The common side effects of Tucatinib include nausea, fatigue, and hand foot syndrome, which require targeted management to alleviate symptoms and maintain treatment. Nausea can be alleviated through dietary adjustments and medication; Fatigue needs to be evaluated for any accompanying symptoms; Hand foot syndrome requires skin care and dosage adjustment. The following are specific response measures.

1. Nausea management

(1) It is recommended to eat in small portions and avoid greasy or irritating foods. After meals, maintain an upright position for 30 minutes.

(2) Use antiemetic drugs (such as 5-HT3 receptor antagonists) according to medical advice, and assess dehydration risk for severe nausea.

(3) If vomiting causes inability to eat for more than 24 hours or electrolyte imbalance, medication should be suspended and medical attention sought.

2 Fatigue coping

(1) Distinguish between drug-induced fatigue and anemia/thyroid dysfunction, and regularly monitor hemoglobin and TSH levels.

(2) Adjust the activity rhythm, prioritize ensuring nighttime sleep, and arrange short-term rest during the day.

(3) Persistent severe fatigue accompanied by fever or weight loss requires screening for infection or other complications.

Management of Hand Foot Syndrome

(1) Early symptoms include erythema on the palms and soles, and it is necessary to avoid friction and high temperature contact, and use urea ointment to moisturize.

(2) When blisters or peeling occur, use antibiotics locally to prevent infection and wear loose shoes and socks to reduce pressure.

(3) Symptoms at level 3 (ulcers or affecting walking) require temporary discontinuation of medication until recovery to level 1, followed by a 25% reduction and restart of treatment.

4 Comprehensive monitoring

(1) Record the time, duration, and triggering factors of side effects, and provide detailed feedback during follow-up visits.

(2) Combination therapy may exacerbate side effects, with particular attention to the effects of CYP3A4 inhibitors.

(3) Emergency treatment is required for symptoms such as blurred consciousness, difficulty breathing, or severe skin reactions.