Tarceva (Erlotinib) and fevers and lower doses? - 1265236

trustandfaith
Posts:4

Please Note: New Treatments Have Emerged Since this Original Post

Hi all, My mom was diagnosed with stage 4 NSCLC, adenocarcinoma, EGFR mutation in March 2014. She is 73 years old and of mid-east descent. She has never smoked. The CT/PET scans showed a large tumour (>5cm) in one lung, and many small tumours in both lungs. Also, the cancer had spread to two lymph nodes in her chest. No cancer was detected in brain scans. She was prescribed 150mg Tarceva as first-line treatment and developed very bad rashes on her face, head, chest and mouth sores soon after starting treatment. After 2 weeks on Tarceva she developed a fever that would go up and down from around 37.7 degrees to 40 degrees as well as chills. Her mouth sores became much worse and she developed rashes on both legs. She was extremely weak, could not walk (bed-ridden), and could barely eat. She was taken to the hospital twice during that period, and the doctors could not find signs of bacterial infection after taking blood and urine samples. My strong feeling is that the Tarceva was the cause of the high fevers, though her oncologist said that fevers are not normally associated with Tarceva. She was given IV antibiotics in the hospital and prescribed oral antibiotics and simulatenously was removed from Tarceva. After 2 days her fevers subsided and she is presently finishing her 10 days of antibiotics. We have an appointment with her oncologist in a few days and I was hoping to hear from other peoples' experience or faculty advice. Have others experienced fevers and chills with Tarceva? Did moving to lower doses reduce the side-effects (and fevers?) ? What dose would be recommended for her once she restarts the Tarceva? 75mg? Half dose every day? Full dose (150mg) every other day? Has anyone who could not tolerate Tarceva (even at lower doses) been able to tolerate Gefitnib? Thanks for any help you can offer!

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JimC
Posts: 2753

Hi trustandfaith,

Welcome to GRACE. I'm sorry to hear of your mom's diagnosis and the trouble she is having with Tarceva side effects. It is unusual for Tarceva to cause fever, so your doctors would want to eliminate any other possible causes first.

Often patients require dose reductions due to Tarceva side effects, without sacrificing efficacy of the treatment. Dr. West has written about that issue here: http://cancergrace.org/lung/2010/05/24/dose-vs-efficacyof-egfr-tki/ Of course one way to see if the fever is related to Tarceva is to drop the dose and if that helps then you have probably found the culprit. Some patients who are particularly sensitive to Tarceva do well at 25 mg per day. It doesn't seem likely that a patient could tolerate Gefitinib if he/she couldn't handle a low dose of Tarceva.

Dr. Mario Lacouture, one of the leading experts on managing Tarceva rash, provided a thorough discussion of the subject here: http://cancergrace.org/cancer-treatments/files/2011/09/dr-lacouture-on-…

Good luck with managing the side effects; I hope you get them under control very soon.

JimC
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Dr West
Posts: 4735

Fever would be quite uncommon, but I suppose it's possible that it could be caused by Tarceva (erlotinib).

If it's felt that a dose reduction is appropriate, we'd usually drop the dose to 100 mg daily. Tarceva is available in tablets at the starting dose of 150 mg daily, as well as 100 and 25 mg tablets.

Good luck.

-Dr. West

trustandfaith
Posts: 4

Hi all,

Just an update on my Mom's condition.

After being off of Tarceva for just over 2 weeks and being in relatively good health, she restarted Tarceva at a reduced dose of 100mg and after 4 days she developed a fever again.

I also found some other anecdotal evidence for Tarceva and fevers.

http://cancergrace.org/forums/index.php?topic=4868.0

http://www.cancercompass.com/message-board/message/all,4637,0.htm?mid=2…

I hope this will help others if they are going through something similar. I hope to give an update in the future with better news. :)

trustandfaith
Posts: 4

Hi all,

Just an update on my Mom’s condition.

She was taken off Tarceva after having developed drug-related fevers, and was switched over to Gefitnib. She has had very few symptoms on Genfitnib, which include dry skin and scalp, occasional lower leg stiffness, and occasional hot flashes; but overall her symptoms are much, much less than when she was on Tarceva and are very manageable. Her dose is presently 250mg/day.

After almost 2 months on Gefitnib she underwent a CT scan and has shown size reduction in all of the tumours in her lungs and in her lymph nodes.

I hope to give an update in the future with continued good news.

Dr West
Posts: 4735

That's great news. Thanks for sharing it, and I hope she continues to do well for a very long time.

-Dr. West

Dr West
Posts: 4735

That's great news. Thanks for sharing it, and I hope she continues to do well for a very long time.

-Dr. West