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Gefitinib (Iressa)
This fact sheet is about gefitinib, which is also known as Iressa. It may be used to treat non-small cell lung cancer (NSCLC). Gefitinib may also be used to treat other types of cancer as part of a research trial. The fact sheet describes gefitinib, how it's given and some of its possible side effects. It should ideally be read with our general information about your type of cancer. You'll see your doctor regularly while you have this treatment so they can monitor its effects. This fact sheet should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse. If youd like to discuss this information with our cancer support specialists, call the Macmillan Support Line free on 0808 808 00 00, MondayFriday, 9am8pm. If youre hard of hearing you can use textphone 0808 808 0121, or Text Relay. For non-English speakers, interpreters are available. Alternatively, visit macmillan.org.uk Includes the following information

What is Gefitinib? How it works When it is used How it is given Possible side effects Additional information Related Macmillan information
What is Gefitinib?
Gefitinib belongs to a group of medicines called epidermal growth factor receptor inhibitors, also known as EGFR inhibitors.

How it works
Gefitinib blocks (inhibits) a protein called an epidermal growth factor receptor. It's involved in the growth and spread of cancer cells. EGFRs are structures on the surface of many types of cancer cells. The receptors allow the epidermal growth factor (a protein present in the body) to attach to them. When the epidermal growth factor (EGF) attaches to the receptor, it causes an enzyme called tyrosine kinase (TK) to trigger chemical processes inside the cell to make it grow and divide. Gefitinib attaches itself to the EGF receptor on the cell and prevents the receptor from being activated. This stops the cells from dividing. Gefitinib therefore has the

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potential to stop the cancer cells from growing.

here, discuss them with your doctor or specialist nurse.

Skin changes An acne-like rash that mainly affects the head, chest and back is the most common side effect of gefitinib. This usually begins during the first 23 weeks of treatment and goes away once treatment ends.

When it is used
Gefitinib is used to treat some people with non-small cell lung cancer (NSCLC). It only works for NSCLCs that have changes called EGFR mutations on the surface of their cells. EGFR mutations are most likely in NSCLC in: women people who have never smoked people with adenocarcinoma people of Asian origin. Tests may be done to check the level of EGFR. These will tell if you're likely to benefit from gefitinib. Testing can be done at the time the cancer is diagnosed, or samples of cancer cells from previous biopsies or surgery may be used. The National Institute for Health and Clinical Excellence (NICE) currently gives advice on which new drugs or treatments should be available on the NHS. They recommend gefitinib as a possible first treatment for people with NSCLC that is EGFR positive and has spread to surrounding tissues or other parts of the body.

Your skin may also become dry and itchy or feel tender and peel. Some people find that the nails on their hands or feet become red, sore and brittle. Taking the following steps may help reduce the severity of skin changes, although they cant prevent them altogether. Use tepid water and mild non-scented soap for bathing and washing. Avoid skincare products that contain alcohol. Dont use anti-acne products, as they can dry your skin and your make symptoms worse. Sunlight can make skin symptoms worse. During treatment with gefitinib, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun, but should wear a sun cream with a high sun protection factor (SPF) and cover up with clothing and a hat. If you are having radiotherapy, don't apply sunscreen to any skin in the area being treated. Moisturise your skin regularly and after bathing. Your doctor or specialist nurse can advise you on which moisturisers are best. Protect your hands and fingernails from detergents by wearing rubber gloves when washing dishes. Let your doctor know as soon as possible if you develop skin or nail changes. They can prescribe treatment to help. In people who have more severe side effects, treatment with gefitinib can be stopped for a few days to allow their skin to recover.

How it is given
Gefitinib is taken as a tablet once a day. You should take the tablet at the same time each day.

Possible side effects

Each persons reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having this treatment. We've outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed

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Hair changes Your eyelashes may grow longer and more curly than usual. Men may notice they have less beard growth. You may notice your head and body hair is finer, curlier or more brittle. Some people have hair thinning or hair loss. If this happens, it usually develops gradually. These changes are usually temporary and gradually improve once treatment is over. Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea. Loss of appetite A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite and maintain your weight. Feeling sick (nausea) and being sick (vomiting) This is usually mild. Let your doctor know if it isn't controlled as they can prescribe effective anti-sickness medication. Tiredness Some people feel tired and lack energy while taking gefitinib.

Its important to let your doctor know straight away if you feel unwell or have any severe side effects, even if theyre not mentioned above.

Additional information

Keep the tablets in a safe place, out of

Bleeding problems Let your doctor know if you have nosebleeds or notice blood in your urine while taking gefitinib.
Eye problems If you notice any change to your vision, or pain or redness of your eyes, let your doctor know immediately. Breathing problems This is an uncommon side effect that may affect about 1 in 100 people taking gefitinib. If you become breathless, if your breathing worsens or if you have a cough or fever, tell your doctor straight away. It may mean you have an inflammation of the lungs called 'interstitial lung disease'. This is potentially very serious, and a small number of people have died because of lung problems they have developed while taking gefitinib. If you're worried about this potential side effect, talk to your doctor or nurse.

the reach of children. Gefitinib may interact with other medicines, including some that are used to treat stomach ulcers, indigestion and epilepsy. It may also interact with the herbal remedy St John's Wort. Tell your doctor about any medicines you are taking, including any non-prescribed drugs such as complementary or herbal therapies. If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away. If you are sick after taking the tablet, let your doctor know. You may need to take another dose. Don't take another tablet without telling your doctor first. If you forget to take a tablet, take it as soon as you remember, as long as it's more than 12 hours before your next scheduled dose. If it's less than 12 hours, don't take the missed dose. It's not advisable to become pregnant or father a child while having this treatment, as it may harm the developing baby. Its important to use effective contraception while having this treatment, and for at least a few months afterwards. You can discuss this with your doctor. Its not known whether biological therapies can be present in semen or vaginal fluids. To protect your partner its safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.

Related Macmillan information

Controlling nausea and vomiting Coping with fatigue Diet and cancer

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 Understanding cancer research trials

(clinical trials)

Understanding lung cancer

For copies of this related information call free on 0808 808 00 00, or see it online at macmillan.org.uk
This fact sheet has been written, revised and edited by Macmillan Cancer Supports Cancer Information Development team. It has been approved by our medical editor, Dr Terry Priestman, Consultant Clinical Oncologist. With thanks to Christine Clark, Macmillan Network Pharmacist, Dermot Ball, Cancer Network Pharmacist, and the people affected by cancer who reviewed this edition. This fact sheet has been compiled using information from a number of reliable sources, including: electronic Medicines Compendium (eMC). Summary of Product Characteristics (SPC): Gefitinib. www.medicines.org.uk/EMC/ medicine/22104/SPC/Iressa+250mg+filmcoated+tablets (accessed 6 August 2010). TA129 Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer. July 2010. National Institute for Health and Clinical Excellence (NICE). This fact sheet was revised in 2011. The next edition will be available in 2013. We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third-party information such as information on websites to which we link. Macmillan Cancer Support 2012. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ. MAC11790_12

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