Afatinib for slidesshare
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1) The document discusses toxicities associated with the lung cancer drug afatinib, including diarrhea, skin rash, and mucositis in 95%, 89%, and 52% of patients respectively. 2) It provides data on managing these toxicities through loperamide, diet modification, skin care, mouthwashes, and potentially dose reduction of afatinib. 3) Afatinib demonstrates efficacy as a first-line treatment for lung cancer but requires managing common toxicities like diarrhea.
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Afatinib for slidesshare
- 1. 吳文碩 醫師 Wen-Shuo Wu, M.D. 台北榮民總醫院胸腔部 Toxicities of Afatinib
- 3. 95.20% 88.30%89.10% 80.80% 72.10% 51.90% Diarrhea Skin rash Mucositis/Stomatitis All Grades Toxicity Adapted from Lancet Oncol. 2014 Feb;15(2):213-22. J Clin Oncol. 2013 Sep 20;31(27):3327-34. 95% 89% 81% 88% 72% 52% LUX-Lung 3 LUX-Lung 6
- 4. Grade 3 Diarrhea 14.4% 5.4% Lancet Oncol. 2014 Feb;15(2):213-22. J Clin Oncol. 2013 Sep 20;31(27):3327-34. LUX-Lung 3 LUX-Lung 6
- 5. 73% 99% JO25567 All Grades ≧Grade 3 80% 16% 15% 25% 2% 13% EURTEC OPTIMAL 89% 81% LUX-Lung 3 LUX-Lung 6 J Clin Oncol. 2013 Sep 20;31(27):3327-34. Lancet Oncol. 2014 Feb;15(2):213-22. Lancet Oncol. 2011 Aug;12(8):735-42 Lancet Oncol. 2012 Mar;13(3):239-46. Lancet Oncol. 2014 Oct;15(11):1236-44 Skin Rash
- 6. LUX-Lung 8 Advanced NSCLC Squamous histology ≥ 4 cycles of platinum-based chemotherapy PS 0-1 Randomization1:1 Afatinib 40mg QD Erlotinib 150 mg QD Treatment until PD or unaccept- able AEs Goss et al. ESMO 2014. Abstract 12220.
- 7. LUX-Lung 8 – Adverse Events Afatinib (n=329) (%) Erlotinib (n=332) (%) Any AE 98 96 Drug-related AEs 91 80 CTCAE grade 3 or higher 50 49 AEs leading to dose reduction 24 12 AEs leading to discontinuations excluding PD-related 15 12 Serious AEs 39 38 Fatal (all cause, excluding PD) 12 11 Goss et al. ESMO 2014. Abstract 12220.
- 8. LUX-lung 8 – Drug Related AEs Afatinib (N=329) n, (%) Erlotinib (N=332) n, (%) AE category All Grade 3 Grade 4 All Grade 3 Grade 4 Total related AEs 298 (91) 75 (23) 4 (1) 266 (80) 48 (15) 1 (<1) Diarrhea 218 (66) 30 (9) 2 (<1) 103 (31) 7 (2) 1 (<1) Rash/acne 208 (63) 18 (6) 221 (67) 30 (9) Stomatitis 90 (27) 11 (3) 28 (8) Fatigue 44 (13) 3 (1) 43 (13) 6 (2) Decreased appetite 38 (12) 3 (1) 34 (10) 2 (<1) Nausea 38 (12) 3 (1) 24 (7) 3 (1) Paronychia 35 (11) 1 (<1) 14 (4) 1 (<1) Pruritus 29 (9) 1 (<1) 36 (11) Dry skin 27 (8)† 2 (<1) 34 (10) Vomiting 25 (8) ‡ 2 (<1) 10 (3) 2 (<1) Goss et al. ESMO 2014. Abstract 12220.
- 9. afatinib 40mg (n=52) erlotinib 150mg (n=56) gefitinib 250mg (n=51) Prospective analysis of AEs Management of Non-Hematologic Toxicities Associated With Different EGFR-TKIs in Advanced NSCLC A comparison Analysis Passaro A, et al. Clin Lung Cancer 2014; 15(4): 307-12.
- 10. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Diarrhea Rash Mucositis/ Stomatitis Afatinib Afatinib Afatinib Erlotinib Erlotinib Erlotinib Gefitinib Gefitinib Gefitinib Passaro A, et al. Clin Lung Cancer 2014; 15(4): 307-12. Time Course of AEs Onset Week 1 Week 2 Week 3
- 11. Incidence of Afatinib-Related Diarrhea Initial Assessment Last Assessment Definitive Grade Grade n (%) Lower Equal Worse 1 22 (47%) 19 (37%) 3 (6%) 0 (0.0%) 1 (2%) 2 12 (23%) 12 (23%) 0 (0%) 0 (0.0%) 0 (0%) 3 7 (14%) 7 (14%) 0 (0%) 0 (0.0%) 0 (0%) 4 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Passaro A, et al. Clin Lung Cancer 2014; 15(4): 307-12. 84% 2%
- 12. Incidence of Afatinib-Related Dermatologic AEs Initial Assessment Last Assessment Definitive Grade Grade n (%) Lower Equal Worse 1 19 (37%) 2 (4%) 16 (31%) 1 (2%) 25 (50%) 2 20 (39%) 8 (16%) 11 (22%) 1 (2%) 18 (35%) 3 10 (20%) 8 (16%) 2 (4%) 0 (0.0%) 3 (6%) 4 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Passaro A, et al. Clin Lung Cancer 2014; 15(4): 307-12. 96% 91%
- 13. Incidence of Afatinib-Related Mucositis or Stomatitis Initial Assessment Last Assessment Definitive Grade Grade n (%) Lower Equal Worse 1 8 (14%) 6 (10%) 2 (3.5%) 0 (0.0%) 3 (5%) 2 2 (3.5%) 2 (3.5%) 0 (0%) 0 (0.0%) 0 (0%) 3 0 (0.0%) 0 (0.0%) 0 (0%) 0 (0.0%) 0 (0%) 4 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Passaro A, et al. Clin Lung Cancer 2014; 15(4): 307-12. 17.5% 5%
- 16. Loperamide max 20 mg/day Diet modification
- 17. 多喝水
- 18. 用抗生素 保濕防曬 擦類固醇
- 19. Mucositis/Stomatitis 三餐飯後溫鹽水漱口 軟毛牙刷 Cholorohexidine oral BID 忌吃熱辣 Systemic pain management
- 20. Dose Reduction
- 21. Japanese Subgroup Analysis in LUX-Lung 3 J Clin Oncol. 2013 Sep 20;31(27):3327-34.
- 22. Take Home Message First-line Afatinib Diarrhea, Skin rash, Mucositis Dose Reduction
- 23. Living with lung cancer