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Afatinib (Giotrif)

This page tells you about the biological therapy drug afatinib. There is information about

 

What afatinib is

Afatinib is pronounced aff-a-tin-ib. It has the brand name Giotrif (jee-oh-triff). It is a type of biological therapy called a tyrosine kinase inhibitor (TKI). It is a treatment for non small cell lung cancer that has spread outside the lung or to other parts of the body. 

 

How afatinib works

This type of drug works by blocking particular proteins on cancer cells that encourage the cancer to grow. Afatinib blocks proteins called epidermal growth factor receptors (EGFR). Cancers that have these receptors are called EGFR positive.

Between 10 and 15 people out of every 100 with non small cell lung cancer (10 to 15%) have EGFR positive cancer. Doctors check your cancer cells to see if they have the receptors before you have this treatment.

Afatinib may shrink the cancer or stop it growing for a time.

 

How you have afatinib

Afatinib is available as blue, or white and yellow, tablets, depending on the strength. Your doctor will tell you which dose to take. You take the tablets once a day on an empty stomach. It is important to take them at least 1 hour before eating or at least 3 hours after eating.

If you find it difficult to swallow the tablets you can dissolve them in a glass of still water. Don’t use any other type of liquid. Drop the tablet into the water without crushing it. Stir it occasionally for up to 15 minutes until the tablet is broken into very small particles. Drink the liquid straight away. Then fill the glass again and drink it to make sure you take the whole dose.

It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

If you accidentally take too much afatinib, see a doctor or go to a hospital straight away. If you forget to take a dose of afatinib and your next dose is due after more than 8 hours, take the missed dose as soon as you remember. If the next dose is due in less than 8 hours, skip the missed dose and take the next dose at the usual time. Don't take a double dose to make up for the missed one.

You usually continue taking afatinib for as long as it works, unless it causes bad side effects.

 

Common side effects

More than 10 in every 100 people have one or more of these side effects.

  • Diarrhoea affects more than 9 out of 10 people (95%). Tell your doctor or nurse straight away if you are worried about how bad it is, or if it continues for more than 2 days. They will give you anti diarrhoea medicines to take. It is important to drink plenty of fluids
  • A skin rash happens in around 7 out of 10 people (70%). Your skin may be more sensitive to the sun so use clothing and a high factor sunscreen to protect your skin if you need to be outside
  • A sore mouth and mouth ulcers occur in around 7 out of 10 people (70%)
  • A nail infection affects about 5 out of 10 people (50%). Your nails may also change shape and colour
  • Itchy skin happens in about 2 out of 10 people (20%)
  • Loss of appetite occurs in around 2 in 10 people (20%)
  • Nosebleeds happen in more than 1 in 10 people (13%). This is due to a drop in platelets
  • Swollen lips occur in more than 1 in 10 people (12%)
  • Weight loss
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these side effects.

  • Sore, red dry eyes. Let your doctor or nurse know if you have this
  • A severe skin rash or blistering of the skin affects more than 3 out of 10 people (30%). Tell your doctor or nurse straight away if you have this. Your doctor may need to reduce the dose or stop the treatment
  • Soreness, redness and peeling on the palms of the hands and soles of the feed (palmar-plantar syndrome). This may cause tingling, numbness, pain and dryness
  • Liver changes that are very mild and unlikely to cause symptoms. Your liver will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your liver is working
  • Soreness and inflammation of the bladder lining, causing a burning feeling when passing urine and the need to pass urine often. Tell your nurse if you have this as they can give you medicines to help
  • Kidney changes that are mild and unlikely to cause symptoms. Your kidneys will usually go back to normal when treatment is finished. You will have regular blood tests to check how well your kidneys are working
  • Taste changes
  • Stomach pains and indigestion
  • A runny nose
  • Muscle cramps
  • A high temperature
 

Rare side effects

Fewer than 1 in 100 people have these side effects.

  • Changes in lung tissue that may cause a cough or breathlessness. Let your doctor or nurse know straight away if you have a sudden cough, breathlessness or a high temperature
  • Severe eye pain and redness. Tell your doctor or nurse straight away if you have this or watery eyes, blurred vision and sensitivity to light. You may need urgent treatment. Don't drive or operate machinery if you have these side effects
 

Important points to remember

You may have some of the side effects listed above. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Tell your doctor or nurse straight away if you are worried about any of the side effects or how bad they are.

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 1 month afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drug may come through in the breast milk.

 

Immunisations and afatinib

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccines. 

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines) but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about afatinib

We don't list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk/emc

If you have a side effect we don't list here and you think it may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority (MHRA). Go to www.mhra.gov.uk

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Updated: 31 January 2014