Nausea, stomatitis, and fatigue commonly seen during Alpelisib treatment can be effectively controlled through graded management, medication intervention, and lifestyle adjustments. The following provides specific treatment plans and preventive measures for these three types of adverse reactions.

1. Nausea management

(1) Graded processing

Grade 1 nausea (decreased appetite but normal eating), it is recommended to have small and multiple meals; Grade 2 (reduced oral intake) requires the use of 5-HT3 receptor antagonists; Medication should be suspended until remission is achieved for grades 3 and above.

(2) Preventive measures

It is recommended to take medication with meals and avoid high-fat diets. Prophylactic antiemetic medication can be used before treatment, and severe vomiting requires assessment of dehydration risk and fluid replacement.

2 Management of stomatitis

(1) Local processing

Grade 1 stomatitis (painless ulcer): rinse mouth with physiological saline solution; Grade 2 (painful ulcer) plus lidocaine gel; Level 3 requires suspension of administration and systemic analgesia.

(2) Nutritional support

Avoid acidic/spicy foods and recommend a liquid diet at room temperature. Persistent symptoms require examination for fungal infection, and if necessary, use antifungal mouthwash.

3 Fatigue Management

(1) Cause investigation

Anemia (hemoglobin<10g/dL), thyroid dysfunction, or depression need to be ruled out. Continuous level 2 fatigue (limited daily activities), dosage adjustment is recommended.

(2) Non pharmacological intervention

Develop a reasonable daily routine and take a 20 minute nap in the afternoon. Moderate aerobic exercise (such as walking for 30 minutes daily) can improve energy metabolism.

4 Comprehensive Suggestions

(1) Patient education

Record the time of occurrence of adverse reactions and their association with diet. Daily photography monitoring of changes in oral mucosa, and trying ginger products to alleviate nausea after episodes.

(2) Follow up reminder

Follow up every 2 weeks for the first 4 weeks of treatment, and once a month thereafter. If there are any grade 2 or 3 symptoms that cannot be relieved, seek medical attention within 24 hours.