Management of diarrhea induced by epidermal growth factor receptor tyrosine kinase inhibitors

  • V. Hirsh McGill University
  • N. Blais University of Montreal
  • R. Burkes The Princess Margaret Hospital Cancer Centre
  • S. Verma University of Toronto
  • K. Croitoru Sunnybrook Health Sciences Centre
Keywords: non-small-cell lung cancer, epidermal growth factor receptor, tyrosine kinase inhibitors, adverse events, diarrhea management

Abstract

Treatment for non-small-cell lung cancer (nsclc) is moving away from traditional chemotherapy toward personalized medicine. The reversible tyrosine kinase inhibitors (tkis) erlotinib and gefitinib were developed to target the epidermal growth factor receptor (egfr). Afatinib, an irreversible ErbB family blocker, was developed to block egfr (ErbB1), human epidermal growth factor receptor 2 (ErbB2), and ErbB4 signalling, and transphosphorylation of ErbB3. All of the foregoing agents are efficacious in treating nsclc, and their adverse event profile is different from that of chemotherapy. Two of the most common adverse events with egfr tkis are rash and diarrhea. Here, we focus on diarrhea. The key to successful management of diarrhea is to treat early and aggressively using patient education, diet, and antidiarrheal medications such as loperamide. We also present strategies for the effective assessment and management of egfr tki–induced diarrhea.

Author Biographies

V. Hirsh, McGill University
Associate Professor, Department of Oncology, Faculty of Medicine, McGill University
N. Blais, University of Montreal
Assistant Professor, Department of Medicine, University of Montreal
S. Verma, University of Toronto
Professor of Medicine, Division of Hematology/Medical Oncology, University of Toronto
K. Croitoru, Sunnybrook Health Sciences Centre
Associate Professor, University of Toronto and Medical Oncology/Hematology, Sunnybrook Health Sciences Centre
Published
2014-09-16
How to Cite
Hirsh, V., Blais, N., Burkes, R., Verma, S., & Croitoru, K. (2014). Management of diarrhea induced by epidermal growth factor receptor tyrosine kinase inhibitors. Current Oncology, 21(6), 329-336. https://doi.org/10.3747/co.21.2241
Section
Practice Guideline