Dacomitinib

How it works

It irreversibly inhibits the EGFR (HER) family tyrosine kinases, blocking signalling from activating EGFR mutations that drive tumour proliferation and survival.

Prescribing in practice

• Commonly causes significant diarrhoea, severe skin and nail toxicity (rash, paronychia) and stomatitis, and can cause interstitial lung disease, requiring prompt management and dose modification.
• Acid-reducing drugs (particularly proton pump inhibitors) reduce its absorption and should be avoided.
• Initiated and supervised only by specialists in anticancer therapy, with EGFR mutation status confirmed per the SPC.

Monitoring

Monitor for diarrhoea, skin and mucosal toxicity and new or worsening respiratory symptoms throughout treatment.

Counselling the patient

• Report severe or persistent diarrhoea early so it can be treated and fluid loss prevented.
• Report new breathlessness or cough; use emollients and sun protection for skin care.
• Avoid over-the-counter heartburn remedies unless agreed with the team, and use effective contraception.

Evidence & guidelines

Efficacy in EGFR-mutant non-small-cell lung cancer was established in the ARCHER 1050 trial and is reflected in the SPC.