title: management of nonhematologic toxicities associated with different EGFR-TKIs in advanced NSCLC: a comparison analysis.
abstract: BACKGROUND
  Nonhematologic toxicities are frequently observed in patients receiving epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in advanced non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  For the 2010-2013 period, the authors evaluated 158 patients diagnosed with advanced or metastatic NSCLC treated in first-, second-, or third-line with the EGFR-TKIs afatinib, erlotinib, or gefitinib. The study assessed the incidence of cutaneous rash, diarrhea, and mucositis/stomatitis by grade at initial assessment (< 30 days) compared with last assessment after correct management, and the authors developed a proposal for a new modality of evaluation and management of adverse events.
  
  
  RESULTS
  The incidence of adverse events (cutaneous rash, diarrhea, and mucositis/stomatitis), classified by grade at the initial assessment and the reevaluation after management, demonstrated a reduction of about 95% from the starting toxicity grade for diarrhea, 65% for cutaneous rash, and approximately 70% for mucositis/stomatitis.
  
  
  CONCLUSIONS
  These results suggest that the safety profiles regarding cutaneous rash, diarrhea, and mucositis after afatinib, erlotinib, or gefitinib treatment become similar after prompt and correct management. This analysis suggests that immediate therapeutic approaches and continuous management are required to ensure treatments without severe adverse events that could adversely affect survival and the quality of life.
authors: Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy. Electronic address: a-passaro@hotmail.it.
authors: Antonio
authors: A
authors: Passaro
authors: Istituto Nazionale Tumori - Fondazione G. Pascale IRCCS, Naples, Italy.
authors: Massimo
authors: M
authors: Di Maio
authors: Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy.
authors: Ester
authors: E
authors: Del Signore
authors: First Oncological Pulmonary Unit, San Camillo, High Specialization Hospital, Rome, Italy.
authors: Bruno
authors: B
authors: Gori
authors: Division of Thoracic Oncology, European Institute of Oncology (IEO), Milan, Italy.
authors: Filippo
authors: F
authors: de Marinis
mesh_terms: D000077716:Afatinib; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D000069347:Erlotinib Hydrochloride; D005076:Exanthema / Q000209:etiology / Q000517:prevention & control; D005247:Feeding Behavior; D000077156:Gefitinib; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy*; D052016:Mucositis / Q000209:etiology / Q000517:prevention & control; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011799:Quinazolines / Q000008:administration & dosage* / Q000009:adverse effects; D028761:Withholding Treatment
chemical_list: D000900:Anti-Bacterial Agents; D011799:Quinazolines; D000077716:Afatinib; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000077156:Gefitinib
keywords: Afatinib; Diarrhea; Erlotinib; Gefitinib; Skin rash