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Systemic Anti-Cancer Therapy Regimen Library

Home > GU Renal cell Metastatic - beVACizumab and erlotinib

GU Renal cell Metastatic - beVACizumab and erlotinib

Treatment Overview

This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycle 1 (and all further cycles) - 28 days

Cycle length:
28

Cycle details

Cycle 1 (and all further cycles) - 28 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
beVACizumab * 10 mg/kg intravenous 1, 15 90 minutes
erlotinib * 150 mg Once daily oral administration 1 to 28
loperamide 2 mg oral administration 1

Full details

Cycle 1 (and all further cycles) - 28 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 erlotinib 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.
  • 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
beVACizumab * 10 mg/kg intravenous 90 minutes
Instructions:
  • Blood pressure and urinalysis should be checked before each administration. If urine dipstick protein is less than or equal to 3+, proceed with infusion.
  • If the initial dose of beVACizumab is well tolerated, the second dose may be administered over 60 minutes, and the third and subsequent doses may be administered over 30 minutes.
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.
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
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 3

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 4

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 5

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 6

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 7

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 8

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 9

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 10

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 11

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 12

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 13

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 14

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 15

Medication Dose Route Max duration Details
beVACizumab * 10 mg/kg intravenous 90 minutes
Instructions:
  • Blood pressure and urinalysis should be checked before each administration. If urine dipstick protein is less than or equal to 3+, proceed with infusion.
  • If the initial dose of beVACizumab is well tolerated, the second dose may be administered over 60 minutes, and the third and subsequent doses may be administered over 30 minutes.
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 16

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 17

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 18

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 19

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 20

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 21

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 22

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 23

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 24

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 25

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 26

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 27

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 28

Medication Dose Route Max duration Details
erlotinib * 150 mg Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Minimal to low
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

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

Srinivasan R, Gurram S, Al Harthy M, et al. Results from a phase II study of bevacizumab and erlotinib in subjects with advanced hereditary leiomyomatosis and renal cell cancer (HLRCC) or sporadic papillary renal cell cancer. Journal of Clinical Oncology 2020;38:5004-5004. https://doi.org/10.1200/JCO.2020.38.15_suppl.5004.

Srinivasan R, Su D, Stamatakis L, et al. Mechanism based targeted therapy for hereditary leiomyomatosis and renal cell cancer (HLRCC) and sporadic papillary renal cell carcinoma: interim results from a phase 2 study of bevacizumab and erlotinib [abstract]. Eur J Cancer 2014;50:8. http://www.ejcancer.com/article/S0959-8049(14)70131-5/abstract.

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., 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. Epub 2011 Jun 1., PMID: 21630130

Deplanque, Gaël, et al. "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 74.6 (2016): 1077-1085., PMID: 26946985

Dika, Emi, and Annalisa Patrizi. "Prevention of erlotinib‐induced folliculitis with doxycycline." Dermatologic therapy 30.1 (2017): e12419., PMID: 27592506

Roche Products (New Zealand) Limited. Tarceva New Zealand Data Sheet 19 July 2022 https://www.medsafe.govt.nz/profs/Datasheet/t/tarcevatab.pdf (Accessed 30 September 2022).

Roche Products (New Zealand) Limited. Avastin New Zealand Data Sheet. 21 December 2021 https://www.medsafe.govt.nz/profs/datasheet/a/Avastininf.pdf (Accessed 30 September 2022).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* 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.