Adverse event management:
pruritus & dry skin
Management recommendation1
Pruritus
Grade 1:
- Continue GIOTRIF® (afatinib) treatment at the current dose
- A topical steroid can be administered at a moderate strength twice daily
Grade 2:
- Continue GIOTRIF® (afatinib) treatment at the current dose
- A topical steroid can be administered at a moderate strength twice daily
- Oral histamines could be added to treatment plan
Grade ≥3 or intolerable Grade 2:
- Refer to a dermatologist
- 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
- Consider oral antihistamines and a GABA modulator – gabapentin or pregabalin
Dry Skin
Grade 1:
- Continue GIOTRIF® (afatinib) treatment at the current dose
- OTC moisturising cream or ointment can be applied twice daily
Grade 2:
- Continue GIOTRIF® (afatinib) treatment at the current dose
- OTC moisturising cream or ointment can be applied twice daily
- Salicylic acid 6% cream twice daily as an alternative option for the body
Grade ≥3 or intolerable Grade 2:
- Refer to a dermatologist
- 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
- OTC moisturising cream or ointment can be applied twice daily
- Salicylic acid 6% cream twice daily as an alternative option for the body
- Add topical steroid to eczematous areas twice daily
Advice for patients1,2
- Use skin creams and lotions that moisturise the skin and prevent dryness
- Minimise exposure to the sun
- Use mild bath cleansers without soap to prevent skin irritation
- Bath or shower in warm water – not hot
- Avoid fabrics that can make skin itch (e.g. wool and synthetics). Wear loose-fitting, cotton or other soft fabrics and switch to cotton blankets and bed sheets
- Use mild soaps when washing sheets and clothing
- Avoid overheating the house, as warm, dry air can make skin dry
- A cool cloth over the affected area can help to relieve itching
Grading3
Adapted from CTCAE version 3.3
ADL=activities of daily living, AE=adverse event, GABA=gamma-aminobutyric acid, OTC=over-the-counter
References
- 1
- Lacouture ME, et al. Expert Rev Anticancer Ther 2013;13(6):721–728.
- 2
- Aw DC, et al. Asia-Pac J Clin Oncol 2018;14(1):23–31.
- 3
- Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0.