title: Expert Consensus on the Management of Adverse Events from EGFR Tyrosine Kinase Inhibitors in the UK.
abstract: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) such as gefitinib, erlotinib, and afatinib are standard-of-care for first-line treatment of EGFR-mutant advanced non-small cell lung cancer (NSCLC). These drugs have a proven benefit in terms of higher response rate, delaying progression and improvement of quality of life over palliative platinum-based chemotherapy. The most common adverse events (AEs) are gastrointestinal (GI) (diarrhoea and stomatitis/mucositis) and cutaneous (rash, dry skin and paronychia). These are usually mild, but if they become moderate or severe, they can have a negative impact on the patient's quality of life (QOL) and lead to dose modifications or drug discontinuation. Appropriate management of AEs, including prophylactic measures, supportive medications, treatment delays and dose reductions, is essential. A consensus meeting of a UK-based multidisciplinary panel composed of medical and clinical oncologists with a special interest in lung cancer, dermatologists, gastroenterologists, lung cancer nurse specialists and oncology pharmacists was held to develop guidelines on prevention and management of cutaneous (rash, dry skin and paronychia) and GI (diarrhoea, stomatitis and mucositis) AEs associated with the administration of EGFR-TKIs. These guidelines detail supportive measures, treatment delays and dose reductions for EGFR-TKIs. Although the focus of the guidelines is to support healthcare professionals in UK clinical practice, it is anticipated that the management strategies proposed will also be applicable in non-UK settings.
authors.affiliation: Cancer Research UK Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK, raffaele.califano@christie.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Califano
authors.forename: N
authors.initials: N
authors.lastname: Tariq
authors.forename: S
authors.initials: S
authors.lastname: Compton
authors.forename: D A
authors.initials: DA
authors.lastname: Fitzgerald
authors.forename: C A
authors.initials: CA
authors.lastname: Harwood
authors.forename: R
authors.initials: R
authors.lastname: Lal
authors.forename: J
authors.initials: J
authors.lastname: Lester
authors.forename: J
authors.initials: J
authors.lastname: McPhelim
authors.forename: C
authors.initials: C
authors.lastname: Mulatero
authors.forename: S
authors.initials: S
authors.lastname: Subramanian
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.forename: N
authors.initials: N
authors.lastname: Thatcher
authors.forename: M
authors.initials: M
authors.lastname: Nicolson
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D032921:Consensus; D004305:Dose-Response Relationship, Drug; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D058990:Molecular Targeted Therapy; D009154:Mutation; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011788:Quality of Life; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects; D012871:Skin Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; C512478:EGFR protein, human; D066246:ErbB Receptors