Saturday, October 24, 2015

Tarceva Side Effects

After Jim’s seventh lung cancer recurrence in October of 2014, his oncologists agreed it was time for him to try Tarceva. We were out of options after three series of chemotherapy with multiple agents, treatment with standard radiation, and three series of targeted radiation. He has been taking Tarceva daily for almost a year and I am beyond happy to report that it is working. The cancer, though still present, is stabilized. In a few weeks, we will do a PET/CT—the third since he started the drug.

As with any drug, one must weigh benefits verses adverse reactions. In Jim’s mind, the benefits win. The drug is easy to take—though expensive (so far our insurance has covered most of it). He is not tethered to an i.v. which has freed us to do some traveling that we couldn’t do in years past. And most importantly it is buying him progression free time.

But Tarceva can have some unpleasant side effects—-diarrhea, dry skin, split fingers, nail bed infections, and the Tarceva rash, which for him has been the worst. The word “rash” which evokes images of a baby’s behind is an inadequate description of the affliction. I imagine this “rash” is more akin to Job’s ordeal.

At week six of treatment the rash appeared—a happy harbinger indicating the efficacy of the drug. A few acne like spots on his face, head, and back were easily manageable and preferable to many of the side-effects he had previously encountered. The rash abated with no treatment.

At six months the rash returned with a vengeance covering face and scalp. Our usually helpful local oncologist wasn’t much help. He recommended ointments and lotions to prevent dry skin but nothing for the increasingly troublesome pustules. (Yuk! I hate that word but it is apt for these breakouts.) We made an appointment with the dermatologist who prescribed Neosynalar, a combination steroidal/antibiotic cream and Ketoconazole Shampoo. Problem solved.

At 9 months, the tormentor struck again—-not as bad on the face but worse in the hair. We sent these pictures to the oncologist who told us to stop the Tarceva for a few days (an unwelcome suggestion for Jim), start on an oral antibiotic, and head back to dermatologist.

The dermatologist did a culture for a yeast infection but we won’t get those results for a few days. Yesterday he started on 100 mgs doxycycline and topical Clindamycin Phosphate. We have already seen improvement. I am concerned, however, about the effect the antibiotic will have on the diarrhea which is already a problem. Perhaps we will just have to choose the lesser of the two evils.

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