patients receiving the single-agent TARCEVA (erlotinib) 2nd/3rd line regimen showed a median half-life of 36.2 hours. Time to reach steady state plasma concentration would therefore be 7 – 8 days. No significant relationships of clearance to covariates of patient age, body weight or gender were observed. Smokers had a 24% higher rate of erlotinib clearance.

An additional population pharmacokinetic analysis was conducted in 291 NSCLC patients administered single-agent erlotinib as maintenance treatment. This analysis demonstrated that covariates affecting erlotinib clearance in this patient population were similar to those seen in the prior single-agent pharmacokinetic analysis. No new covariate effects were identified.

A third population pharmacokinetic analysis was conducted that incorporated erlotinib data from 204 pancreatic cancer patients who received erlotinib plus gemcitabine. Similar results were observed to those seen in the prior single-agent pharmacokinetic analysis. No new covariate effects were identified. Coadministration of gemcitabine had no effect on erlotinib plasma clearance.

In vitro assays of cytochrome P450 metabolism showed that erlotinib is metabolized primarily by CYP3A4 and to a lesser extent by CYP1A2, and the extrahepatic isoform CYP1A1. Following a 100 mg oral dose, 91% of the dose was recovered: 83% in feces (1% of the dose as intact parent) and 8% in urine (0.3% of the dose as intact parent).

Cigarette smoking reduces erlotinib exposure. In the Phase 3 NSCLC trial, current smokers achieved erlotinib steady-state trough plasma concentrations which were approximately 2-fold less than the former smokers or patients who had never smoked. This effect was accompanied by a 24% increase in apparent erlotinib plasma clearance. In a separate study which evaluated the single-dose pharmacokinetics of erlotinib in healthy volunteers, current smokers cleared the drug faster than former smokers or volunteers who had never smoked. The AUC0-infinity in smokers was about 1/3 to ½ of that in never/former smokers. In another study which was conducted in NSCLC patients (N=35) who were current smokers, pharmacokinetic analyses at steady-state indicated a dose-proportional increase in erlotinib exposure when the TARCEVA (erlotinib) dose was increased from 150 mg to 300 mg. However, the exact dose to be recommended for patients who currently smoke is unknown [see DRUG INTERACTIONS and PATIENT INFORMATION].

Special Populations

Patients with Hepatic Impairment

Patients with hepatic impairment (total bilirubin > ULN or Child Pugh A, B and C) should be closely monitored during therapy with TARCEVA (erlotinib) . Treatment with TARCEVA (erlotinib) should be used with extra caution in patients with total bilirubin > 3 x ULN [see WARNINGS AND PRECAUTIONS, ADVERSE REACTIONS, and DOSAGE AND ADMINISTRATION].

In vitro and in vivo evidence suggest that erlotinib is cleared primarily by the liver. However, erlotinib exposure was similar in patients with moderately impaired hepatic function (Child-Pugh B) compared with patients with adequate hepatic function including patients with primary liver cancer or hepatic metastases.

Patients with Renal Impairment

Less than 9% of a single dose is excreted in the urine. No clinical studies have been conducted in patients with compromised renal function.

Clinical Studies

NSCLC – Maintenance Study

The efficacy and safety of TARCEVA (erlotinib) as maintenance treatment of NSCLC were demonstrated in a randomized, double-blind, placebo-controlled trial conducted in 26 countries, in 889 patients with locally advanced or metastatic NSCLC whose disease did not progress during first line platinum-based chemotherapy. Patients were randomized 1:1 to receive TARCEVA (erlotinib) 150 mg or placebo orally once daily (438 TARCEVA (erlotinib) , 451 placebo) until disease progression or unacceptable toxicity. The primary objective of the study was to determine if the administration of TARCEVA (erlotinib) after standard platinum-based chemotherapy in the treatment of NSCLC resulted in improved progression free survival (PFS) when compared with placebo, in all patients or in patients with EGFR immunohistochemistry (IHC) positive tumors.

Demographic characteristics were balanced between the two treatment groups (Table 5).

