My 69 year old wife (non smoker) has Stage 3b lung cancer – adenocarcinoma in one lung, which has spread only to lymph nodes in both lungs. After 3 cycles of Gemcitabine + Carboplatin she was stable, and was moved to Tarceva (150 mg, daily). She is EGFR Positive.
She has taken it “at least 1 hour before food or 2 hours after” – usually allowing more time. We understand that taking it with food may give higher serum levels of Tarceva, so why not, for more Tarceva effect on tumours? Would she risk developing Tarceva resistance sooner?
If she stays with 1hr/2hrs, what are the merits of first thing in the morning (1 hr/12 hrs) vs mid morning (1/2)?
She also gets diarrhoea 4-6 hours after taking it, most days. Any advice on what & when to eat to minimise that? Loperamide is effective, but avoiding the problem would be better.
Reply # - September 26, 2012, 09:17 PM
Reply To: Optimum time to take Tarceva
The issue is that there isn't good evidence that taking more or getting a higher "effective dose" by taking it with food leads to better outcomes. It does lead to greater side effects, so there is a real chance that all that would be gained is a lower tolerability.
There is no real difference in terms of time of day. Some people who have nausea in the hours after taking it prefer to take Tarceva (erlotinib) in the evening, so that they sleep through any nausea they might have. Otherwise, it doesn't really matter.
Fiber is something that often leads patients to be prone to diarrhea while they're on an EGFR mutation. I have some patients recognize that salads cause a lot of trouble. Other people here who have been on an oral EGFR inhibitor may have suggestions.
-Dr. West
Reply # - September 27, 2012, 01:44 AM
Reply To: Optimum time to take Tarceva
Hallo Loftus. How long has your wife been taking the Tarceva? I found the diarrhoea at its worst early on (by which I mean the first few months). Nothing I ate/didn't eat seemed to determine how bad it was.
Since then I have found that it comes and goes - I will be fine for a couple of weeks and then have a really bad week.
I saw an interesting comment recently by one of the doctors to the effect that the point of taking it on an empty stomach is to reproduce the conditions in which it was trialled. I take it first thing - otherwise I spend all day trying to remember whether I've taken it or not! Very best.
Reply # - September 27, 2012, 06:24 AM
Reply To: Optimum time to take Tarceva
I take Tarceva at bedtime. I do get the diarrhea occasionally. It comes and goes--much like Certain Spring's comment. I'm prone to nausea, too. So, taking it at bedtime has been good for me. Hope this info helps. Good Luck!!
Reply # - September 27, 2012, 04:51 PM
Reply To: Optimum time to take Tarceva
Many thanks for the feedback. She has been taking Tarceva precisely one month, so perhaps the worst will soon be over - the rash has certainly receded.
Perhaps it's the scientist in both of us, but we were thinking that diarrhoea 4-6 hours after taking it indicated the residual erlotinib in the gut was causing the problem. Getting more into the bloodstream might leave less in the gut, so help the diarrhoea, and present more to the tumour. Maybe we're being a bit naive - the body is complex, and the trials a challenge.
Reply # - October 7, 2012, 10:41 PM
Reply To: Optimum time to take Tarceva
She is taking Tarceva in the morning, but unfortunately diarrhoea develops 8-10 hours later. Immodium stops it eventually, but two to three days later frequent and very strong diarrhoea starts again.
We are worried that diarrhoea decreases the level of Tarceva in the body and therefore it’s potential beneficial effect. Is this possible? Might she be better on a lower dose if it doesn't cause diarrhoea?
You'll notice she is actually 68 not 69 yo. And my name is mud - I'd better not make that mistake again!
Reply # - October 8, 2012, 04:45 AM
Reply To: Optimum time to take Tarceva
Not the best mistake to make. Be careful :wink:
That description of diarrhea is pretty common and isnt usually cause to change dose.
It is usual to keep someone on the 150 dose as long as it is tolerable. Every three days would be considered safe as far as loosing too much hydration or nutrients.
I do understand from my husbands very similar experience that the tolerability was close to unexceptable except when compared to the alternative. It would be worth talking with her onc. Everyone must balance the level of acceptable side effects so trying a lower dose may be more acceptable than stopping treatment.
I'm so sorry your wife is going through this. There aren't many easy answers.
Janine