Erlotinib: Brands, Price & Uses in Bangladesh

Erlotinib is an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor used in oncology. Its use is guided by the strength of clinical evidence and biomarker (EGFR mutation) status.

Established/FDA-approved indications

• Non-small cell lung cancer (NSCLC): First-line, maintenance, or second-line and beyond treatment of metastatic NSCLC in patients whose tumors have EGFR exon 19 deletions or exon 21 (L858R) substitution mutations, as detected by an FDA-approved test. Erlotinib is not recommended in combination with platinum-based chemotherapy.
• Pancreatic cancer: First-line treatment of locally advanced, unresectable, or metastatic pancreatic cancer, used in combination with gemcitabine (a combination-therapy requirement, not monotherapy).

Important note

Erlotinib is a specialist oncology medicine. It must only be prescribed, dosed, and monitored by a qualified oncologist, with EGFR mutation testing performed before starting therapy for NSCLC.

Non-small cell lung cancer (NSCLC)

150 mg orally once daily, taken on an empty stomach, at least 1 hour before or 2 hours after a meal, until disease progression or unacceptable toxicity. EGFR exon 19 deletion or exon 21 (L858R) mutation must be confirmed before starting.

Pancreatic cancer

100 mg orally once daily, taken on an empty stomach, in combination with gemcitabine, until disease progression or unacceptable toxicity.

Dose modification for toxicity

Interrupt or reduce dose (typically in 50 mg decrements) for severe diarrhea, skin reactions, hepatotoxicity, or other significant adverse reactions, and permanently discontinue for interstitial lung disease (ILD)-like events, GI perforation, severe bullous/exfoliative skin conditions, or severe hepatic failure (see Precautions and Warnings). Dose adjustment is also required with certain drug interactions (see Interactions) and in patients who smoke.

Hepatic impairment

Use with caution and increased monitoring in patients with hepatic impairment; dose reduction or interruption may be required, and Erlotinib should generally be avoided in severe hepatic impairment or bilirubin elevation greater than 3 times the upper limit of normal.

Renal impairment

Limited data are available; use with caution and appropriate monitoring in patients with renal impairment.

Very common side effects (occurring in a large proportion of patients) include:

• Acneiform (acne-like) skin rash
• Diarrhea
• Loss of appetite (anorexia)
• Fatigue and weakness
• Shortness of breath (dyspnea) and cough
• Nausea and vomiting
• Dry skin, itching
• Mouth sores (stomatitis)

Less common but serious reactions include severe or dose-limiting diarrhea, liver enzyme elevations, and eye irritation/dry eyes. For rare but potentially life-threatening reactions such as interstitial lung disease, severe hepatotoxicity, gastrointestinal perforation, and severe skin/eye reactions, see Precautions and Warnings. Patients should promptly report any new or worsening breathlessness, cough, fever, yellowing of skin/eyes, severe abdominal pain, severe rash, or eye pain to their oncologist.