Table 5: Demographic and Disease Characteristics

Characteristics TARCEVA
N=438
PLACEBO
N=451
N (%) N (%)
Gender
  Female 117 (27%) 113 (25%)
  Male 321 (73%) 338 (75%)
Age (years)
   ≥ 65 Years 148 (34%) 151 (33%)
   < 65 Years 290 (66%) 300 (67%)
Stage of NSCLC
  Unresectable Stage IIIB 116 (26%) 109 (24%)
  Stage IV 322 (74%) 342 (76%)
Race
  Caucasian 370 (84%) 376 (83%)
  Black 3 (<1%) 1 (<1%)
  Asian 62 (14%) 69 (15%)
  Other 3 (<1%) 5 (1%)
ECOG Performance Status at Baseline
  0  135 (31%) 145 (32%)
  1 303 (69%) 306 (68%)
EGFR IHC
  Positive 308 (70%) 313 (69%)
  Negative 62 (14%) 59 (13%)
  Indeterminate 16 (4%) 24 (5%)
  Missing 52 (12%) 55 (12%)
Histology
  Squamous 166 (38%) 194 (43%)
  Adenocarcinoma including Bronchioloaveolar 205 (47%) 198 (44%)
  Large Cell 21 (5%) 24 (5%)
  Other 46 (11%) 35 (8%)
Smoking Status
  Current Smoker 239 (55%) 254 (56%)
  Never Smoked 77 (18%) 75 (17%)
  Past Smoker 122 (28%) 122 (27%)
Smoking status: Current smoker = smoker at time of randomization or stopped within 1 year prior to randomization.

Progression free survival (PFS) and overall survival (OS) were evaluated in the intent-to-treat (ITT) population. The results of the study are shown in Table 6.

Table 6: Efficacy Results: (ITT Population)

  Median in Months (95% CI) Hazard Ratio (1)
(95% CI)
p-value (2)
TARCEVA 150 mg
N = 438
Placebo
N=451
Progression-Free Survival based on investigator's assessment 2.8 (2.8, 3.1) 2.6 (1.9, 2.7) 0.71 (0.62, 0.82) p < 0.0001
Overall Survival 12.0 (10.6, 13.9) 11.0 (9.9,12.1) 0.81 (0.70, 0.95) 0.0088
(1) Univariate Cox regression model
(2) Unstratified log-rank test.

Figure 1 depicts the Kaplan Meier Curves for Overall Survival (ITT Population).

Figure 1 : Kaplan-Meier Curve for Overall Survival of Patients by Treatment Group

TARCEVA® (erlotinib) Figure 1 Illustration

Note: HR is from a univariate Cox regression model.

The PFS and OS Hazard Ratios, respectively, in patients with EGFR IHC-positive tumors were 0.69 (95% CI: 0.58, 0.82) and 0.77 (95% CI: 0.64, 0.93). The

PFS and OS Hazard Ratios in patients with IHC-negative tumors were 0.77 (95% CI: 0.51, 1.14) and 0.91 (95% CI: 0.59, 1.38), respectively.

Patients with adenocarcinoma had an OS Hazard Ratio of 0.77 (95% CI: 0.61, 0.97) and patients with squamous histology had an OS Hazard Ratio of 0.86 (95% CI: 0.68, 1.10).

NSCLC – Second/Third Line Study

The efficacy and safety of single-agent TARCEVA (erlotinib) was assessed in a randomized, double blind, placebo-controlled trial in 731 patients with locally advanced or metastatic NSCLC after failure of at least one chemotherapy regimen. Patients were randomized 2:1 to receive TARCEVA (erlotinib) 150 mg or placebo (488 Tarceva (erlotinib) , 243 placebo) orally once daily until disease progression or unacceptable toxicity. Study endpoints included overall survival, response rate, and progression-free survival (PFS). Duration of response was also examined. The primary endpoint was survival. The study was conducted in 17 countries.

Table 7 summarizes the demographic and disease characteristics of the study population. Demographic characteristics were well balanced between the two treatment groups. About two-thirds of the patients were male. Approximately one-fourth had a baseline ECOG performance status (PS) of 2, and 9% had a baseline ECOG PS of 3. Fifty percent of the patients had received only one prior regimen of chemotherapy. About three quarters of these patients were known to have smoked at some time.

