EGFR mutation assessment of the tumour tissue is recommended in 1st-line treatment for advanced or metastatic NSCLC. Not to be used in preference to doublet chemotherapy in mutation -ve patients in 1st-line setting. Interrupt treatment & initiate prompt investigation if patients present w/ worsening of resp symptoms (eg, dyspnoea, cough & fever). Discontinue use & treat patient appropriately if ILD is confirmed. Perform periodic LFT; consider discontinuation if changes are severe. Possible cerebrovascular events. Concomitant use w/ CYP3A4 inducers (eg, phenytoin, carbamazepine, rifampicin, barbiturates or St. John's wort); drugs causing significant sustained elevation in gastric pH may reduce efficacy. Regularly monitor changes in prothrombin time or INR in patients taking warfarin. Advise patients to promptly seek medical advice in the event of developing severe or persistent diarrhoea, nausea, vomiting or anorexia. Promptly refer to an ophthalmologist if patient presents w/ signs & symptoms suggestive of keratitis (eg, acute or worsening eye inflammation, lacrimation, light sensitivity, blurred vision, eye pain &/or red eye). Interrupt treatment if diagnosis of ulcerative keratitis is confirmed; consider permanent discontinuation if symptoms do not resolve or recur on reintroduction of treatment. Patients w/ history of keratitis, ulcerative keratitis or severe dry eye. Possible CNS haemorrhages. May exacerbate neutropenic effect of vinorelbine. Possible GI perforation associated w/ other known risk factors including increasing age, concomitant use of steroids or NSAIDs, underlying history of GI ulceration, smoking or bowel metastases at sites of perforation. Possible asthenia during treatment; observe caution when driving or using machines. Women of childbearing potential must be advised to avoid becoming pregnant. Pregnancy. Recommend to discontinue nursing while receiving therapy. Not recommended for use in childn or adolescents.
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