Afatinib (Giotrif®)

Afatinib (Giotrif®) is a targeted therapy drug used to treat non-small cell lung cancer (NSCLC). It may also be used to treat other cancers as part of clinical trial.

Afatinib is given as tablets. You usually have it as an outpatient. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, afatinib can cause side effects. Some of these can be serious so it’s important that you read the detailed information below. How targeted therapy affects people varies from person to person. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you have a temperature, feel unwell or have severe side effects, including any we don’t mention here. If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is afatinib?

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

It is best to read this information with our general information about lung cancer.

Afatinib may also be used to treat other types of cancer as part of a clinical trial.

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

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How afatinib works

Afatinib is a type of drug called a tyrosine kinase inhibitor (TKI), also known as a cancer growth inhibitor. Kinases are proteins in the body that regulate how the cells grow and divide.

Afatinib blocks the proteins from sending signals to the cancer to grow. Blocking the signals causes the cells to die. This may help to stop or slow down the cancer.


When afatinib is given

Afatinib may be given if you have non-small cell lung cancer (NSCLC) that has spread to surrounding tissues (locally advanced). It may also be given if you have NSCLC that has spread to 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 usually 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. If you have a type of lung cancer called squamous cell lung cancer, you may be given afatinib without having an EGFR test.


Taking afatinib tablets

You take afatinib as a tablet once a day. Take the tablets with a glass of water, at least one hour before you eat or three hours after. Afatinib is less effective if taken at the same time as food.

If you have trouble swallowing tablets, you can 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 is dissolved, drink it straight away. Then refill the glass with water and drink that, to make sure you’ve taken all of the afatinib.

Always take your tablets exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.

Do not stop taking any of your tablets unless your doctor tells you to. Here are some important things to remember:

  • If you are sick just after taking the tablets, tell your doctor as you may need to take another dose. Don't take another dose without telling your doctor first. 
  • If you forget to take a tablet, take it as soon as you realise. But if there is less than eight hours until your next regular dose, don’t take the missed dose. Instead, just take your next dose at the usual time. Never take a double dose.
  • Keep tablets in the original package and at room temperature, away from heat and direct sunlight. 
  • Keep them safe and out of the reach of children. 
  • Get a new prescription before you run out of tablets. Make sure you have plenty for holidays. 
  • Return any unused tablets to the pharmacist if your treatment is stopped.

You usually take afatinib for as long as it controls the cancer.


Possible side effects of afatinib

We have included the most common likely side effects of afatinib here. We have also included some less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.

Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. Your nurse will give you advice about managing side effects. Always tell your doctor or nurse about the side effects you have.

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.

Diarrhoea

Diarrhoea is the most common side effect. It usually starts in the first two weeks of treatment. It can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explained. If you have diarrhoea, it is important to drink plenty of fluids. Try to drink around two litres (three and a half pints) of fluids per day.

If you have diarrhoea more than four to six times a day, or at night, contact the hospital straight away on the numbers your nurse gave you. Your doctor may ask you to stop taking afatinib until the diarrhoea is better. Sometimes your doctor will reduce the dose of afatinib that you take.

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. It’s important to follow any advice you are given and to drink plenty of fluids.

You may also notice your lips are chapped 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 mouth infections and reduce any soreness.

Skin changes

Afatinib may cause an acne-like rash that mainly affects the head, chest and back. This usually begins during the first two to three weeks of treatment and goes away once treatment ends.

Your skin may also become dry and itchy, or feel tender and peel.

There are some things that you can do to help avoid skin changes, although they can’t prevent them altogether:

  • Use tepid water and mild, non-scented soap for bathing and washing.
  • Avoid skincare products containing alcohol.
  • Don’t use anti-acne products. They can dry your skin and make your symptoms worse.
  • Moisturise your skin regularly and after a bath or shower. Your doctor or specialist nurse can tell you which moisturisers are best.
  • Wear rubber gloves when washing dishes to protect your hands and nails from the detergent.
  • Protect your skin in the sun. Sunlight can make skin symptoms worse. During treatment with afatinib, and for several months afterwards, you will be more sensitive to the sun. This means your skin may burn more easily than normal. You can still go out in the sun, but you should wear a suncream with a high sun protection factor (SPF), and cover up with clothing and a hat. If you’re having radiotherapy, don't apply suncream to any skin in the area being treated.

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

Nail infections

Afatinib 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.

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. It gets better when treatment ends. 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 to avoid tight-fitting socks, shoes and gloves.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Loss of appetite

This treatment can affect your appetite. Don’t worry if you don’t 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.

Eye problems

Your eyes may become dry and feel sore, or get red and inflamed. Your doctor can prescribe eye drops to help with these problems.

Symptoms of eye problems include:

  • severe pain in your eyes
  • watery eyes
  • your eyes become sensitive to light
  • changes in your vision.

If you notice any of these symptoms, tell your doctor straight away.

Changes in the way your liver or kidneys 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 blood tests to check how well your kidneys and liver are working.

Nasal problems

Afatinib may cause nosebleeds or you may have a runny nose. Tell your doctor straight away if a nosebleed doesn’t stop after 15 minutes.


Less common side effects of afatinib

Breathing problems

Afatinib may cause breathing problems, but this is not common. If you become breathless, your breathing suddenly worsens, or you have a cough or fever, tell your doctor straight away. It may mean you have an inflammation of the lungs, which can be serious.

It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.


Other information

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

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

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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 this treatment.