Management   |   Patient advice   |   Grading

 

Adverse event management:
decreased appetite

Management recommendations1,2

If possible, the first step in treating decreased appetite is to address the underlying cause:

  • Addressing symptoms of nausea may help improve appetite
  • Treatment for any conditions such as mouth sores, dry mouth, pain or depression may help
    to improve appetite
  • Additional treatments for appetite loss and associated weight loss may include medications that
    increase appetite, medications that help food move through the intestine and nutritional supplements

Grade 1–2:

  • Continue GIOTRIF® (afatinib) treatment at current dose

Grade ≥3 or intolerable Grade 2:

  • Interrupt GIOTRIF® (afatinib), resuming treatment at a reduced dose (10 mg lower) if patient recovers to grade ≤1. Permanent discontinuation should be considered in patients who cannot tolerate 20 mg/day of GIOTRIF® (afatinib) treatment

 


Advice for patients1

  • Eat 5–6 small meals a day and snack when hungry
  • Identify the times of day when usually hungry − eat at those times and do not limit the amount eaten
  • Eat nutritious snacks that are high in calories and protein, such as dried fruits, nuts, yogurt, cheeses, eggs, milkshakes, ice cream, cereal and muesli bars
  • Drink fluids between meals, instead of with meals, to avoid filling up too quickly
  • When too tired to shop/cook, ask family members or friends for help; consider buying pre-cooked meals
  • If the smell or taste of food brings on nausea, eat cold/room temperature food to decrease odour and reduce taste
  • Meet with a dietitian for additional advice on meal planning

Grading3

Grade 1

Grade 2

Grade 3

Grade 4

Loss of appetite without alteration in eating habits

Oral intake altered without significant weight loss or malnutrition; oral nutritional supplements indicated

Associated with significant weight loss or malnutrition (e.g. inadequate oral caloric and/or fluid intake); tube feeding or TPN indicated

Life-threatening consequences

Grade 1

Loss of appetite without alteration in eating habits

Grade 2

Oral intake altered without significant weight loss or malnutrition; oral nutritional supplements indicated

Grade 3

Associated with significant weight loss or malnutrition (e.g. inadequate oral caloric and/or fluid intake); tube feeding or TPN indicated

Grade 4

Life-threatening consequences

 

Adapted from CTCAE version 3.3


CTCAE=Common Terminology Criteria for Adverse Events, TPN=total parenteral nutrition


References

1
Cancer.Net. Appetite Loss. Available at: www.cancer.net/all-about-cancer/treating-cancer/managing-side-effects/ap.... Last accessed April 2019.
2
GIOTRIF® (afatinib) Summary of Product Characteristics, 2018.
3
Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0.