What is afatinib?

Afatinib (Giotrif®) is a targeted therapy drug used to treat non-small cell lung cancer (NSCLC). 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 targeted therapy and the type of cancer you have.

Afatinib is used if tests show the cancer cells have a genetic change called EGFR (EGFR-positive) and if the cancer has spread to:

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

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

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.

Afatinib comes in tablets. 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. 

You usually take afatinib for as long as it is controlling the cancer. Do not stop taking your tablets unless your doctor tells you to.

While you are taking afatinib, a nurse or person trained to take blood (phlebotomist) will take regular blood samples from you. These samples may be used to check the level of your blood cells and how well your liver and kidneys are working.

If you have certain side effects, or changes in your blood test results, your doctor may tell you to stop taking afatinib for a short time or to reduce the dose you take.

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 eating. Afatinib is less effective if taken at the same time as food.

If you have trouble swallowing tablets, ask your pharmacist for advice. They can explain what to do.

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. 
  • 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.

You may have some rarer side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor, nurse or pharmacist can give you drugs to help control some side effects. It is important to take them exactly as they tell you. This means the drugs will be more likely to work for you. Your doctor, nurse or pharmacist 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 treatment may cause diarrhoea. It usually starts in the first 2 weeks of treatment. You may be given anti-diarrhoea drugs to take home.

Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (31/2 pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Contact the hospital straight away if:

  • you have diarrhoea at night
  • you have diarrhoea more than 4 times in a day 
  • you have a moderate or severe increase in stoma activity 
  • if anti-diarrhoea drugs and do not work within 24 hours.

If you have diarrhoea, your doctor may need to stop your treatment or lower the dose for a while.

Sore mouth and throat

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get an infection in your mouth or throat. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco and foods that irritate your mouth and throat.

Sore and swollen lips

This treatment can cause your lips to become sore and swollen. The corners of your mouth, and the skin around the mouth, may:

  • feel sore
  • crack
  • bleed.

If this happens, tell your doctor, nurse or pharmacist. They can advise you and suggest treatments to help.

Skin changes

Afatinib can affect your skin. It may cause an acne-like rash on your head, chest and back. This usually begins in the first 2 to 3 weeks of treatment. Your skin may also:

  • become dry and itchy
  • feel tender and peel.

If you develop skin changes, let your doctor know straight away. They can prescribe treatment to help.

The following things 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 especially after a bath or shower.

A rash may get worse if exposed to the sun. You should protect your skin in the sun by:

  • using a sun cream with a high sun protection factor (SPF) of at least 30
  • covering up with clothing and a hat.

If you are having radiotherapy, do not put sun cream on the area being treated.

Very rarely, afatinib may cause a more serious skin condition. You may have a skin rash which then blisters. Your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If this happens, contact the hospital straight away.

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 palms of hands and soles of feet

You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.

Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:

  • keep your hands and feet cool
  • moisturise your hands and feet regularly
  • avoid tight-fitting socks, shoes and gloves.

Feeling or being sick

If you feel sick, your doctor can prescribe anti-sickness (anti-emetic) drugs to help. Tell your doctor if the sickness does not improve. They can prescribe other anti-sickness drugs which may work better for you.

Loss of appetite

This treatment can affect your appetite. Don't worry if you do not eat much for a day or 2. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Taste changes

This treatment can cause changes to your taste. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

Tummy pain or indigestion

If you have this pain in your tummy (abdomen), or indigestion, tell your doctor or nurse. They may give you drugs to help.

Rarely, this treatment can cause more serious stomach problems. If your pain is severe, contact the hospital straight away.

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.

Effects on the liver

This treatment can cause changes in the way your liver works. This does not generally cause any symptoms and usually goes back to normal when treatment stops. You will have regular blood tests to check how your liver is working.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.

It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.

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

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Other information

Other medicines

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

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations. 

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • throbbing pain or swelling in a leg or arm
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
  • suddenly feeling breathless or coughing.

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

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. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

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.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 01 September 2022
|
Next review: 01 March 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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