BC Cancer Protocol Summary for Maintenance Therapy of Advanced
Non-Small Cell Lung Cancer (NSCLC) with Erlotinib After First-Line
Chemotherapy
Protocol Code: LUAVMTNE
Tumour Group: Lung
Contact Physician: Dr. Barbara Melosky
ELIGIBILITY:
Stage IV non-small-cell lung cancer
EGFR mutation-positive tumour confirmed by an accredited laboratory
Stable disease as best response after 4 cycles of first-line platinum-based doublet
Maintenance therapy to be started 21 to 42 days after fourth cycle of first-line
platinum-based doublet
ECOG performance status 0-1 at start of maintenance
EXCLUSIONS:
Progressive disease after first-line platinum-based doublet
Complete or partial response after 4 cycles of first-line platinum-based doublet
Prior treatment with first-line EGFR tyrosine kinase inhibitor (LUAVGEFF)
ECOG 2-4
Patients with moderate or severe hepatic impairment
TESTS:
Baseline: alkaline phosphatase, ALT, total bilirubin, LDH, chest X-ray.
During treatment: alkaline phosphatase, ALT, total bilirubin and LDH should be
checked two weeks after starting erlotinib and at each subsequent visit.
For patients with pre-existing liver disease or concomitant hepatotoxic medications,
hepatic function should be closely monitored throughout treatment.
As required: chest X-ray and scans to monitor index lesions.
Chest radiographs should be performed for monitoring of dyspnea to rule out
development of interstitial pneumonitis.
PREMEDICATIONS:
At physician’s discretion, prophylaxis for rash: minocycline 100 mg PO BID.
TREATMENT:
Drug Dose BC Cancer Administration
Guideline
erlotinib 150 mg daily PO
continue until disease progression or undue toxicity
BC Cancer Protocol Summary: LUAVMTNE Page 1 of 2
Activated: 1 Jul 2011 Revised: 1 July 2018 (LFTs clarified)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/legal.htm
DOSE MODICATIONS:
1. Rash: generally improves with time but if severe, may require treatment interruption
and/or dose reduction.
2. Diarrhea: if severe, may require treatment interruption and/or dose reduction.
3. Elevated liver enzymes: no guidelines for dose modification, but if very high may
need to interrupt or stop therapy.
PRECAUTIONS:
1. Skin toxicity: rash, acne, dry skin and pruritus are common. They appear on the
face, neck and trunk, and commonly fade or improve despite continuing erlotinib
therapy. Interrupt or discontinue treatment if severe bullous, blistering or exfoliating
conditions develop as fatal cases suggestive of Stevens-Johnson syndrome/toxic
epidermal necrolysis have been reported.
2. Diarrhea: this is usually mild and self-limiting. No routine prophylactic antidiarrheal
medication is needed.
3. Gastrointestinal Perforation: patients receiving concomitant corticosteroids and/or
NSAID’s, or who have prior history of peptic ulceration or diverticular disease are at
increased risk for developing gastrointestinal perforation. Permanently discontinue
erlotinib in patients who develop gastrointestinal perforation as fatalities have been
reported.
4. Ocular Disorders: corneal perforation or ulceration have been reported. Interrupt
or discontinue therapy if patients present with acute/worsening of ocular disorders
such as eye pain.
Call Dr. Barbara Melosky or tumour group delegate at (604) 877-6000 or 1-800-663-
3333 with any problems or questions regarding this treatment
program.
Reference:
Cappuzzo F et al. Erlotinib as maintenance treatment in advanced non-small cell lung cancer: a
multicenter, randomized, placebo-controlled phase 3 trial. Lancet Oncol 2010:11(6):521-9.
BC Cancer Protocol Summary: LUAVMTNE Page 2 of 2
Activated: 1 Jul 2011 Revised: 1 July 2018 (LFTs clarified)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/legal.htm
