You are about to begin taking Tarceva as therapy for your lung cancer.  This drug, taken as a once-a-day pill, is a great convenience compared to having I.V. infusions.  However, Tarceva, like all drugs used to fight cancer, has several secondary effects that are not pleasant or easy to accept without specific attention.

Primarily, Tarceva acts like a sponge for water.  Tarcevans (patients taking Tarceva) need to pay particular attention to staying hydrated. Any unwanted secondary effects may be amplified if you are dehydrated. 

Twenty-four hours before you take your first daily pill, you should begin drinking a minimum of 8 eight-ounce glasses of liquid per day.  This can be water, tea, soda, Crystal lite, or any other caffeine-free liquid, and could even include cubed pieces of watermelon, in season.  You should continue to drink a minimum of 8 eight-ounce glasses of liquid per day for as long as you take Tarceva.

One way to assure that you drink enough is to begin the morning with two glasses of water and then have sixteen ounces of liquid at breakfast.  That means that by 8:30 a.m. you are half-way to your goal of eight glasses.  It’s a good start to every day.

The next common side-effect of Tarceva is problems with your skin.  These problems fall into multiple categories with the most common being a rash consisting of acne-like pimples on your face.  The rash can be minor (an occasional pimple) or severe (pustules all over your face, making you look like an adolescent).

The rash may not appear immediately, but you may notice changes to your skin before any pimples appear.  You may be able to lessen the severity of the reaction if you begin treating your face at the moment you begin taking the Tarceva therapy.  See the suggestions under “Face” in this informational note.

It may be more difficult to resolve skin problems once they occur than to prevent them from happening.  Begin your new approach to hydration and skin care before you begin taking Tarceva.

However, if you have a severe skin reaction, your oncologist will be able to recommend a dermatologist specifically knowledgeable in dealing with Tarceva skin reactions. 

Do not attempt to treat a severe rash by yourself.  Call your oncologist.

For a thorough discussion of skin reactions on EGFR inhibitors likeTarceva see the post on the Lindi Skin products web site.    Lindi sells skin care products especially formulated for cancer patients.  From their home page click on Our Store.

Part of the systemic dehydration noted with Tarceva is the diarrhea experienced by about 50% of the patients taking the drug.  This side-effect is relatively easy to control with over-the-counter anti-diarrheal medications such as Immodium.  The most difficult part is learning to time the medication according to the severity of the symptoms.  It may take a few months to get it under control but most people manage to get it down to a system. You will eventually figure out what can set off your intestinal contractions.

Drug Interactions

To avoid potential problems, and potential fatalities, check all drugs (prescription and over-the-counter) with your oncologist BEFORE you take them.

Skin

Face

Wash your face twice a day with non-soap facial wash. Avoid anything with alcohol.   Neutrogena makes a particularly wide range of washes and mild exfoliants (such as their Nightly Scrub). All are in the mid-price range and are widely available at chain drup stores.  Some Tarcevans also like Beyond Belief ABH Pore Refining Exfoliating Scrub, available at Sally’s Beauty Supply and on line at for under $6.00.

To help keep germs from re-infecting your face you might try to use a clean washcloth every day when you wash your face and you should pat your face dry with a second clean washcloth.  Washcloths are inexpensive and you can get a week’s supply for less than $25.  Walmart is a good source for these.

After washing and drying, be sure to re-hydrate your face. 

Some Tarcevans swear by Almond Oil (available in health food stores).  You can use it on your face, or on your whole body, and then apply a thin layer of a perfume-free skin cream such as Eucerin, or an ointment such as Aquaphor. 

Hydrating with a lotion, such as Cetaphil, may be more appropriate if you want to wear make-up once you have re-hydrated your face.
 

Please be warned that most Tarcevans are photo-sensitive and it’s a good idea to mix some 30-45 SPF sun-screen with the ointment, cream, or lotion, to assure that your face, neck, and arms are protected from the sun (see The Sun, below).

When pimples open, you can treat them against infection with over-the-counter anti-bacterial ointments.  You can also ask your dermatologist to prescribe a topical anti-biotic gel such as Clindamycin, but be careful to apply it only to areas of rash as Clindamycin is very drying.

One Tarcevan, contrary to “manufacturer’s directions”, has found Clindamycin effective for pustules in her nose.  She applies it on a Q-tip and finds that the pustules clear up in a few days.

If your rash is severe, your dermatologist may prescribe a systemic anti-biotic to get the eruptions under control.

Don’t self-treat.  Use the medical expertise available to you.  But, you’re probably the best judge of what is working for you at any given time.

Body

To prevent excessive drying of your skin cut down on the number, and duration, of the showers you take and use lukewarm water rather than hot water.  Avoid any perfumed soaps.

Olay's In Shower Lotion seems to work to hydrate your whole body.

Use hydrating cream on your body if the skin seems dry.  Don’t forget to hydrate your feet as well.

If dry skin, or a rash, leads to excessive itching there are several effective anti-itch lotions on the market.  Try Eucerin Calming Itch-relief Treatment or Benadryl itch stopping gel.

 

Nails

The skin at your fingertips may become so dry that it cracks.  The fissure may extend under the nail bed.  If that happens, you should ask for help from your dermatologist. 

Other Tarcevans have had success with Tea Tree oil and Tea Tree nail saver, also available on the web   Also reported effective is Copper complex intensive tissue repair cream (see Elbows, below).  

To increase the effectiveness of the nail oils and cream you might consider wearing cotton dermatological gloves to keep your fingers covered and bathed in the treatment overnight.

Some Tarcevans complain of splitting and breaking nails.  Nailtiques makes a product specifically for splitting nails.  Try their “2 plus” treatment if your dermatologist thinks it will help.

Feet
Many Tarcevans with nail problems also experience toe problems.  Try regular foot soaks in very warm Epsom salts.  Tea Tree Oil works here too.   Any infection should be seen and treated by a doctor.  Don't wait, call.

Elbows
Dry, cracked, and peeling skin on the elbows can be cured by twice daily application of ProCyte Copper complex intensive tissue repair creme   Rub in a tiny amount, then cover with gauze so it stays on you, not on your shirt.  Works on fingers and toes too.

Hair

Some Tarcevans may experience thinning hair.  Several hairdressers have suggested the use of Nioxin products for thinning hair.  They have shampoos, conditioners and scalp treatments that seem to offer some improved growth.  Your dermatologist may also be able to help.

Eyes
A rash near your eyes can best be washed using baby shampoo, which is especially formulated not to sting when it gets in your eyes.

The Sun

Despite warnings of photo-sensitivity some Tarcevans stay out in the sun.  If you do, please tell your oncologist so you can have your Vitamin D level checked.  It has been observed that a lack of Vitamin D may cause you to have greater aches and pains, particularly if you have arthritis.