Treatments
NSCLC, toxicities, diarrhea, Cancer
ADVERSE EVENT, DISEASE PROGRESSION, ADVERSE EVENTS, INTERSTITIAL PNEUMONITIS, SKIN TOXICITIES, NSCLC, EVENTS, SKIN TOXICITY, CANCER
Patients can participate in the study regardless of prior treatment for NSCLC. If the patients have received prior therapy, the following periods must have elapsed before study entry and adverse events: at least 2 weeks after cytotoxic chemotherapy administration and 4 weeks after chest irradiation. If the patient received EGFR‐TKI treatment, skin toxicities must have recovered to Grade <2 based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) scale for eligibility. All adverse events were graded according to CTCAE, version 5.0.Eligible patients received dacomitinib and comprehensive prophylaxis for skin toxicity. Dacomitinib was started at 45 mg/day and tolerated for up to two dose reductions (30 and 15 mg/day). The preemptive strategy consisted of five agents: minocycline (100 mg orally, once daily); skin moisturizer containing heparinoid (twice daily for the face, neck, chest, back, and extremities); a medium topical steroid (class IV, twice daily for the face); a very strong topical steroid (class II, twice daily for the neck, chest, back, and extremities); and sunscreen (sun protection factor ≥ 25, protection factor UVA 4–8, and UVA and UVB protection). We provided patient guidance for medicine use and evaluated their adherence to the prophylactic treatment using a patient diary.Treatments were discontinued when the following events occurred: (1) disease progression; (2) severe adverse events (interstitial pneumonitis of any grade or non‐hematological toxicities of Grade 4); (3) requirement for threefold dose reduction of dacomitinib administration; and (4) discontinuation of dacomitinib treatment for ≥3 weeks. Severe adverse events led to the interruption of dacomitinib treatment, which could restart after recovery. In the case of diarrhea or skin toxicities, dacomitinib administration was restarted after improvement to Grade ≤1. In the case of other adverse events, dacomitinib was restarted after recovery with Grade ≤2.