Table 7: Demographic and Disease Characteristics

Characteristics TARCEVA (N =488) Placebo (N = 243)
n (%) n (%)
Gender
  Female 173 (35) 83 (34)
  Male 315 (65) 160 (66)
Age (years)
   < 65 299 (61) 153 (63)
   ≥ 65 189 (39) 90 (37)
Race
  Caucasian 379 (78) 188 (77)
  Black 18 (4) 12 (5)
  Asian 63 (13) 28 (12)
  Other 28 (6) 15 (6)
ECOG Performance Status at Baseline*
  0 64 (13) 34 (14)
  1  256 (52) 132 (54)
  2 126 (26) 56 (23)
  3 42 (9) 21 (9)
Weight Loss in Previous 6 Months
   < 5% 320 (66) 166 (68)
  5 – 10% 96 (20) 36 (15)
   > 10% 52 (11) 29 (12)
  Unknown 20 (4) 12 (5)
Smoking History
  Never Smoked 104 (21) 42 (17)
  Current or Ex-smoker 358 (73) 187 (77)
  Unknown 26 (5) 14 (6)
Histological Classification
  Adenocarcinoma 246 (50) 119 (49)
  Squamous 144 (30) 78 (32)
  Undifferentiated Large Cell 41 (8) 23 (9)
  Mixed Non-Small Cell 11 (2) 2 ( < 1)
  Other 46 (9) 21 (9)
Time from Initial Diagnosis to Randomization (Months)
   < 6 63 (13) 34 (14)
  6 – 12 157 (32) 85 (35)
   > 12 268 (55) 124 (51)
Best Response to Prior Therapy at Baseline*
  CR/PR  196 (40) 96 (40)
  PD 101 (21) 51 (21)
  SD 191 (39) 96 (40)
Number of Prior Regimens at Baseline*
  1 243 (50) 121 (50)
  2 238 (49) 119 (49)
  3 7 (1) 3 (1)
Exposure to Prior Platinum at Baseline*
  Yes 454 (93) 224 (92)
  No 34 (7) 19 (8)
* Stratification factor as documented at baseline; distribution differs slightly from values reported at time of randomization.

The results of the study are shown in Table 8.

Table 8: Efficacy Results

  TARCEVA Placebo Hazard Ratio (1) 95% CI p-value
Survival Median 6.7 mo Median 4.7 mo 0.73 0.61 – 0.86 < 0.001 (2)
1-year Survival 31.2% 21.5%      
Progression-Free Survival Median 9.9 wk Median 7.9 wk 0.59 0.50 – 0.70 < 0.001 (2)
Tumor Response (CR+PR) 8.9% 0.9%     < 0.001 (3)
Response Duration Median 34.3 wk Median 15.9 wk      
(1) Cox regression model with the following covariates: ECOG performance status, number of prior regimens, prior platinum, best response to prior chemotherapy.
(2) Two-sided Log-Rank test stratified by ECOG performance status, number of prior regimens, prior platinum, best response to prior chemotherapy.
(3) Two-sided Fisher's exact test

Survival was evaluated in the intent-to-treat population. Figure 2 depicts the Kaplan-Meier curves for overall survival. The primary survival and PFS analyses were two-sided Log-Rank tests stratified by ECOG performance status, number of prior regimens, prior platinum, best response to prior chemotherapy.

Figure 2 : Kaplan-Meier Curve for Overall Survival of Patients by Treatment Group

Kaplan-Meier Curve for Overall Survival of Patients by Treatment Group -  Illustration

Note: HR is from Cox regression model with the following covariates: ECOG performance status, number of prior regimens, prior platinum, best response to prior chemotherapy. P-value is from two-sided Log-Rank test stratified by ECOG performance status, number of prior regimens, prior platinum, best response to prior chemotherapy.

NSCLC - TARCEVA (erlotinib) Administered Concurrently with Chemotherapy

Results from two, multicenter, placebo-controlled, randomized, trials in over 1000 patients conducted in first-line patients with locally advanced or metastatic NSCLC showed no clinical benefit with the concurrent administration of TARCEVA (erlotinib) with platinum-based chemotherapy [carboplatin and paclitaxel (TARCEVA (erlotinib) , N = 526) or gemcitabine and cisplatin (TARCEVA (erlotinib) , N = 580)].

