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Treatment Name: Afatinib (Gilotrif®)

Afatinib (Gilotrif®) is a Chemotherapy Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)

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.


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  • 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.

Side Effects

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.

Side effect videos Side Effect Videos
DiarrheaDiarrheaNausea and VomitingNausea and VomitingFatigue Fatigue BleedingBleedingAnemiaAnemiaConstipationConstipationPainPain


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.

ChemoExperts Tips

  • 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 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:

  • Afatinib

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.

Emotional Wellness

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®)

Individual Drug Label Information

Afatinib (Gilotrif®)

  • Afatinib is an oral tablet that comes in 20 mg, 30 mg, or 40 mg strengths 
  • Take on an empty stomach, at least one hour before a meal or two hours after a meal. Food may decrease absorption so it is best to take on an empty stomach to avoid a decrease in effectiveness
  • Can be taken at any time of the day as long as it is taken at roughly the same time each day
  • If you forget to take a dose, take the missed dose only if it has been less than 12 hours since the dose should have been taken. If it has been more than 12 hours, wait to take your next regularly scheduled dose. Do not double your dose to make up for the missed dose 
  • Stored at room temperature in a cool, dry place 
  • Dosage adjustments may be required for drug interactions and severe side effects 
  • Avoid during pregnancy. Contact your doctor immediately if you think you may have become pregnant 
General Afatinib (Gilotrif) Side Effects  
  • Skin rash is common and can often be treated with either prescription or over-the-counter medications 
  • May cause severe diarrhea. Diarrhea often responds to over-the-counter medications. Contact your doctor before you try these medications 
  • Can cause inflammation of the cornea (tissue on the very front of the eye). Contact your doctor if you experience blurry vision, pain in the eye, red eye, or sensitivity to light 
  • May cause a decrease in how forcefully your heart beats. An echocardiogram may be performed to assess your heart function during therapy
  • Rare but serious lung toxicities have been reported 
  • Click on the afatinib (Gilotrif) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

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Sequist LV, Chih-Hsin Yang J, Yamamoto N, et al. Phase III Study of Afatinib or Cisplatin Plus Pemetrexed in Patients With Metastatic Lung Adenocarcinoma With EGFR Mutations. J Clin Oncol. 2013;31:3327-3334.

Created: February 15, 2016 Updated: January 8, 2020

What is Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)?

What is Non-Small Cell Lung Cancer?
A disease of the tissue found in the lung.  Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Known causes include smoking and exposure to environmental toxins.  The stage of NSCLC can vary at diagnosis and throughout treatment.  Stages include stage I, II, III, and IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

A note about side effect percentages

The number you see next to the percent sign (%) means how many people out of 100 are likely to experience this side effect.

For example, if the side effect is reported to occur in 8% of patients, this means that roughly 8 out of 100 people receiving this treatment will experience this side effect.