PMID- 30116943
OWN - NLM
STAT- MEDLINE
DCOM- 20190315
LR  - 20200225
IS  - 1433-7339 (Electronic)
IS  - 0941-4355 (Linking)
VI  - 27
IP  - 3
DP  - 2019 Mar
TI  - Multi-disciplinary proactive follow-up algorithm for patients with advanced NSCLC 
      receiving afatinib.
PG  - 1029-1039
LID - 10.1007/s00520-018-4392-x [doi]
AB  - PURPOSE: 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). METHODS: 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. CONCLUSIONS: 
      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.
FAU - Cheema, Parneet K
AU  - Cheema PK
AUID- ORCID: 0000-0002-9680-7073
AD  - Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada. 
      parneet.cheema@williamoslerhs.ca.
FAU - Thawer, Alia
AU  - Thawer A
AD  - Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada.
FAU - Leake, Joanne
AU  - Leake J
AD  - Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada.
FAU - Cheng, Susanna Y
AU  - Cheng SY
AD  - Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada.
FAU - Khanna, Suneil
AU  - Khanna S
AD  - Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada.
FAU - Charles Victor, J
AU  - Charles Victor J
AD  - Institute of Health Policy Management and Evaluation, University of Toronto, 
      Toronto, Canada.
LA  - eng
PT  - Journal Article
DEP - 20180816
PL  - Germany
TA  - Support Care Cancer
JT  - Supportive care in cancer : official journal of the Multinational Association of 
      Supportive Care in Cancer
JID - 9302957
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Quinazolines)
RN  - 41UD74L59M (Afatinib)
RN  - EC 2.7.10.1 (ErbB Receptors)
SB  - IM
MH  - Afatinib/administration & dosage/*adverse effects
MH  - Aged
MH  - *Algorithms
MH  - Antineoplastic Agents/administration & dosage/*adverse effects
MH  - Canada
MH  - Carcinoma, Non-Small-Cell Lung/*drug therapy
MH  - Diarrhea/chemically induced
MH  - ErbB Receptors/antagonists & inhibitors
MH  - Exanthema/chemically induced
MH  - Female
MH  - Humans
MH  - Lung Neoplasms/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Quinazolines/adverse effects
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Adverse events
OT  - Afatinib
OT  - Algorithm
OT  - EGFR
OT  - NSCLC
OT  - Proactive monitoring
EDAT- 2018/08/18 06:00
MHDA- 2019/03/16 06:00
CRDT- 2018/08/18 06:00
PHST- 2017/09/18 00:00 [received]
PHST- 2018/07/31 00:00 [accepted]
PHST- 2018/08/18 06:00 [pubmed]
PHST- 2019/03/16 06:00 [medline]
PHST- 2018/08/18 06:00 [entrez]
AID - 10.1007/s00520-018-4392-x [pii]
AID - 10.1007/s00520-018-4392-x [doi]
PST - ppublish
SO  - Support Care Cancer. 2019 Mar;27(3):1029-1039. doi: 10.1007/s00520-018-4392-x. 
      Epub 2018 Aug 16.