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Afatinib (Giotrif)

Afatinib (pronounced aff-a-tin-ib) is a cancer treatment drug and is also known by its brand name Giotrif (pronounced jee-oh-triff).

It is a treatment for lung cancer.

How it works

Afatinib is a type of cancer growth blocker called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that stimulate cells to grow. Afatinib blocks tyrosine kinases and also blocks epidermal growth factor receptor proteins in cancer cells. So afatinib is also called an EGFR-TK inhibitor.

Your doctor will check your cancer cells to see if they have these receptors. Cancers that have these receptors are called EGFR-TK positive.

How you have it

Afatinib is a tablet. You swallow it whole with a glass of water.

You can dissolve afatinib in a glass of still water if you have difficulty swallowing tablets. 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 has broken up into very small particles. Drink it straight away. Fill the glass again with water and drink it to make sure you take the whole dose.

When you have it

You take afatinib once a day on an empty stomach. You take them at least one hour before eating or 3 hours after eating.

You usually carry on taking it for as long as it is still working, unless the side effects get too bad.

You must take tablets and capsules according to the instructions your doctor or pharmacist gives 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.

Talk to your specialist or advice line before you stop taking a cancer drug.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse
Early treatment can help manage side effects better.

Common side effects

Each of these effects happens in more than 10 out 100 people (10%). You might have one or more of them. They include:

Diarrhoea 

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Skin changes 

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Swelling around nails (Paronychia)

Talk to the team looking after you about this. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Nosebleeds

Talk to the team looking after you about this.

Occasional side effcets

Each of these effects happens in between 1 and 10 out of 100 people (1 and 10%). You might have one or more of them. They include:

  • eye problems
  • redness and peeling on the hands and feet
  • liver changes
  • soreness and inflammation of the bladder
  • kidney changes
  • taste changes
  • indigestion
  • swollen lips
  • high temperature (fever)
  • weight loss
  • runny nose
  • muscle cramps
  • nail changes
  • change in mineral levels in the blood

Rare side effects

These effects happens in fewer than 1 out of 100 people (1%). They include:

  • changes in lung tissue
  • inflammation of the pancreas

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

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 a month afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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