Afatinib (GIOTRIF)

Non-small cell lung cancer – advanced or metastatic, with EGFR mutations

Non-small cell lung cancer – advanced or metastatic, with EGFR mutations

• Oral: 40 mg once daily continuously until disease progression or unacceptable toxicity

Available as 20 mg, 30 mg or 40 mg film-coated tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature.

EGFR (epidermal growth factor receptor) inhibitor

Take on an empty stomach at least 1 hour before or 3 hours after a meal

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Diarrhea, Paronychia (nail infections), Rash.

Less Common: Gastrointestinal perforation, Interstitial lung disease, Pneumonitis, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Left ventricular ejection fraction decrease, Fatigue, Hepatic dysfunction (ALT and AST increase), Renal Dysfunction, Visual disturbances.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: creatinine, alkaline phosphatase, ALT, total bilirubin and LDH. If clinically indicated: MUGA scan or echocardiogram, C-reactive protein, albumin.

During treatment: alkaline phosphatase, ALT, total bilirubin and LDH should be checked two weeks after starting afatinib, and at each subsequent visit.

If clinically indicated: liver function, creatinine, sodium, potassium, cardiac monitoring.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Diarrhea commonly occurs. Severe diarrhea can result in dehydration, electrolyte imbalance, and renal insufficiency. Diarrhea appears within the first 2 weeks of treatment, while severe cases occur within the first 6 weeks of treatment. Manage with loperamide.
• Rash is very common, patients should minimize sun exposure and use sunscreen.
• Paronychia is a common side effect. Patients should avoid trauma to nails, finger tips, and chemicals such as soaps, detergents and nail products.
• Avoid in pregnancy and lactation.

BC Cancer. BC Cancer Drug Manual. Afatinib. Vancouver, British Columbia: BC Cancer Agency.. Available at http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Afatinib_monograph.pdf.Updated September 1, 2019 Accessed January 22, 2024.

Lexicomp. Afatinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.; 2023. Available at: https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/4590262?cesid=574GQMCouFW&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dafatinib%26t%3Dname%26acs%3Dtrue%26acq%3Dagain. Updated January 24, 2024. Accessed January 28, 2024.

Cancer Care Ontario. Afatinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/AFAtinib. Updated June 2022. Accessed January 22, 2024.Boehringer Ingelheim (Canada) Ltd. GIOTRIF® Product Monograph. Burlington, Ontario: Boehringer Ingelheim (Canada) Ltd.. Updated June 6, 2019.