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If Tarceva works then stops working


yirol

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My Dad just started on 150mg of Tarceva as first-line treatment, with no other chemo yet. (Not sure if I've seen others on these boards who've used it alone as a first line.)

I have a general question about this medication. If Tarceva works then stops working, do we stop Tarceva altogether, or do we just combine it with other chemos and see if it works in combination? I'm sure this is a scientifically ignorant question, but please bear with me!

Thanks,

Yirol

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Hi, Yirol:

If you haven't yet visited Dr. West's website at onctalk.com, I strongly recommend that you do. In a couple minutes of browsing some of the "tarceva" search results, I found this recent discussion which might be of interest to you (there may be others):

http://onctalk.com/bbPress/topic.php?id=117

Here's an excerpt:

[ Dr. West ] ...The results in never-smokers receiving tarceva have been pretty consistently favorable, leading many to favor giving it in the first-line setting. I had been a bit more of a purist and would like to see more data in the first-line setting with tarceva, but that's been trickling in and has continued to look favorable. When I've been part of expert panels that were asked how they would treat a never-smoker with advanced NSCLC, about half would favor first-line tarceva, alone or with chemo or with avastin, and the others would be tempted but would give chemo or chemo and avastin a try and leave tarceva as the next thing they'd definitely use in second-line, and would have a low threshold for switching to it, in light of the strong expectation that tarceva will be quite beneficial.

The discussion board software on onctalk.com has been modified recently, and there are still some problems in date stamping (i.e., the "7 years ago" is clearly erroneous), but the correct timeframe is usually apparent from the posts themselves.

Best wishes and Aloha,

Ned

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Yirol,

I have heard of many different ways Tarceva has been used. The manufacture states that if there is improvement that it will be used till progression starts or the side effects can not be tolerated. I have been taking Tarceva for 21 months. I have had no bad side effects. Side effects from Tarceva are usually less than with traditional chemo. I also had other chemo with the Tarceva. I have heard of them adding a drug like Avastin to the Tarceva. I think there may be many combinations that could be tried. Finding perfect agreement among oncologists will be hard to find. Each person is different. There is nothing ignorant about your question; because I can guarantee you that you can get different answers from different oncologists. There is always another drug if Tarceva fails. Let’s just pray that it works and keeps on working.

Stay positive, :)

Ernie

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I have also heard of adding Celebrex to Tarceva to help prevent resistance. However, I don't think it is well researched at this time. But you can bet I will bring it up with my mom's onc. if the Tarceva doesn't work right away or stops working as well over time.

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I hope this drug works for my Dad! He's been on it alone (no chemo) for 8 days now, and had amazing symptom relief almost immediately. But yesterday, was a difficult day for him and his wheezing seemed to come back...so doctors sent him for another xray this morning to check it out. He doesn't start chemo for 2 weeks more, and I'm am just so afraid of the wait and the damn cancer taking advantage of the wait...and I wonder if we're all doing enough for him, pressing the doctors enough. They say he's too thin for chemo, but waiting isn't making him any fatter...so I really don't get that logic AT ALL. I hate, hate, hate this disease. I feel so at a loss, so lost... not at all used to being so powerless to help my Dad. When he coughs so helplessly, I imagine his cancer to be this clear gelinous beast in his chest THAT I HATE!

Today is a day of worry. 8 days out of initial treatment, 15 days since dx. Bad day.

Please pray for my Dad. He's pretty incredible.

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Thanks, everybody. Thank you, thank you, thank you!

--Today, my question is about the 30mg of Prevacid my Dad takes and has been taking for acid-reflux. I remember reading something about "proton pump inhibitors" (PPI) like Prevacid reducing the absorption and effectiveness of Tarceva, but Dad's oncologist didn't tell us about his and his general hospital staff poo-pooed our question about it saying "the pharmacy would've said something."

Is anyone else out there taking Tarceva with an antacid? Has anyone still had success with Tarceva while also taking an antacid? The strange thing is, I know oncologists will recommend a PPI for Tarceva-induced acid...so I'm very confused.

Any info would be appreciated.

Virtual hug to everyone.

Yirol

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My Dad ate (and kept down!) Ethiopian and Indian food two nights in a row! Whoohooo! He hasn't been able to handle and has had no desire for spicy foods-- yet alone any food-- for a long time now, so we are all dancing circles around his bed, completely happy. He just rolls his eyes. :roll: It's funny how big little achievements like this become...God, we'll take more of them...no climbing mountains here (at least not yet)...just one step, one small step at a time....

Thank you all for your encouragement.

