Barron Feliciano, de la Torre-Vallejo Martha, Luna-Palencia Rosa Luz, Cardona Andres F, Arrieta Oscar
a Thoracic Oncology Unit , Instituto Nacional de Cancerología , Mexico City , Mexico.
b Clinical and Translational Oncology Group, Institute of Oncology , Clínica del Country , Bogota , Colombia.
Expert Opin Drug Saf. 2016 Nov;15(11):1563-1572. doi: 10.1080/14740338.2016.1236910. Epub 2016 Sep 28.
Lung cancer tumors present EGFR mutations associated with an increased response rate to tyrosine kinase inhibitors (TKIs). Afatinib acts as an irreversible pan-ErbB-TKI. Areas covered: This review summarizes the results of clinical trials in NSCLC regarding its safety and efficacy. Expert opinion: Afatinib in 40 mg doses is highly effective in patients with NSCLC and EGFR mutations, improving progression-free survival and disease-related symptoms compared to chemotherapy. Additionally, afatinib has a better response rate and shows a small benefit in progression free survival compared to first-generation TKIs, and patients with exon 19 deletion could represent a subgroup with better prognosis and overall survival. Diarrhea, mucositis and rash are frequent adverse events induced by afatinib, these can impair quality of life and sometimes afatinib discontinuation is necessary. Management of adverse events, including early antidiarrheal treatment and prophylactic or early antibiotic management can reduce the gastrointestinal and cutaneous adverse events, respectively. Different risk factors, including malnourishment, sarcopenia, and low body surface might be associated with a higher toxicity risk, and these groups of patients could begin treatment with a low dose of afatinib followed by a close evaluation on tolerability and toxicity in order to slowly increase the dosage of afatinib.
肺癌肿瘤存在与酪氨酸激酶抑制剂（TKIs）反应率增加相关的表皮生长因子受体（EGFR）突变。阿法替尼是一种不可逆的泛表皮生长因子受体酪氨酸激酶抑制剂（pan-ErbB-TKI）。涵盖领域：本综述总结了非小细胞肺癌（NSCLC）临床试验中关于其安全性和有效性的结果。专家观点：40毫克剂量的阿法替尼对NSCLC和EGFR突变患者非常有效，与化疗相比可改善无进展生存期和疾病相关症状。此外，与第一代TKIs相比，阿法替尼有更好的反应率，且在无进展生存期显示出小的优势，外显子19缺失的患者可能代表预后和总生存期较好的亚组。腹泻、粘膜炎和皮疹是阿法替尼常见的不良事件，这些会损害生活质量，有时需要停用阿法替尼。不良事件的管理，包括早期止泻治疗和预防性或早期抗生素管理，可分别减少胃肠道和皮肤不良事件。不同的风险因素，包括营养不良、肌肉减少症和低体表面积，可能与更高的毒性风险相关，这些患者群体可以从低剂量阿法替尼开始治疗，随后密切评估耐受性和毒性，以便缓慢增加阿法替尼的剂量。