Pancreatic Cancer - TARCEVA (erlotinib) Administered Concurrently with Gemcitabine

The efficacy and safety of TARCEVA (erlotinib) in combination with gemcitabine as a first-line treatment was assessed in a randomized, double blind, placebo-controlled trial in 569 patients with locally advanced, unresectable or metastatic pancreatic cancer. Patients were randomized 1:1 to receive TARCEVA (erlotinib) (100 mg or 150 mg) or placebo once daily on a continuous schedule plus gemcitabine IV (1000 mg/m², Cycle 1 - Days 1, 8, 15, 22, 29, 36 and 43 of an 8 week cycle; Cycle 2 and subsequent cycles - Days 1, 8 and 15 of a 4 week cycle [the approved dose and schedule for pancreatic cancer, see the gemcitabine package insert]). TARCEVA (erlotinib) or placebo was taken orally once daily until disease progression or unacceptable toxicity. The primary endpoint was survival. Secondary endpoints included response rate, and progression-free survival (PFS). Duration of response was also examined. The study was conducted in 18 countries. A total of 285 patients were randomized to receive gemcitabine plus TARCEVA (erlotinib) (261 patients in the 100 mg cohort and 24 patients in the 150 mg cohort) and 284 patients were randomized to receive gemcitabine plus placebo (260 patients in the 100 mg cohort and 24 patients in the 150 mg cohort). Too few patients were treated in the 150 mg cohort to draw conclusions.

Table 9 summarizes the demographic and disease characteristics of the study population that was randomized to receive 100 mg of TARCEVA (erlotinib) plus gemcitabine or placebo plus gemcitabine. Baseline demographic and disease characteristics of the patients were similar between the 2 treatment groups, except for a slightly larger proportion of females in the TARCEVA (erlotinib) arm (51%) compared with the placebo arm (44%). The median time from initial diagnosis to randomization was approximately 1.0 month. Most patients presented with metastatic disease at study entry as the initial manifestation of pancreatic cancer.

Table 9: Demographic and Disease Characteristics: 100 mg Cohort

  TARCEVA (erlotinib) +
Gemcitabine
(N=261)
Placebo+
Gemcitabine
(N=260)
Characteristics N (%) N (%)
Gender
  Female 134 (51) 114 (44)
  Male 127 (49) 146 (56)
Age (Years)
   < 65 136 (52) 138 (53)
   ≥ 65 125 (48) 122 (47)
Race
  Caucasian 225 (86) 231 (89)
  Black 8 (3) 5 (2)
  Asian 20 (8) 14 (5)
  Other 8 (3) 10 (3)
ECOG Performance Status*
  0 82 (31) 83 (32)
  1 134 (51) 132 (51)
  2 44 (17) 45 (17)
  Unknown* 1 ( < 1) 0 (0)
Disease Status at Baseline**
  Locally Advanced 61 (23) 63 (24)
  Distant Metastasis 200 (77) 197 (76)
*Unknown includes responses of 'Unknown' and missing.
**Stratification factor as documented at baseline; distribution differs slightly from values reported at time of randomization.

The results of the study are shown in Table 10.

Table 10: Efficacy Results: 100 mg Cohort

  TARCEVA +
Gemcitabine
Placebo+
Gemcitabine
Hazard
Ratio (1)
95% CI p-value
Survival Median Median      
6.4 mo 6.0 mo      
250 deaths 254 deaths 0.81 0.68 – 0.97 0.028 (2)
1-year Survival 23.8% 19.4%      
Progression-Free Survival Median Median      
3.8 mo 3.5 mo      
225 events 232 events 0.76 0.64 – 0.92 0.006 (2)
Tumor Response (CR+PR) 8.6% 7.9%     0.87 (3)
Response Duration Median Median      
23.9 wk 23.3 wk      
(1) Cox regression model with the following covariates: ECOG performance status, and extent of disease.
(2) Two-sided Log-Rank test stratified by ECOG performance status and extent of disease.
(3) Two-sided Fisher's exact test.

Survival was evaluated in the intent-to-treat population. Figure 3 depicts the Kaplan-Meier curves for overall survival in the 100 mg cohort. The primary survival and PFS analyses were two-sided Log-Rank tests stratified by ECOG performance status and extent of disease.

Figure 3 : Kaplan-Meier Curve for Overall Survival : 100mg Cohort

Kaplan-Meier Curve for Overall Survival : 100mg Cohort -  Illustration

Note: HR is from Cox regression model with the following covariates: ECOG performance status and extent of disease. P-value is from two-sided Log-Rank test stratified by ECOG performance status and extent of disease.

