Common And Serious Side Effects Of Tagrisso (osimertinib)
Tagrisso (osimertinib) is a kinase inhibitor. It inhibits the action of tyrosine kinase in epidermal growth factor receptors (EGFR). It binds to a specific mutant form of EGFR and elicits its anti-tumor activity by inhibiting the activity of genes that play a role in the growth of cancer cells. Tagrisso is used to treat individuals with metastatic epidermal growth factor T790M mutation non-small cell lung cancer who have progressed on or after previous epidermal growth factor tyrosine kinase inhibitor therapy. Here, we will discuss some of the more common and serious side effects of Tagrisso along with some information about how to manage them.
About 44% of patients taking Tagrisso experience anemia, which is defined as a reduction in the number of red blood cells below normal levels. Common symptoms of anemia include fatigue, loss of energy, dizziness, and pale skin. Anemia caused by Tagrisso may be treated with iron and/or vitamin supplements, medications that stimulate red blood cell production, or a transfusion of red blood cells depending on the severity.
Gastrointestinal disorders are very common adverse reactions that are observed in patients on Tagrisso therapy. The most common gastrointestinal adverse effect is diarrhea, which is seen in 42% of patients. A bland, low-fiber diet may help patients experiencing diarrhea. Fibrous foods such as raw fruits, vegetables, and grains may actually worsen diarrhea. Over the counter medications or prescription medications may also be used to manage diarrhea.
While 42% of patients experience diarrhea, about 15% of patients experience constipation. Different types of laxatives can be used to relieve constipation and a high-fiber diet, rich in raw fruits and vegetables, helps prevent constipation. Another way to prevent constipation is the daily use of stool softeners in addition to drinking plenty of fluids.
Nausea is seen in about 17% of patients on Tagrisso therapy. Common home remedies for managing nausea include ginger root and peppermint. Ginger, when compared to a placebo, has been shown to treat nausea significantly better than placebo in a small number patients who receive chemotherapy for breast cancer. Ginger root is commonly consumed in the form of tea. And although peppermint's effectiveness has yet to be established, many have used peppermint oil as aromatherapy to tame an upset stomach. Prescription medications may also be used to treat nausea.
Skin and nail
Skin and nail issues have also been associated with taking Tagrisso. 41% of patients develop a rash, 31% get dry skin, and 25% develop nail toxicity. Inflammation of nail beds and cuticles is indicative of nail toxicity. To manage a rash and dry skin, mineral or baby oils can be added to bath water to keep the skin supple and moist. Thick moisturizers can also help to keep skin moist, keeping in mind that perfume-free options are better. Hot showers can also exacerbate rashes and further dry the skin so showers and bath water should be lukewarm to cool. Managing nail changes is the same as managing the skin issues, but it is also important to keep nails clean and dry. Moreover, staying hydrated by drinking plenty of fluids can help both skin and nail problems.
Back pain and headaches
Tagrisso therapy can also cause back pain and headaches. Back pain can be relieved by applying heat using hot packs and warm baths/showers or by applying an ice or cold pack. Over-the-counter analgesics or prescription medications may also be used to relieve back pain and headaches.
More serious complications can also occur with the use of Tagrisso such as interstitial lung disease (ILD)/pneumonitis, decreased ejection fraction, and QT prolongation. ILD is a progressive lung disease that is associated with scarring of the lung and pneumonitis is the inflammation of the lung. Symptoms that may indicate ILD or pneumonitis include difficulty breathing, cough, and fever. A decreased ejection fraction is when the amount of blood pumped by the heart is decreased. This can present as feeling tired all the time, shortness of breath, or swelling in the feet. QT prolongation is a heart rhythm disorder that can lead to serious irregular heart rhythms (arrhythmias). An echocardiogram should be obtained before initiation of therapy and then at regular intervals thereafter to monitor for any changes in heart rhythm. Because there is no definite way to prevent these serious adverse reactions, it is imperative to continually monitor for signs and symptoms of these adverse effects in all patients who ae treated with Tagrisso.
Tagrisso FDA Prescribing Information