Multi-disciplinary proactive follow-up algorithm for patients with advanced NSCLC receiving afatinib.

Area of Science:

• Oncology
• Pharmacology
• Clinical Pharmacy

Background:

• Afatinib is a standard first-line treatment for advanced EGFR-positive non-small cell lung cancer (NSCLC).
• Managing afatinib-related adverse events (AEs) is crucial for treatment adherence and efficacy.
• Early identification and intervention for AEs can prevent severe complications and treatment discontinuation.

Purpose of the Study:

• To implement and evaluate a pharmacist-led proactive follow-up algorithm for identifying and managing early afatinib-related adverse events (AEs).
• To assess the impact of this algorithm on real-world AE management in patients with advanced EGFR-positive NSCLC.

Main Methods:

• Retrospective chart review of patients treated with afatinib from April 2015 to July 2016.
• Implementation of an in-house algorithm involving in-person consultations and proactive pharmacist-led callbacks on specific days (5, 10, 17).
• Standardized grading and real-time documentation of all AEs, with management based on toxicity grade.

Main Results:

• All 33 reviewed patients experienced at least one drug-related AE, with 18.2% being grade 3/4.
• The most frequent AEs included diarrhea (87.9%), rash (81.8%), stomatitis (57.6%), and paronychia (45.5%).
• Pharmacist-led proactive calls identified 36.5% of all drug-related AEs and 33.3% of grade 3/4 AEs, improving compliance and early detection.

Conclusions:

• The pharmacist-led AE management algorithm effectively identified early toxicities, leading to a low rate of urgent assessments and treatment discontinuation.
• This proactive, multi-disciplinary approach helps maintain afatinib at ideal doses, offering a valuable tool for clinicians.
• The algorithm demonstrated success in managing afatinib-related AEs, supporting its use in clinical practice for EGFR-positive NSCLC patients.