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

PATIENT INFORMATION

If the following signs or symptoms occur, patients should be advised to seek medical advice promptly[see WARNINGS AND PRECAUTIONS, ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION].

Given that skin reactions are anticipated when taking TARCEVA (erlotinib) , proactive intervention may include alcohol-free emollient cream and use of sunscreen or avoidance of sun exposure [see ADVERSE REACTIONS]. The management of rash should be discussed with the patient. This may include topical corticosteroids or antibiotics with anti-inflammatory properties. These approaches were used in the NSCLC and pancreatic pivotal clinical trials. Acne preparations with drying properties may aggravate the dry skin and erythema. Treatment of rash has not been formally studied and should be based on rash severity.

Women of childbearing potential should be advised to avoid becoming pregnant while taking TARCEVA [see WARNINGS AND PRECAUTIONS and Use in Specific Populations].

Smokers should be advised to stop smoking while taking TARCEVA as plasma concentrations of erlotinib are reduced due to the effect of cigarette smoking [see CLINICAL PHARMACOLOGY].

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

>

PATIENT INFORMATION

If the following signs or symptoms occur, patients should be advised to seek medical advice promptly[see WARNINGS AND PRECAUTIONS, ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION].

Given that skin reactions are anticipated when taking TARCEVA (erlotinib) , proactive intervention may include alcohol-free emollient cream and use of sunscreen or avoidance of sun exposure [see ADVERSE REACTIONS]. The management of rash should be discussed with the patient. This may include topical corticosteroids or antibiotics with anti-inflammatory properties. These approaches were used in the NSCLC and pancreatic pivotal clinical trials. Acne preparations with drying properties may aggravate the dry skin and erythema. Treatment of rash has not been formally studied and should be based on rash severity.

Women of childbearing potential should be advised to avoid becoming pregnant while taking TARCEVA [see WARNINGS AND PRECAUTIONS and Use in Specific Populations].

Smokers should be advised to stop smoking while taking TARCEVA as plasma concentrations of erlotinib are reduced due to the effect of cigarette smoking [see CLINICAL PHARMACOLOGY].

Last reviewed on RxList: 5/7/2010
This monograph has been modified to include the generic and brand name in many instances.

Disclaimer

Tarceva Consumer

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

ERLOTINIB - ORAL

(er-LOE-tye-nib)

COMMON BRAND NAME(S): Tarceva

USES: This medication is used to treat lung cancer. Erlotinib is used after other chemotherapy drugs have not been effective. It works by slowing cancer cell growth.

HOW TO USE: Take this medication by mouth on an empty stomach, at least 1 hour before or 2 hours after a meal, usually once daily, or as directed by your doctor. Do not take erlotinib within 2 hours of taking an antacid (liquid or tablets). Doing so can prevent the absorption of the medication.

Acid-lowering medications for indigestion, heartburn, or ulcers (such as prescription or over-the-counter medications including famotidine, omeprazole) may prevent erlotinib from working. Ask your doctor or pharmacist how to use these medications safely.

Use this medication regularly. Remember to take it at the same time every day. The dosage is based on your medical condition and response to therapy.

Do not increase your dose or take this medication more often without your doctor's approval. Your condition will not improve any faster and the risk of serious side effects may be increased.

Avoid eating grapefruit or drinking grapefruit juice while being treated with this medication unless your doctor instructs you otherwise. Grapefruit can increase the amount of certain medications in your bloodstream. Consult your doctor or pharmacist for more details.

Since this drug can be absorbed through the skin, women who are pregnant or who may become pregnant should not handle or break the tablets of this medication.

Disclaimer

Tarceva Consumer (continued)

SIDE EFFECTS: Nausea, vomiting, loss of appetite, mouth sores, dry skin, or eye irritation may occur. Changes in diet such as eating several small meals or limiting activity may help lessen the chance of nausea. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Diarrhea is a common side effect. Drink plenty of fluids as directed by your doctor to reduce your risk of losing too much body water. Your doctor may prescribe anti-diarrhea medication (e.g., loperamide) to control your symptoms. Tell your doctor immediately if you develop: severe or persistent diarrhea, signs of dehydration (e.g., dizziness, decreased amount of urine).

