Frecuencia y manejo de la diarrea como efecto adverso del uso de afatinib en pacientes mexicanos con cáncer de pulmón de células no pequeñas: serie de casos y revisión de la literatura

Background: Reversible inhibitors of tyrosine kinase (erlotinib and gefitinib) have shown benefit in metastatic non-small cell lung cancer (NSCLC) with EGFR mutations; however, patients will develop resistance. Afatinib is a selective reversible ErbB family blocker, which inhibits mutated EGFR and EGFR with mutations L858R and Del19. It has proved efficacy in the treatment of the abovementioned patients. Diarrhea is present in 96% of the patients treated with afatinib; its management prevents doses reductions and treatment suspension. Material and methods: The objective of this work is reporting diarrhea frequency in Mexican patients with NSCLC and EGFR mutations, treated with afatinib, under a compassionate use at Medical Unit in Puebla, Mexico between December 2012 and February 2014. Medical records were examined; cases with diarrhea and its treatment were presented. Frequencies were recorded. Literature revision was carried out. Results: Seven patients were included. Diarrhea was present in 85% of them; the median was 9 days (0-44). The 100% was treated with loperamida and astringent diet. Other administered drugs were codeine and morphine. No doses adjustments or treatment suspension secondary to diarrhea were recorded. Conclusions: Diarrhea is a common adverse effect of afatinib treatment. Its frequency in our population was similar to the reported in literature. Educate the patient and timely treat diarrhea are key to accomplish for an optimal treatment with afatinib. 1665-9201 © 2014 Gaceta Mexicana de Oncologia. Publicado por Masson Doyma Mexico S.A. Todos los derechos reservados.