Afatinib (Giotrif®)

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.

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

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. 

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.

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.

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.

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.

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.

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

• be sore
• be painful, tingle, or swell
• peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

• keeping your hands and feet cool by washing in cool water
• gently moisturising your hands and feet regularly
• wearing gloves to protect your hands and nails when working in the house or garden
• wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

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.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. 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.

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.

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.

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.

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.

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

• have blood in your urine (pee) 
• are passing less urine or peeing less often than usual.

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

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.

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: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

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.

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

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

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

Your doctor, nurse or pharmacist can give you more information.

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.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.