Tell your doctor immediately if any of these rare but very serious side effects occur: black stools, vomit that looks like coffee grounds, easy bleeding/bruising, stomach/abdominal pain, yellowing eyes or skin, dark urine, unusual fatigue, signs of infection (e.g., fever, chills, persistent sore throat), eye pain, vision changes.

Seek immediate medical attention if you develop any of these rare but very serious side effects: new or worsening shortness of breath or cough.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Erlotinib can commonly cause a mild rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe allergic reaction. Therefore, seek immediate medical attention if you develop any rash.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Tarceva (erlotinib) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS: Before taking erlotinib, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney problems, stomach/intestinal disease (such as ulcers, diverticulosis).

Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports to lower the chance of getting cut, bruised or injured.

This medicine may increase your risk of stomach bleeding. Limit alcoholic beverages.

Sunlight may worsen any skin reactions that may occur while you are taking this drug. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors.

This drug is not recommended for use during pregnancy. It may cause harm to an unborn baby or miscarriage. Women of childbearing age should use reliable form(s) of birth control during treatment and for at least 2 weeks following the end of treatment with this drug. Consult your doctor for more details.

It is not known whether this drug passes into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Disclaimer

Tarceva Consumer (continued)

DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: "blood thinners" (e.g., warfarin), corticosteroids (such as prednisone), drugs that lower stomach acid (some examples are H2 blockers such as famotidine/ranitidine, proton pump inhibitors such as omeprazole), drugs affecting liver enzymes that remove erlotinib from your body (such as azole antifungals, including itraconazole; macrolide antibiotics, including erythromycin; cimetidine; rifamycins, including rifabutin; St. John's wort; certain anti-seizure medicines, including carbamazepine; HIV protease inhibitors, including ritonavir).

Check all prescription and nonprescription medicine labels carefully since many contain pain relievers/fever reducers (nonsteroidal anti-inflammatory drugs-NSAIDs such as aspirin, celecoxib, ibuprofen, naproxen) which may increase your risk for stomach bleeding while you are taking erlotinib. Ask your pharmacist about the safe use of these products. Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually these dosages are 81-325 milligrams per day), should be continued. Consult your doctor or pharmacist for more details.

Cigarette smoking decreases blood levels of this medication. If you currently smoke, stop smoking while taking this medication. Consult your doctor or pharmacist for details.

See also the How to Use section.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (e.g., kidney/liver function tests) should be performed to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature (77 degrees F or 25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).

Information last revised June 2010. Copyright(c) 2010 First Databank, Inc.

Tarceva Patient Information Including Side Effects

Brand Names: Tarceva

Generic Name: erlotinib (Pronunciation: er LOE ti nib)

What is erlotinib (Tarceva)?

Erlotinib is a cancer medication that interferes with the growth of cancer cells and slows their spread in the body.

Erlotinib is used to treat non-small cell lung cancer. Erlotinib is also used in combination with other cancer medicine to treat pancreatic cancer.

Erlotinib may also be used for purposes not listed in this medication guide.

Tarceva 100 mg

round, white, imprinted with T 100

What are the possible side effects of erlotinib (Tarceva)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking erlotinib and call your doctor at once if you have a serious side effect such as:

  • new or worsening lung problems such as chest pain, dry cough with fever, wheezing, rapid breathing, feeling short of breath;
  • chest pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
  • sudden numbness or weakness, sudden severe headache, or problems with vision, speech, or balance;
  • eye pain, redness, or irritation;
  • confusion, mood changes, increased thirst, urinating less than usual or not at all;
  • swelling, rapid weight gain;
  • severe or ongoing diarrhea, vomiting, or loss of appetite;
  • black, bloody, or tarry stools;
  • coughing up blood or vomit that looks like coffee grounds;
  • pale or yellowed skin, easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
  • white patches or sores inside your mouth or on your lips;
  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
  • the first sign of any type of skin rash, no matter how mild; or
  • nausea, upper stomach pain, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

  • mild stomach upset, nausea, or diarrhea;
  • weight loss;
  • acne, dry skin; or
  • tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the Tarceva (erlotinib) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about erlotinib (Tarceva)?

Before taking erlotinib, tell your doctor if you have lung problems (other than lung cancer), kidney or liver disease, if you are dehydrated, or if you smoke.

