NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

51 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Very rarely, severe lung and liver problems occur. Don’t take gefitinib if pregnant, trying to get pregnant, or breastfeeding. Afatinib Afatinib is the same type of drug as erlotinib. However, it also stops another surface receptor called HER2. Unlike erlotinib and gefitinib, afatinib doesn’t detach from EGFR and HER2. Its effect on cells doesn’t stop. Afatinib is made as a pill. It should be taken on an empty stomach. The dose given differs among people. Your doctor will decide the dose you need. Common side effects of afatinib include diarrhea, nausea, vomiting, skin rash or dryness, acne, nail infection, mouth sores, itching, and not feeling hungry. Diarrhea and skin problems may be severe. Likewise, you may also have lung, liver, heart, and eye problems. Don’t take afatinib if you are pregnant, trying to get pregnant, or breastfeeding. Osimertinib Osimertinib is the same type of drug as erlotinib. It is made as a pill. It can be taken with or without food. The dose given differs among people. Your doctor will decide the dose you need. The most common side effects of osimertinib are tiredness, diarrhea, skin rash, dry skin, and nail changes. Nail changes include redness, swelling, pain, and nails breaking and detaching from the finger. Osimertinib may also cause severe eye, lung, or heart problems, but these problems are rare. Osimertinib may harm your baby if you’re pregnant or breastfeeding. Cetuximab Cetuximab attaches to the ends of EGFRs that are outside of the cell. Thus, molecules (ligands) are blocked from attaching to and turning on EGFRs. No growth signals are started. Cetuximab also attracts immune cells that help to kill the cancer cells. Cetuximab with afatinib may be received if the cancer worsens while taking another EGFR-targeted therapy. It is given by infusion. It is usually received once a week or every other week. It may take 2 hours to receive the first dose. Later doses will take only 1 hour. Common side effects of cetuximab are skin problems. These problems include acne-like rash, dry skin, eye inflammation, and skin infections. Other common side effects are diarrhea and loss of appetite. Blood magnesium levels may drop. Rare but serious side effects include a severe reaction to the infusion and lung damage. Cetuximab may harm your baby if you’re pregnant or breastfeeding. ALK rearrangement ALK is a surface receptor that can trigger growth signals in lung cancer cells. In lung cancers with an ALK rearrangement, ALK is overactive. With overactive ALK, new cancer cells form quickly. There are four medicines used to stop ALK from triggering growth signals. Crizotinib Crizotinib attaches to a part of ALK that is within cells. This part of ALK is a tyrosine kinase. It is a docking site for phosphate as it is moved from one molecule to another. Crizotinib blocks the phosphate and stops ALK signaling. Crizotinib is made as a pill. It is taken twice a day. It can be taken with or without food. Common side effects of crizotinib include vision problems; stomach problems (nausea, vomiting, diarrhea, constipation); not feeling hungry; fluid buildup; and feeling tired despite sleep. It can cause dizziness, lung infections, and nerve damage. Severe problems may include lung, liver, and heart 5 Overview of cancer treatments Targeted therapy

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