Management   |   Patient advice   |   Grading

 

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

Adverse Event

Grade 1

Grade 2

Grade 3

Pruritus

Mild or localised

Intense or widespread

Intense or widespread and interfering with ADL

Dry Skin

Asymptomatic

Symptomatic, not interfering with ADL

Interfering with ADL

Adverse Event

Pruritus

Dry Skin

Grade 1

Mild or localised

Asymptomatic

Grade 2

Intense or widespread

Symptomatic, not interfering with ADL

Grade 3

Intense or widespread and interfering with ADL

Interfering with ADL

 

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.

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