To be sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. This will help your doctor determine how long to treat you with erlotinib. Visit your doctor regularly.

Avoid exposure to sunlight or tanning beds. Erlotinib can cause skin rash, dryness, or other irritation. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Avoid using skin products that can cause dryness or irritation.

Stop taking erlotinib and call your doctor at once if you have new or worsening lung problems (chest pain, dry cough with fever, wheezing, feeling short of breath), chest pain spreading to the arm or shoulder, sudden numbness or weakness, eye pain or irritation, rapid weight gain, urinating less than usual or not at all, severe or ongoing diarrhea or vomiting, coughing up blood, black or bloody stools, pale skin, easy bruising or bleeding, mouth sores, or a severe skin rash.

Side Effects Centers

Tarceva Patient Information including How Should I Take

What should I discuss with my healthcare provider before taking erlotinib (Tarceva)?

You should not take erlotinib if you are allergic to it.

If you have any of these other conditions, you may need a dose adjustment or special tests:

  • lung or breathing problems (other than lung cancer);
  • kidney disease;
  • liver disease;
  • if you are dehydrated; or
  • if you smoke.

FDA pregnancy category D. Do not take erlotinib if you are pregnant. It could harm the unborn baby. Use effective birth control while you are taking this medication and for at least 2 weeks after your treatment ends.

It is not known whether erlotinib passes into breast milk or if it could harm a nursing baby. You should not breast-feed while taking erlotinib.

How should I take erlotinib (Tarceva)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Take erlotinib on an empty stomach, at least 1 hour before or 2 hours after eating.

Do not crush an erlotinib tablet. The medicine from a crushed or broken pill can be dangerous if it gets on your skin. If this occurs, wash your skin with soap and water and rinse thoroughly.

To be sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. This will help your doctor determine how long to treat you with erlotinib. Visit your doctor regularly.

Store at room temperature away from moisture and heat.

Side Effects Centers

Tarceva Patient Information including If I Miss a Dose

What happens if I miss a dose (Tarceva)?

Take the missed dose as soon as you remember (take only on an empty stomach). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose (Tarceva)?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe diarrhea, severe skin rash, dark urine, stomach pain, or jaundice (yellowing of your skin or eyes).

What should I avoid while using erlotinib (Tarceva)?

Avoid taking an antacid within several hours before or after you take erlotinib.

Avoid exposure to sunlight or tanning beds. Erlotinib can cause skin rash, dryness, or other irritation. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Avoid using skin products that can cause dryness or irritation, such as acne medications, harsh soaps or skin cleansers, or skin products that contain alcohol.

Avoid smoking. It can make erlotinib less effective.

Grapefruit and grapefruit juice may interact with erlotinib and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

What other drugs will affect erlotinib (Tarceva)?

Many drugs can interact with erlotinib. Below is just a partial list. Tell your doctor if you are using:

  • a blood thinner such as warfarin (Coumadin);
  • bosentan (Tracleer);
  • conivaptan (Vaprisol);
  • dexamethasone (Decadron, Hexadrol);
  • imatinib (Gleevec);
  • isoniazid (for treating tuberculosis);
  • St. John's wort;
  • steroid medicine (prednisone and others);
  • an antibiotic such as ciprofloxacin (Cipro), clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate), rifapentine (Priftin), or telithromycin (Ketek);
  • an antidepressant such as nefazodone;
  • antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegal), or voriconazole (Vfend);
  • a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton);
  • heart or blood pressure medication such as diltiazem (Cartia, Cardizem), felodipine (Plendil), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others;
  • HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva), etravirine (Intelence), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), or saquinavir (Invirase);
  • medicines to treat narcolepsy, such as armodafanil (Nuvigil) or modafanil (Progivil);
  • NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or
  • seizure medication such as carbamazepine (Carbatrol, Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), phenytoin (Dilantin), or primidone (Mysoline).

Where can I get more information?

Your pharmacist can provide more information about erlotinib.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.03. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

Healthwise

Side Effects Centers

توزیع کنندگان این دارو
شرکت های تولید کننده یا وارد کننده دارو

دارونـــما
نوآوری برای سلامت

طراحی و اجرا M.Ramezani
ارتباط با ما Info@darunama.com