Afatinib

Posted on 21/01/2018 by Dr. Joe — No Comments ↓

What is Afatinib?

Afatinib is a medication used for non-small cell lung cancer that has metastasized outside the lungs and that has certain EGFR mutations as per specified testing. The trade name for Afatinib is Gilotrif. Afatinib is a tyrosine kinase inhibitor, an epidermal growth factor receptor (EGFR) inhibitor.

This medication can be used by patients that have not been treated previously for metastases or by patients that have a metastasized squamous type of cancer and have already tried chemotherapy that contained platinum.

Afatinib attaches to the EGFR molecules and blocks the cancer causing proteins and discourages the cancer from growing. EGFR positive means that the cancer has the EGFR receptors. About 10 to 15 % of people with non-small cell lung cancer have EGFR positive cancer.

The doctor needs to check for these receptors before choosing Afatinib as a treatment. Afatinib may shrink the cancer or slow down its growth for a while. ^{[1, 2, 3, 4]}

Taking Afatinib

Afatinib is available in tablet form. There are different strengths of the oral tablet. Patients take this medication once a day on an empty stomach, at least one hour before the patient eats or two hours after the patient eats. If a dose is missed, the patient is to take it as soon as remembered.

If the next dose was supposed to be within twelve hours, they should skip that dose and start taking them again at the regular time. Patients are not to take two doses at once. If a patient takes too much Afatinib, they need to go to the hospital at once.

Tips for Patients:

Limit time in the sun, people could get severe sun burns
This medication can make skin sensitive to the sun, wear sun screen, clothes to cover the skin and a hat
Some people get worsening acne or skin rashes
Take the medication as prescribed
Swallow the medication whole with water
Take the medication at the same time everyday
Don’t take this medication with food
Don’t change the dose or stop taking the medication unless your doctor says so
Store the medication between 20-25 C or 68-77 F
Keep the container closed tight in the original bottle
Store away from light and moisture
Safely throw away any un-used or expired medication ^{[1, 2, 3]}

Side Effects

Very Common and Common Side Effects

Diarrhea
Skin rash
Mouth sores or ulcers
Nail infections, nails can also change color/shape
Itchy skin, dry skin, blistering skin
Loss of appetite
Nose bleeds
Swollen lips and mouth
Weight loss
Skin conditions resembling acne and actual acne
Nausea and vomiting
Dehydration
Taste changes
Dry eyes, pink eye infection
Urinary tract infections
Fever
Runny nose
Low potassium levels
Increased AST and ALT levels
Hand foot syndrome
Muscle spasms
Sore, red and peeling skin to palms and soles
Stomach pain and indigestion

Serious Side Effects

Kidney failure or impairment
Liver problems leading to yellowing of the eyes/skin, dark urine, abdominal pain, easy bruising and fatigue that can cause possible death
Blurry vision, eye pain, light sensitivity and changes in vision
Shortness of breath, cough, fatigue, swelling, heart palpitations and sudden weight change, all can be caused by heart problems

Uncommon Side Effects

Inflammation of the cornea (eye pain and redness)
Lung disease leading to trouble breathing, cough and fever that can cause possible death

Call a doctor immediately if these symptoms occur:

Fever of 100 F / 38 C of higher and chills
Shortness of breath, cough or trouble breathing
Chest pain or palpitations

The following symptoms require medical attention within 24 hours:

Diarrhea (4-6 episodes in 24 hours)
Nausea that interferes with eating/unrelieved with medications
Vomiting (more than 4-5 times in 24 hours)
Unable to eat/drink for 24 hours and have signs of dehydration
Yellow skin or eyes
Dark urine
Decreased appetite
Abdominal pain
Easy bruising
Skin or nail changes
Cough
Mouth sores
Pain or burning urination
Eye changes
Extreme fatigue
Swelling in the legs, feet or ankles
Sudden weight gain ^{[1, 2, 3, 4]}

Precautions

Patients must tell their doctor if they already have kidney problems, liver problems, breathing/lung problems other than from cancer, history of very dry eyes/other eye problems/if they wear contact lenses, heart problems, other medical conditions, are pregnant or plan to become pregnant or are breast feeding.

Before taking Afatinib, the patient must tell the doctor about the other medications they are taking to prevent interactions. While taking this medication, the patient should not get any immunizations without their doctor’s approval. Patients need to limit time in the sun, use sun screen, wear clothes that cover the skin and wear a hat.

Patients must tell their doctor if they are pregnant or if they may be pregnant. This medication is a class D pregnancy drug that means it can cause severe harm to a fetus. Male and female patients need to use contraception to avoid pregnancies while using this medication. Patients should not breast feed while on this medication to avoid passing the medication to the baby through the breast milk. ^{[1, 2, 3]}

Tips

Drink plenty of water daily
Wash hands before and after taking the medication
Avoid crowds and sick people to avoid infections
Use a soft toothbrush and frequently rinse the mouth to minimize bleeding and to prevent mouth sores
Use an electric razor for shaving to minimize bleeding
Avoid contact sports/activities that could cause injuries
Take prescribed anti-nausea medications and eat small frequent meals
Eat foods that help lessen diarrhea, follow prescribed anti-diarrhea medicine regimens
Avoid sun exposure
Alcohol consumption minimal or not at all
Good rest
Proper nutrition
Discuss side effects with doctor or pharmacist ^{[1, 2, 3]}

Reference List:

Cancer Research UK, Available from: http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/cancer-drugs/afatinib
Chemocare, Available from: http://chemocare.com/chemotherapy/drug-info/afatinib.aspx
Gilotrif.com, Available from: http://www.gilotrif.com/
Wikipedia, Available from: https://en.wikipedia.org/wiki/Afatinib
MPR, Available from: http://www.empr.com/gilotrif/drug/22862/
Netdoctor, Available from: http://www.netdoctor.co.uk/conditions/heart-and-blood/a1154/nosebleeds-epistaxis/
Noksid, Available from: http://noksid.net/jaundice-yellow-skin-and-eyes.html

Afatinib