Erlotinib (Tarceva, Roche Products) is an inhibitor of epidermal growth factor receptor tyrosine kinase (EGFR‑TK). It blocks the signal pathways involved in cell proliferation and helps to slow the growth and spread of tumours. Erlotinib has a UK marketing authorisation for the 'treatment of patients with locally advanced or metastatic non‑small‑cell lung cancer after the failure of at least 1 prior chemotherapy regimen'.
The summary of product characteristics lists the following as the most common adverse reactions for erlotinib: infection, anorexia, keratoconjunctivitis sicca, conjunctivitis, dyspnoea, cough, diarrhoea, nausea, vomiting, stomatitis, abdominal pain, rash, pruritus, dry skin and fatigue. For full details of adverse reactions and contraindications, see the summary of product characteristics.
Erlotinib is given orally at a recommended dosage of 150 mg once daily. The cost for a 30‑tablet pack of 150-mg tablets is £1,631.53 (excluding VAT; BNF, accessed online September 2015). Costs may vary in different settings because of negotiated procurement discounts. Roche Products has agreed a patient access scheme with the Department of Health, with a simple discount applied at the point of purchase or invoice. The level of discount is commercial in confidence. The Department of Health considered that this patient access scheme does not constitute an excessive administrative burden on the NHS.
Gefitinib (Iressa, AstraZeneca) is an EGFR‑TK inhibitor. It blocks the signal pathways involved in cell proliferation and helps to slow the growth and spread of tumours. Gefitinib has a UK marketing authorisation for the treatment of adults with 'locally advanced or metastatic non‑small‑cell lung cancer with activating mutations of EGFR‑TK'.
The summary of product characteristics lists the following as common and very common adverse reactions for gefitinib: diarrhoea, skin reactions, anorexia, conjunctivitis, blepharitis, dry eye, haemorrhage, interstitial lung disease, vomiting, nausea, stomatitis, dehydration, dry mouth, elevations in alanine aminotransferase, elevations in total bilirubin, nail disorder, alopecia, asymptomatic laboratory elevations in blood creatinine, proteinuria, cystitis and asthenia. For full details of adverse reactions and contraindications, see the summary of product characteristics.
Gefitinib is given orally at a recommended dosage of 250 mg once daily. The cost for a 30‑tablet pack of 250‑mg tablets is £2,167.71 (excluding VAT; BNF, accessed online September 2015). Costs may vary in different settings because of negotiated procurement discounts.