Afatanib (Giotrif®)

Afatinib (Giotrif®) is a targeted therapy drug. It is used to treat non-small cell lung cancer (NSCLC) that has spread.

What is afatinib?

Afatinib (Giotrif®) is used to treat non-small cell lung cancer (NSCLC) that has started to spread to:

  • surrounding tissues (locally advanced)
  • other parts of the body (advanced or metastatic). 

Afatinib works for cancers that have an abnormal form of a protein called epidermal growth factor receptor (EGFR). Tests are done on the cancer cells from a biopsy or previous surgery to check the level of EGFR. This tells your doctor whether afatinib is likely to work for you. 

Afatinib may also be used to treat other cancers as part of a clinical trial

It is best to read this information with our general information about lung cancer or the type of cancer you have.

Afatinib belongs to a group of targeted therapy drugs known as cancer growth inhibitors. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How afatinib is given

Afatinib comes in tablets, so you can take it at home. You usually take afatinib for as long as it is controlling the cancer. 

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention a doctor, nurse or pharmacist in this information.

The nurse or pharmacist will give you the tablets to take home. Always take your tablets exactly as your nurse or pharmacist explains. This is important to make sure they work as well as possible for you. Do not stop taking your tablets unless your doctor tells you to.

Before and during treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check the level of your blood cells and to check how well your liver and kidneys are working.

Taking afatinib tablets

You take afatinib as a tablet once a day. Swallow it whole with a glass of water. Take it at least 1 hour before you eat or 3 hours after. Afatinib is less effective if taken at the same time as food.

If you have trouble swallowing tablets, put the afatinib tablet in a glass of water and leave it to dissolve. It may take 15 minutes to completely dissolve. Once the tablet has dissolved, drink it straight away. Then refill the glass with water and drink that, to make sure you have taken all the afatinib. 

Other things to remember about your tablets: 

  • If you are sick just after taking the tablets, contact the hospital. Do not take another dose. 
  • If you forget to take a tablet, take the missed dose as soon as possible within the same day. But if there is less than 8 hours until your next usual dose, do not take the missed dose. Take your next dose at the usual time. Never take a double dose.
  • Keep your tablets in the original package and at room temperature, away from heat and direct sunlight. 
  • Keep them safe and out of sight and reach of children. 
  • Get a new prescription before you run out of tablets. Make sure you have plenty of tablets before you go on holiday. ys.
  • If your treatment is stopped, return any unused tablets to the pharmacist. 

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Diarrhoea

This is the most common side effect. It usually starts in the first two weeks of treatment. It can sometimes be severe. Your nurse or doctor may give you anti-diarrhoea drugs to take at home. It’s important to take them exactly as your nurse or pharmacist explained.

It is important to:

  • Follow any advice you have been given about taking anti-diarrhoea drugs.
  • Drink at least 2 litres (3½ pints) of fluids each day if you have diarrhoea.
  • Contact the hospital straight away if you have diarrhoea more than four to six times a day, or at night.

Your doctor may ask you to stop taking this treatment until the diarrhoea is better. Sometimes they may reduce the dose.

Sore mouth and lips

Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes.

Your lips may become dry, cracked or swollen. The corners of your mouth may also be sore and irritated. Tell your nurse or doctor if you have any problems with your mouth or lips. They can prescribe medicines to prevent or treat infections and reduce any soreness.

Skin changes

This treatment may cause an acne-like rash affecting the head, chest and back. This usually begins during the first 2 to 3 weeks of treatment. Your skin may also become dry and itchy, or feel tender and peel.

There are some things that may help:

  • Use tepid water and mild, non-scented soap.
  • Avoid skincare products containing alcohol.
  • Do not use anti-acne products.
  • Moisturise your skin regularly and after a bath or shower.

A rash may get worse if exposed to the sun. You should protect your skin in the sun. Use a suncream with a high sun protection factor (SPF) of at least 30. And cover up with clothing and a hat. If you are having radiotherapy, do not put suncream on the area being treated. 

Let your doctor know as soon as possible if you develop skin changes. They can prescribe treatment to help. If skin changes are more severe, your doctor may stop the treatment for a few days to let your skin recover.

Nail infections

This treatment may cause infections in your nails or the beds of your finger or toe nails. If you get pain, redness or swelling around your nails, let your nurse or doctor know. Wear gloves to protect your nails when you are doing housework or gardening.

Sore and red hands and feet

Having sore and red palms of hands and soles of feet is called palmar-plantar or hand-foot syndrome. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and avoid tight-fitting socks, shoes and gloves. Tell your nurse about any changes in your hands or feet.

Feeling sick

You may feel sick with this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started. 

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Nosebleeds

This treatment may cause nosebleeds or you may have a runny nose. Tell your doctor if you have these side effects. If a nosebleed does not stop after 15 minutes, contact a doctor straight away.

Eye problems

Your eyes may become dry and feel sore. Or they may become red and inflamed. This is called conjunctivitis. Your doctor can give you eye drops to help with these symptoms. 

Tell your doctor straight away if your eye problems get worse or if you have:

  • pain in your eyes
  • watery eyes
  • eyes that are sensitive to light
  • changes in your vision (eyesight).

Do not drive or use machinery if your eyesight is affected or you find it difficult to concentrate.

Changes in the way the kidneys and liver work

This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have regular blood tests during treatment to check how well your kidneys and liver are working.

Bladder irritation

Your bladder may feel irritated during your treatment. You may notice a burning feeling when you pass urine (pee), or you may need to go more often or more ur-gently. Tell your nurse or doctor if you have these symptoms. Drink around 2 litres (3½ pints) of fluids per day.

Less common side effects of afatinib

Breathing problems

This treatment may cause breathing problems, but this is not common. Tell your doctor straight away if:

  • you become breathless
  • your breathing suddenly gets worse
  • you have a cough or fever.

It may mean you have an inflammation of the lungs, which can be serious. 

Other information

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • throbbing pain, redness or swelling in a leg or arm
  • suddenly feeling breathless or coughing
  • sharp chest pain, which may be worse when you cough or take a deep breath.

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.

You can help reduce the risk of developing a blood clot by:
  • staying active during treatment
  • drinking plenty of fluids, especially water.

You may be given anticoagulants to help prevent a clot.

Lactose

This drug contains lactose. If you have a lactose intolerance, talk to your doctor before you start taking this treatment.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.