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Home > LUNG NSCLC Locally advanced/Metastatic - osimertinib

LUNG NSCLC Locally advanced/Metastatic - osimertinib

Treatment Overview

Cycle 1 (and all further cycles) - 30 days

Cycle length:
30

Cycle details

Cycle 1 (and all further cycles) - 30 days

Medication Dose Route Days Max Duration
doxycycline * 100 mg Once daily oral administration 0
hydrocortisone * 1 % Once daily topical administration 0
cetostearyl alcohol + paraffin liquid + paraffin soft white 50 g Once daily topical administration 0
avobenzone + homosalate + octisalate + octocrilene + oxybenzone 50 g topical administration 0
osimertinib 80 mg Once daily oral administration 1 to 30
loperamide 2 mg oral administration 1

Full details

Cycle 1 (and all further cycles) - 30 days

Day: 0

Medication Dose Route Max duration Details
doxycycline * 100 mg Once daily oral administration
Instructions:
  • To prevent rash.
  • Commence taking the day before osimertinib and continue for 6 weeks or as per institutional policy. If no rash develops after 6 weeks, consider stopping.
  • Take each dose with food and a large glass of water. Swallow whole, do not crush or chew. Remain sitting upright or standing for at least 30 minutes afterwards. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
hydrocortisone * 1 % Once daily topical administration
Instructions:
  • To prevent rash.
  • Apply to the face, hands, feet, neck, back and chest at bedtime or as directed by your oncologist to prevent rash.
  • If no rash develops after 6 weeks, consider stopping.
cetostearyl alcohol + paraffin liquid + paraffin soft white 50 g Once daily topical administration
Instructions:
  • Apply as a moisturiser to the face, hands, feet, neck, back and chest each morning or as directed by your oncologist.
  • Whilst this is a subsidised preparation, other moisturisers may also be suitable.
  • Quantity is approximate only, prescriber discretion required.
avobenzone + homosalate + octisalate + octocrilene + oxybenzone 50 g topical administration
Instructions:
  • SPF 50+ Sunscreen—apply to skin 30 minutes before going outdoors as directed by your oncologist.
  • Certified condition for subsidy. Whilst this is the subsidised preparation, alternative SPF 50+ sunscreen preparations may also be suitable.
  • Quantity is approximate only, prescriber discretion required.

Day: 1

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

Day: 2

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 3

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 4

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 5

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 6

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 7

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 8

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 9

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 10

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 11

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 12

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 13

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 14

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 15

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 16

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 17

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 18

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 19

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 20

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 21

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 22

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 23

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 24

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 25

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 26

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 27

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 28

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 29

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Day: 30

Medication Dose Route Max duration Details
osimertinib 80 mg Once daily oral administration
Instructions:
  • Swallow whole with a glass of water, do not break crush or chew.
  • If unable to swallow tablets or to give via a nasogastric tube, see Tagrisso® NZ Medsafe Data Sheet.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Minimal to low

Emetogenicity: Antiemetics may be required with continuous dosing of oral anti-cancer medicines with MINIMAL to LOW emetic risk; an individualised approach is appropriate. 

References

Soria JC, Ohe Y, Vansteenkiste J, et al. FLAURA Investigators. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. N Engl J Med. 2018 Jan 11;378(2):113-125. doi: 10.1056/NEJMoa1713137. Epub 2017 Nov 18. , PMID: 29151359

Mok TS, Wu Y-L, Ahn M-J, et al. AURA3 Investigators. Osimertinib or Platinum-Pemetrexed in EGFR T790M-Positive Lung Cancer. N Engl J Med. 2017 Feb 16;376(7):629-640. doi: 10.1056/NEJMoa1612674. Epub 2016 Dec 6. , PMID: 27959700

Ramalingam, S. S., J. Vansteenkiste, D. Planchard, et al. 2020. Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. N Engl J Med 382(1):41-50.

Leighl NB, Karaseva N, Nakagawa K, Cho BC, Gray JE, Hovey T, Walding A, Rydén A, Novello S. Patient-reported outcomes from FLAURA: Osimertinib versus erlotinib or gefitinib in patients with EGFR-mutated advanced non-small-cell lung cancer. Eur J Cancer. 2020 Jan;125:49-57. doi: 10.1016/j.ejca.2019.11.006. Epub 2019 Dec 12. , PMID: 31838405

AstraZeneca Limited. Tagrisso® New Zealand Data Sheet 18 April 2024. https://www.medsafe.govt.nz/profs/datasheet/t/tagrissotab.pdf (Accessed 24 Sept 2024)

Hofheinz RD, Deplanque G, Komatsu Y, et al. Recommendations for the Prophylactic Management of Skin Reactions Induced by Epidermal Growth Factor Receptor Inhibitors in Patients With Solid Tumors. Oncologist. 2016;21(12):1483-1491. doi:10.1634/theoncologist.2016-0051, PMID: 27449521

Lacouture ME, Anadkat MJ, Bensadoun RJ, Bryce J, Chan A, Epstein JB, Eaby-Sandy B, Murphy BA; MASCC Skin Toxicity Study Group. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011 Aug;19(8):1079-95. doi: 10.1007/s00520-011-1197-6. Epub 2011 Jun 1., PMID: 21630130

Deplanque G, Gervais R, Vergnenegre A, Falchero L, Souquet PJ, Chavaillon JM, Taviot B, Fraboulet G, Saal H, Robert C, Chosidow O. Doxycycline for prevention of erlotinib-induced rash in patients with non-small-cell lung cancer (NSCLC) after failure of first-line chemotherapy: A randomized, open-label trial. Journal of the American Academy of Dermatology. 2016 Jun 1;74(6):1077-85., PMID: 26946985

Dika, E., & Patrizi, A. (2017). Prevention of erlotinib-induced folliculitis with doxycycline. Dermatologic therapy, 30(1), https://doi.org/10.1111/dth.12419 , PMID: 27592506

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.