Team management for skin toxicity induced by afatinib

Abstract

Background: Afatinib as a second generation of epidermal grouth factor recepter (EGFR) tyrosine kinase inhibitor (TKI) occurs in side effects such as diarrhea, skin rash, oral mucosotis, and paronychia. Management of thease side effects is important in treatment for advanced non-small cell lung cancer (NSCLC). Case 1: 73-years-old male. His disease was a reccurence of NSCLC harboring EGFR mutaion. Afatinib was administered as a first-line treatment. Due to taste disorder and finger crack, one week dose-on and one week dose-off was done. His taste was improved for sustained periods, while finger cracks with bleeding was continued with severity. Limitation of daily life was great threshold. We would like to debate about the treatment and prevention of skin cracks. Case 2: 56-years-old male. He had mild exercise aphasia and disorientation due to past cerebral infarction. He suffered from advanced NSCLC (cT4N1M1a, stage IV) with EGFR active mutaion. Gefitinib was administered as a first-line treatment for 1 year. After resistance to gefitinib, four cycles of carboplatin plus pemetrexed chemotherapy followed by six cycles of maintenance pemetrexed therapy was administered. Afatinib was treated as a re-charange of EGFR-TKI. Paronychia developed on two months later. He could not manage to do self-cares enough. It is important to manage the side effect as soon as possible, and to teach patient as well as family members for self-care management.