Afatinib is a standard first-line therapy for advanced EGFR-positive NSCLC. We implemented a pharmacist-led proactive follow-up algorithm to identify and manage early afatinib-related adverse events (AEs).
We conducted a retrospective chart review of all patients treated with afatinib after implementation of the algorithm at the Sunnybrook Odette Cancer Centre (Toronto, ON, Canada) from April 1, 2015 to July 31, 2016. Our in-house algorithm involved consultations in person and proactive pharmacist-led callbacks on days 5, 10, and 17. All AEs were graded and documented in real time and management based on toxicity grade was standardized. This study evaluated the impact of our algorithm on real-world AEs.
Results and discussion
Thirty-three patients were identified and reviewed. Median follow-up was 248 days. All patients experienced at least one drug-related AE; 18.2% were grade 3/4. The most common AEs were diarrhea 87.9%, rash 81.8%, stomatitis 57.6%, and paronychia 45.5%. Median dose of afatinib was 40 mg daily; 51.5% of patients had ≥ 1 dose reduction and 6.3% discontinued afatinib due to AEs. Proactive calls by the pharmacist identified 36.5% of all drug-related AEs, 33.3% of grade 3/4 AEs, 58.1% of first drug-related AEs and identified two patients that were non-compliant. Only 3.2% of AEs were identified by an emergency room/urgent clinic visit.
This proactive multi-disciplinary AE management algorithm resulted in a low rate of urgent assessments and discontinuation due to toxicity while maintaining afatinib at ideal dose, thus providing a useful tool for centers prescribing afatinib.
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We would like to thank Paul Card and Loretta Collins from Kaleidoscope Strategic Inc. for their editorial support in preparation of this paper.
This study was funded by an unrestricted research grant from Boehringer Ingelheim, Canada.
Conflict of interest
Boehringer Ingelheim Canada supported this study with an unrestricted educational grant. Funds were used for data collection, statistical analysis, and writing of our retrospective analysis. Boehringer Ingelheim had no input on the follow-up algorithm, the data results, or interpretation of the analysis. We have full control of the primary data and will allow the journal to review our data if requested. Dr. Cheema, Alia Thawer, and Dr. Suneil Khanna have participated in advisory boards for Boehringer Ingelheim.
This review was prepared according to ICMJE standards with editorial assistance from Kaleidoscope Strategic Inc.
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Cheema, P.K., Thawer, A., Leake, J. et al. Multi-disciplinary proactive follow-up algorithm for patients with advanced NSCLC receiving afatinib. Support Care Cancer 27, 1029–1039 (2019). https://doi.org/10.1007/s00520-018-4392-x
- Adverse events
- Proactive monitoring