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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