It is of great importance for both patients and doctors to understand the precautions before using dacomitinib (Vizimpro). Dacomitinib is an oral targeted therapeutic drug, commonly used in the treatment of non-small cell lung cancer (NSCLC) with EGFR gene mutations. To ensure the safety and effectiveness of the treatment, patients should understand and comply with some important precautions.
Precautions for Dacomitinib
1. Interstitial Lung Disease (ILD)
(1) Severe and fatal ILD/pneumonia have occurred in patients treated with dacomitinib. Among 394 patients who received dacomitinib treatment, the incidence rate of ILD/pneumonia was 0.5%, of which 0.3% of the cases were fatal.
(2) Monitor patients for pulmonary symptoms that indicate ILD/pneumonia. Temporarily discontinue dacomitinib in patients with worsening respiratory symptoms that may indicate ILD (such as dyspnea, cough, and fever) and immediately conduct a diagnosis for ILD. If ILD of any grade is confirmed, permanently discontinue dacomitinib.
2. Diarrhea
(1) Severe and fatal diarrhea have occurred in patients treated with dacomitinib. Among 394 patients who received dacomitinib treatment, the incidence rate of diarrhea was 86%, of which 11% of the patients reported grade 3 or 4 diarrhea, and 0.3% of the cases were fatal.
(2) For grade ≥2 diarrhea, temporarily discontinue dacomitinib until the condition resolves to grade ≤1, then resume dacomitinib at the same dose level or a reduced dose level according to the severity of diarrhea. For patients with diarrhea, initiate antidiarrheal treatment (loperamide or diphenoxylate hydrochloride combined with atropine sulfate) immediately.
3. Skin Adverse Reactions
(1) Rash and exfoliative skin reactions have occurred in patients treated with dacomitinib. Among 394 patients who received dacomitinib treatment, the incidence rate of rash was 78%, and 21% of the patients reported grade 3 or 4 rash. 7% of the patients reported exfoliative skin reactions of varying severity, and 1.8% of the patients reported grade 3 or 4 exfoliative skin reactions.
(2) For persistent grade 2 or any grade 3/4 skin adverse reactions, temporarily discontinue dacomitinib until the condition resolves to grade ≤1, then resume dacomitinib at the same dose level or a reduced dose level according to the severity of the skin adverse reactions. The incidence and severity of rash and exfoliative skin reactions may increase with sun exposure. When starting dacomitinib use, simultaneously use moisturizers and take appropriate sun protection measures. Once grade 1 rash occurs, initiate treatment with topical antibiotics and topical steroids. After the appearance of grade ≥2 skin adverse reactions, initiate oral antibiotic treatment.
4. Embryo-Fetal Toxicity
Based on the results of animal studies and its mechanism of action, administration of dacomitinib to pregnant women can cause harm to the fetus. In animal reproductive studies, when pregnant rats were given oral dacomitinib at a certain dose (exposure level close to that of the 45mg human dose) during the organogenesis period, the incidence of post-implantation abortion and fetal weight loss increased. The absence of EGFR signaling leads to embryonic death and postnatal death in animals. Pregnant women should be informed of the potential risk of dacomitinib to the fetus. Women of reproductive potential are advised to use effective contraceptive measures during treatment with dacomitinib and continue to do so for at least 17 days after taking the last dose of dacomitinib. If you want to know other relevant information, you can click for free online consultation.
When using dacomitinib, attention should be paid to some important matters to ensure the safety and effectiveness of the treatment. Patients should follow the advice of doctors or pharmacists and maintain regular communication and follow-up with them. In addition, patients should proactively report any uncomfortable symptoms or adverse reactions to facilitate timely adjustment of the treatment plan. By complying with the precautions, patients can better manage the treatment process and improve the efficacy of dacomitinib treatment.
