Can Tagrisso Be Given With Turmeric?
There is no evidence-based guidance on combining osimertinib (Tagrisso) with turmeric, and this combination should be avoided due to potential drug interactions that could compromise treatment efficacy or increase toxicity.
Why This Combination Is Problematic
The primary concern stems from turmeric's active compound, curcumin, which has documented effects on multiple cellular pathways and drug metabolism systems. While no guidelines or drug labels specifically address this combination, several mechanistic concerns exist:
Potential Drug Interaction Mechanisms
- Curcumin affects multiple signaling pathways including NF-κB, Akt, MAPK, and STAT3, which overlap with osimertinib's mechanism of action and could theoretically alter drug efficacy 1, 2
- Osimertinib is metabolized primarily by CYP3A4, and many herbal supplements including turmeric can affect cytochrome P450 enzymes, potentially altering osimertinib blood levels 3
- The combination of osimertinib with other agents requires careful consideration due to its narrow therapeutic window and potential for increased adverse events, particularly pneumonitis 3
Clinical Guidance on Osimertinib Use
- Osimertinib is the preferred first-line treatment for EGFR exon 19 deletion or L858R mutations, with response rates of approximately 77-80% 3, 4, 5
- The NCCN guidelines emphasize caution when combining osimertinib with other agents, particularly noting increased adverse event rates (such as pneumonitis) when used within 3 months of immune checkpoint inhibitors 3, 4
- Even approved combination regimens (osimertinib plus chemotherapy) significantly increase grade ≥3 adverse events from 27-34% to 64-70% 4
Practical Recommendations
What to Tell Patients
- Discontinue turmeric/curcumin supplements before starting osimertinib and throughout treatment 3
- Avoid all herbal supplements unless specifically approved by the oncology team, as many can cause unpredictable drug interactions 3
- Report all supplements and over-the-counter medications to the treatment team, as seemingly benign products can interfere with cancer therapy 3
Monitoring Considerations
- If a patient has been taking turmeric, document this and monitor closely for altered osimertinib efficacy (earlier progression) or increased toxicity (particularly rash, diarrhea, or pneumonitis) 3, 6
- Standard osimertinib monitoring includes CT imaging every 6-12 weeks and assessment for adverse events including pneumonitis, which occurs in approximately 3-10% of patients 3
Critical Pitfalls to Avoid
- Do not assume "natural" supplements are safe during targeted cancer therapy—the lack of evidence is not evidence of safety 3
- Do not delay osimertinib treatment to allow turmeric "washout," as osimertinib should be initiated promptly once EGFR mutations are confirmed 3
- Do not substitute turmeric for proven therapies—while curcumin shows anti-cancer properties in laboratory studies, it has no established role in treating EGFR-mutated NSCLC 1, 2