How to scientifically manage diarrhea and skin reactions while taking pyrotinib/Areni

In the treatment of Pyrotinib Maleate combined with capecitabine, the incidence of diarrhea is as high as 96.9%, and it is more common in the first week of treatment. Grade 1-2 diarrhea can be controlled by dietary modification (eg, low-fiber, low-lactose diet) and oral loperamide. Capecitabine should be suspended for grade 3 diarrhea. If it persists for more than 3 days, pyrotinib should be discontinued and restarted at the original dose or at a reduced dose after recovery. Hand-foot syndrome manifests as palmar/plantar erythema, swelling, scaling, or painful blisters. Grade 2 requires capecitabine to be suspended, and grade 3 requires immediate discontinuation of capecitabine. For daily care, it is recommended to use moisturizer, avoid high temperature friction, and use topical hormone ointment or vitamin B6 when necessary. Timely intervention can avoid treatment interruption, and most patients can continue treatment after dose adjustment to ensure a balance between efficacy and safety.