Grade 1:
Decreased appetite that doesn’t change eating habits.

Grade 1:
1) Maintain TKI dose.
2) If necessary, start anti-nausea treatment with Domperidone (10 mg prn max x 3) or Vogalene (15 mg prn max x 3)

Grade 1:
Instruct the patient on good dietary habits (see below) and adequate fluid intake.

Grade 2:
Decreased oral food intake without significant weight loss, dehydration or malnutrition.

Grade 2:
1) Maintain TKI dose.
2) Commence regular anti-nausea treatment with Domperidone (10 mg x 3) or Vogalene (15 mg prn max x 3) – should be taken approx. ½ hour before main meals.
3) In the absence of sufficient effect, Ondansetron (8 mg prn, max x 2 daily) can be tried.
4) If grade 2 persists despite the above intervention, TKI should be paused. TKI can be resumed if improved at a reduced dose.

Grade 2:
See above. Consider a prescription for protein drinks. Consider referral to dietician.

Grade 3:
Inadequate oral intake of caloric or liquid fluids, indication for tube feeding, TPN, or hospital admission.

Grade 3:
1) Discontinue TKI.
2) Consider admission for fluids therapy and/or tube feeding and intensification of antiemetics (IV infusion).
3) At grade ≤ 2, TKI may be resumed at a reduced dose.

–