Treatment Name: Afatinib (Gilotrif®)
How does Afatinib (Gilotrif®) work?
Lung cancer cells have specific protein receptors on their surface. One protein, known as epidermal growth factor receptor, or "EGFR," can be present in higher than normal numbers or can be stuck in the "on" position due to a mutation. When either of these happen, an unregulated signal tells the cell to grow and divide uncontrollably.
Afatinib (Gilotrif®) mechnism of action: afatinib is designed to enter cancer cells and block the EGFR signal. EGFR testing is done prior to starting to see if the lung cancer cells have the specific mutation in EGFR that predicts a positive response to afatinib.
Goals of therapy:
Afatinib (Gilotrif®) is a chemotherapy drug taken to shrink lung cancer and to slow its progression to other areas of the body. Afatinib is also given to decrease symptoms such as cough, shortness of breath, and pain associated with non-small cell lung cancer. Afatinib is not currently taken with the goal of cure.
- Usual starting dose: 40 mg oral tablet by mouth once daily
Afatinib is usually taken at home. Afatinib is taken continuously as long as the drug is working and no unacceptable side effects are experienced.
In clinical studies, the most commonly reported afatinib (Gilotrif®) side effects are shown here:
A note about side effect percentages
- Diarrhea (95%)
- Rash (89%)
- Mouth sores (72%)
- Fingernail or toenail infection (57%)
- Dry skin (29%)
- Decreased appetite (21%)
- Itching (19%)
- Nausea (18%)
- Fatigue (18%)
- Vomiting (17%)
- Nose bleed (13%)
- Inflammation of lips or corners of mouth (12%)
- Anemia [low red blood cells] (3%)
- Constipation (3%)
On average, 8% of patients discontinue afatinib due to unacceptable side effects.
Importantly, not all people who experience a side effect from Gilotrif® (afatinib) will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid future treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with Gilotrif®, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and every 6 to 12 weeks during treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. You may have an echocardiogram to assess your heart function before treatment and periodically during treatment.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue afatinib as planned, or delay or switch therapy.
- Development of a skin rash is common while on afatinib; however, development of skin rashes may be linked with better disease response from afatinib. Mild skin rashes can be treated with over-the-counter lotions or topical steroids. More severe rashes can be treated with oral or topical antibiotics or oral steroids that are prescribed by your doctor. Tell your doctor about any skin reactions that you have
- May cause severe diarrhea that can lead to severe dehydration. Diarrhea often responds to over-the-counter medications such as loperamide (Imodium®). Contact your doctor if your diarrhea does not resolve after 24 hours of using loperamide
- Afatinib contains lactose. Talk to your doctor before starting this if you are lactose intolerant
- If you are going to the hospital or the emergency room, be sure to bring your supply of afatinib with you. Many hospitals don’t carry this medication and your supply may need to be used if you are admitted to the hospital and your doctors want to continue afatinib during your stay
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for non-small cell lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Afatinib (Gilotrif®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Afatinib (Gilotrif®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Afatinib (Gilotrif®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Afatinib (Gilotrif®)