Low Dose Tarceva - 1258275

There are plenty of people who are just sensitive to Tarceva, so that 25 mg for them may lead to the same efficacy and side effects as 150 mg in someone else. If someone is experiencing problematic side effects that make it prohibitive to continue at the same dose for a sustained period, I have them lower the dose and hope that we can achieve a balance of disease control with prolonged tolerability.

That said, I had a patient who I recently dropped down to 25 mg because 50 mg was very challenging, then experienced progression after a good response on a higher dose. We're now trying to do alternating days of 25 and 50 mg.

If someone is very sensitive to the drug, I think 25 mg daily is very different from being off of it entirely. It should be very possible to resume the higher dose and do better if there is actually progression, or alternatively, it's certainly reasonable to stay at the same dose and be very attentive about sun exposure...though a miscalculation could lead to a much more severe rash in the sun-exposed areas.

Good luck, and I hope you can enjoy your vacation without worrying too much about this. I do think a rapid pace of progression on a dose reduction from 50 to 25 mg is quite unlikely.

-Dr. West

Dear Sherry, Dr. West

I responded well to 25mg for the first year, but due to slow progression, my onc had asked me to push up the dose, so I am taking 50mg daily which is VERY CHALLENGING. you need to wear a hat out all the time, otherwise, my scalp feels burned and itching. I develop inflammatory nodules on my scalp, which then oozes and scab over. I have tried Minocin, topical antibiotics, topical steroid, sulfacetamide shampoo, etc, all without much improvement. BUT
In this past 7 days, I have discovered that Septra actually does a great job in preventing the inflammatory response of my skin. The reason for this is that Minocin or Doxy is great for miliary acne, and Septra is generally used by Derm for nodular cystic acne. The inflammatory nodules I get is similar to the inflammatory nodule in acne, although we don't have the bacteria infection. I also noticed my hair texture has improved and my skin is actually not as dry too!!! My skin used to turn red with a simple light scratch. I think if anyone has similar bad rash/nodular inflammation that I did, and hasn't responded to everything else, you can try Septra. I only used 1 tab Septra DS. I just hope I don't get diarrhea from it and I will try to titrate Septra to a lower dose if I can!!

ssflxl

That's great to hear ssflxl!

I have very similar reactions but at a higher dose - 100 MG. Based on this I'll be trying Septra, since doxy hasn't really worked for a while. Will hopefully update with good news!

yes,

Septra works very well for me. I have tried everything and was about to try Prednisone too. I used a very strong steroid cream - Clobetasol, topical Clindaymycin, different shampoos, which helped slightly to decrease the inflammation but doesn't prevent the outbreak. the septra prevents the outbreak which is more important. I used to take Septra single strength 2 times/day ( not double strength), but I started having some stomach problems so now I am only taking 1/2 the dose and I still have rather good effect from it. I hope it works well for you.

ssflxl

I already have the outbreak. I'm hoping it will calm the outbreak down.