I began taking Tarceva eight days ago, with instructions to call when a rash developed, I called today and explained I had a mild rash on face and arms, diarrhea, dry nose/lips. Diarrhea under control with diet and Imodium. My Onc is on vacation and his NP prescribed doxycycline 100mg and gave instructions to take Tarceva every other day instead of every day.
I did not get to talk to NP, but 'hot line' nurse said this was standard procedure if someone developed the rash. This is a University cancer center. I have been researching Tarceva on this site since my EGFR
mutation was found. I was certainly not expecting to reduce the dose so soon, given the rash is more like the mild poster in the tarceva info. Is dose reduction standard procedure at the start of taking Tarceva? I have not found anything about it.
This site has saved my sanity and is so appreciated.
Sarah
Reply # - July 19, 2012, 07:00 PM
Reply To: reduce tarceva dosage to half ?
Hi Sarah,
When my wife was taking Tarceva, her dermatologist (an expert in rashes caused by EGFR inhibitors like Tarceva) always said that his goal was to keep the rash under control so that she could continue at the full 150mg dose of Tarceva. Although there is evidence that patients with an EGFR mutation may do just as well at a reduced dosage (see this post: http://cancergrace.org/lung/2010/05/24/dose-vs-efficacyof-egfr-tki/ ) you can see that Dr. West concludes that reducing the dosage is not a superior strategy. It's just good to know that if you need to reduce the dose you should do just as well. In your case it doesn't seem that you need to reduce the dose, since your rash is not severe and may be controlled by the antibiotic. You will probably want to discuss this with your oncologist when he returns. In the meantime, whether you take the full dose or half during his presumably brief absence is not likely to affect its efficacy.
I hope that Tarceva is effective for you for a very long time. Please let us know if you have further questions.
JimC
Forum Moderator
Reply # - July 19, 2012, 09:02 PM
Reply To: reduce tarceva dosage to half ?
I really agree with Jim, that while I absolutely wouldn't hesitate to drop the dose in patients who are going to be miserable with side effects of full dose Tarceva (erlotinib), and that many patients will do extremely well with a lower daily dose, we don't want to have too low a threshold to drop the dose if a patient really can manage on full dose.
-Dr. West
Reply # - July 20, 2012, 01:16 AM
Reply To: reduce tarceva dosage to half ?
Hi Sarah
I am now on day 21 of 150 mg Tarceva My Onc also prescribed Doxycyline daily 100mg from day one day 5 just a reddening of skin but by day 8 the rash was getting a bit more but really nothing all that bad just red glowing and bumpy no pustules :0) plus itchy head
I got loose bowels ( NOT Diarrhea) also on day 8 -10 then back to normal my face was stinging and feels like windburn I used 1% Cortisoid cream and an hour later Paw Paw ointment (works for nappy rash:0) and olive oil to ease the tightness as they were the only things that did not sting
by the 18th day my face was no longer stinging but dry and peeling bowels loose agin and now day 21 back to normal I feel fine
from what I read Tarceva has a 36.2 hour day half life which makes it fully kick in about 7-8 days
web sites below may be of interest
http://www.tarceva.com/professional/prescribing/rash.jsp
http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid…
http://www.chemocare.com/bio/tarceva.asp
best wishes Lesley
Reply # - July 20, 2012, 07:29 PM
Reply To: reduce tarceva dosage to half ?
Thank you for the very helpful responses, you are the best. All of the insights and info has been very helpful. Apparently I have some decisions to make about my health care. Sarah