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Sounds like Tarceva is doing the job for Dad. Many here have had amazing results with it. I can't help with the Prevacid question as Maurice is in the Tarceva/Avastin clinical trial & cannot take any antacids because of the Avastin. Prayers for continued success. Good Luck & God Bless

wendyr

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Hey Raney: we were told no antacids while on Avastin. I've checked back through the trial papers we signed & can't find anything on antacids & I checked the Avastin website and they don't say anything about antacids either. I thought I was losing it & questioned Maurice & he remembers being told not to use antacids without permission and especially don't use alka seltzer, so there you have it. If you're using prilosec with the onc's permission I wouldn't be too worried about it. You can always call Genentech on Monday & clear it up but if the onc knows about the prilosec I wouldn't worry about it. Of course NSAIDS are definitely a no no on Avastin, but you already know that.

wendyr

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A few people asked this question at OncTalk, but I hadn't heard anything to say that there is an interaction and that there would be a problem by taking either medications like TUMS or proton pump inhibitors, the drugs like protonix and nexium that shut off stomach acid. So I looked into the materials I had (aside from the standard package insert the company puts out, I had some slides from the company that were from working with doctors on educational programs), and I really don't see anything there. I did a search online and still found no references except for just one or two trials with tarceva that say not to take proton pump inhibitors with it (but really don't give a good rationale for why it should be prohibited), but there are probably more than a hundred trials out there with tarceva that don't seem to include this prohibition. And I've been in contact with a few people from the company to see what I can find out. So far, no bells or whistles have gone off to say "yes, this is an issue we need to publicize". In fact, so far, if there's an issue, it's being kept as a state secret.

I'll let you know what I learn. I expect to get a more official word from Genentech, but that's what I know so far.

-Dr. West

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It appears that anti-acids may reduce the effectiveness of Tarceva

Erlotinib is characterised by a decrease in solubility at pH above 5. The effect of antacids, proton pump inhibitors and H2 antagonists on the absorption of erlotinib have not been investigated but absorption may be impaired, leading to lower plasma levels. Caution should be exercised when these medicinal products are combined with erlotinib.

http://emc.medicines.org.uk/emc/assets/ ... ntID=16781

Agenta Effect Mechanism

--------------------------------------------------------------------------------

CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, barbiturates, St. John’s Wort) Decreases gefitinib/erlotinib plasma concentration and reduces efficacy Enhances gefitinib/erlotinib CYP3A4 metabolism

CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, protease inhibitors, grapefruit juice) Increases gefitinib/erlotinib plasma concentration and increases toxicity Decreases gefitinib/erlotinib CYP3A4 metabolism

Proton pump inhibitors (e.g., omeprazole) Reduces gefitinib absorption (not documented for erlotinib) Sustained elevation of gastric pH

Histamine H2-receptor antagonists (e.g., ranitidine, cimetidine, famotidine) Reduces gefitinib absorption (not documented for erlotinib) Sustained elevation of gastric pH

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[ wendyr ] Raney...I checked the Avastin website and they don't say anything about antacids...Of course NSAIDS are definitely a no no on Avastin, but you already know that.

Well, how about this -- I wasn't told to avoid either one on Avastin! Looking at my notes, I see the nurse practitioner who was giving me the chemo orientation before my Taxol/Carbo/Avastin program recommended Tylenol for pain. I asked if ibuprofen was okay as it worked better for me, and she gave an unequivocal "yes."

I thought Dr. West's post was going to straighten this out for me, then realized he was talking about Tarceva, not Avastin. This discussion thread started out with Tarceva as the focus, then it morphed to Avastin, and now I think it's back more or less to Tarceva.

[ yirol ] I really hope a talk with the oncologist tomorrow will clear this all up! So confusing.

My next onc appointment and Avastin infusion is tomorrow (Tuesday), so that's my goal too. We may find that even oncologists don't agree on this question. Aloha,

Ned

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Thanks for pointing out the morphing of this thread, Ned. I was wondering if I missed something! :shock:

Still, since Avastin and Tarceva are often taken together, I figured it didn't matter if both were addressed w/regards to PPI's.

Still no meeting with the oncologist, strangely, but hopefully before the end of the day....

Today a "palliative care doctor" (ugh) came by and told us Dad was on Omeprazole Magnesium Tab 20 MG controlled release (CR) -- one dose daily -- and that it is a PPI, for stomach acidity. NEWS TO US!

So, hopefully Dr. West and your own oncologist can help us sort this through. If Tarceva and/or Avastin is going to be effective, I don't want anything limiting that for anyone, and I'd like to know if there's another way to deal with the stomach acidity (in addition to avoiding Indian and Ethiopian foods!).

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