Table 2.

RECOMMENDATIONS FOR MANAGEMENT OF AFATINIB-ASSOCIATED AEs

PRURITUS (Lacouture et al., 2013)	DERMATOLOGIC ADVERSE EVENTS (Boehringer Ingelheim, 2014; Lacouture et al., 2013)	STOMATITIS/ORAL MUCOSITIS (Lalla et al., 2013; McGuire et al., 2013)	PARONYCHIA (Lacouture et al., 2013)
Recommendations for grade 1: • Topical steroid twice daily or topical antipruriticsa 4× /day Recommendations for grade 2: • Topical steroid twice daily or topical antipruriticsa 4×/day and oral antihistaminesb Recommendations for grade ≥3: • Oral antihistaminesb or GABA agonistsc or aprepitant or tricyclicsd	Recommendations for any grade: • Early intervention with emollients (alcohol free), topical or oral (e.g., tetracycline class) antibiotics, topical or oral steroids, tacrolimus ointment, or antihistamines • Protective clothes that cover the head, face, hands, arms, and legs • Sunscreen (SPF 15) when outside; every 4 hours in sun exposure areas • Skin creams and lotions that moisturize the skin and prevent dryness, and use hypoallergenic products that do not have perfumes or preservatives • Mild bath soap that will not irritate the skin; take a bath or shower in warm (not hot) water • Wash sheets, clothing, and undergarments in mild soaps • To relieve itching, place a cool washcloth or some ice over the area that itches, rather than scratching For any grade, avoid: • Sun exposure, especially direct sunlight between 10 am and 4 pm • Certain fabrics (e.g., wool, synthetics) that can make skin itch; recommend wearing loose-fitting cotton clothing or other soft fabrics and switching to cotton bed sheets • Overheating the house, as warm dry air can make skin dry, and suggest using a humidifier	Recommendations for any grade: • Topical steroids (e.g., dexamethasone mouth rinse), viscous lidocaine, or magic mouthwash (i.e., antihistamine or local anesthetic, antifungal, corticosteroid, and antacid) • Practice good mouth care, gently brushing teeth and gums with a soft toothbrush, and rinsing with warm salt water after every meal and at bedtime • Eat foods cold or at room temperature; hot and warm food can irritate a tender mouth • Eat soft, soothing, and moist food; suggest avoiding rough or coarse foods • Drink plenty of water and use a straw to drink liquids • Lip balm or petroleum jelly for dry lips • Numb the mouth with ice chips or flavored ice pops, as needed For any grade, avoid: • Salty, spicy, acidic, or irritating foods and juices	Recommendations for grade 1: • Topical antibiotics/antiseptics,e vinegar soaks,f and topical ultra-potent steroidsRecommendations for grade 2: • Topical antibiotics,e vinegar soaks,f silver nitrate application weekly, and topical ultra-potent steroids with dermatology consultation Recommendations for grade ≥3: • Topical antibiotics,e vinegar soaks,f silver nitrate application weekly/nail avulsion, and systemic antibioticsg

AE, adverse event; GABA, gamma-aminobutyric acid; SPF, sun protection factor.

^aExamples of topical antipruritics: pramoxine 1% cream or doxepin 5% cream.

^bExamples of antihistamines: levocetirizine 5 mg 4×/day, desloratadine 5 mg 4×/day, diphenhydramine 25–50 mg 3×/day, hydroxyzine 25 mg 3×/day, or fexofenadine 60 mg 3×/day.

^cExamples of GABA agonists (adjust for renal impairment): gabapentin 300 mg or pregabalin 50–75 mg, every 8 hours.

^dExamples of tricyclics: doxepin 25–50 mg every 8 hours or aprepitant three doses (125 mg on day 1, 80 mg on days 2 and 3).

^eExamples of topical antibiotics/antiseptics: clindamycin 1%, erythromycin 1%, tetracycline 1%, or chloramphenicol 1%, iodine ointment.

^fVinegar soaks consist of soaking fingers or toes in a solution of white vinegar in water 1:1 for 15 minutes every day.

^gSystemic antibiotics include tetracyclines and antimicrobials (the potent P-glycoprotein inhibitor of erythromycin should be avoided).