Enhertu (fam-trastuzumab deruxtecan-nxki) is a targeted therapy used for certain types of cancer, and like many treatments, it can cause a range of side effects that impact a patient's appetite and digestion. Proper nutritional management is a cornerstone of supportive care, helping to mitigate these effects and ensure the body receives the necessary fuel to heal and fight illness.
Managing Nausea and Vomiting with Your Diet
Nausea and vomiting are common side effects of Enhertu, and dietary adjustments can be very effective in managing them. The goal is to eat in a way that doesn't overwhelm the digestive system.
Foods to Eat for Nausea
- Small, frequent meals: Instead of three large meals, try eating five or six smaller, blander meals or snacks throughout the day.
- Bland foods: Stick to simple, easy-to-digest options like toast, plain crackers, rice, and clear broths.
- Cool or room-temperature foods: Hot foods can have a stronger odor that may trigger nausea.
- Ginger: Ginger ale, ginger tea, or ginger chews can help soothe an upset stomach.
- Hydrating liquids: Sip on clear fluids like water, apple juice, or sports drinks to stay hydrated.
Foods to Avoid for Nausea
- Fatty, greasy, and fried foods: These are harder to digest and can aggravate nausea.
- Spicy and acidic foods: Hot spices, lemons, and tomatoes can irritate the digestive tract and mouth.
- Strong odors: If smells are a trigger, avoid cooking foods with strong aromas and opt for pre-prepared, cold meals.
- Alcohol: Alcohol can contribute to dehydration and interact with treatment.
Coping with Changes in Appetite and Taste
Some patients experience a loss of appetite or altered taste sensations while on Enhertu. The following strategies can help make eating more manageable and enjoyable.
Strategies for Decreased Appetite
- Set a schedule: Eat by the clock, rather than waiting for hunger cues, to ensure consistent intake.
- Boost nutrients: Add calorie-dense ingredients to meals, such as nuts, seeds, avocado, or olive oil.
- Nutritional supplements: High-protein, high-calorie shakes like Ensure or Boost can help fill in nutritional gaps when solid food is difficult.
- Light exercise: Gentle walking before meals can sometimes stimulate appetite.
Dealing with Metallic or Altered Taste
- Try alternative proteins: If red meat tastes metallic, substitute with poultry, fish, eggs, or dairy.
- Use plastic utensils: Sometimes a metallic taste can be caused or worsened by metal silverware.
- Enhance flavors naturally: Marinate meats and fish in sweet or tart sauces. Use herbs and spices like basil, rosemary, or oregano to add flavor.
- Experiment with temperatures: Cold foods often have less odor and can be more appealing.
Dietary Recommendations for Diarrhea and Constipation
Enhertu can cause both diarrhea and constipation, and specific dietary changes are needed for each condition.
Foods for Diarrhea Management
- Low-fiber, bland foods: The BRAT diet (bananas, rice, applesauce, toast) is often recommended. Other options include boiled potatoes, white bread, and cooked vegetables without skins.
- Soluble fiber: Foods high in soluble fiber, like oatmeal and canned fruit, absorb fluid and can help firm up stools.
- Electrolyte-rich fluids: Restore lost fluids and minerals with broths or sports drinks.
Foods for Constipation Management
- Increase fiber gradually: If your healthcare team approves, slowly add high-fiber foods like fresh fruits, vegetables, beans, and whole grains.
- Stay hydrated: Drink plenty of non-caffeinated fluids throughout the day.
- Add healthy fats: Incorporate healthy fats like olive oil and nuts to aid digestion.
- Gentle exercise: Regular, light physical activity, such as walking, can stimulate bowel movements.
Hydration: A Critical Component
Staying well-hydrated is vital while taking Enhertu, especially if experiencing vomiting or diarrhea. Hydration helps flush toxins and supports overall organ function. Aim for 8-10 glasses of non-caffeinated fluids per day unless advised otherwise by your doctor.
Sample Meal Plan Comparison for Enhertu Side Effects
| Side Effect | Recommended Foods | Foods to Limit |
|---|---|---|
| Nausea | Bland, easy-to-digest items like crackers, toast, rice, and broth. Cold foods often work well. Ginger tea or chews. | Greasy, fried, spicy, or fatty foods. Acidic items like tomatoes and citrus. Strong-smelling hot foods. |
| Appetite Loss | Small, frequent meals. High-calorie, high-protein shakes and smoothies. Nutrient-dense snacks like nuts and avocados. | Large, heavy meals. Filling up on low-calorie drinks before eating. |
| Diarrhea | BRAT diet (bananas, rice, applesauce, toast). Boiled chicken or potatoes. Foods with soluble fiber like oatmeal. Clear fluids. | High-fiber foods, raw vegetables, whole grains, dairy (if lactose intolerant). Caffeinated and alcoholic beverages. |
| Constipation | Gradually increase intake of fruits, vegetables, whole grains, and beans. Drink plenty of water and warm fluids. | White rice, low-fiber crackers (unless for diarrhea). Excessive caffeine. |
Conclusion
Navigating the dietary challenges of Enhertu treatment requires a proactive and informed approach. By focusing on small, frequent meals, choosing bland and easily digestible foods, and staying well-hydrated, patients can effectively manage side effects like nausea, appetite loss, and gastrointestinal issues. It is crucial to remember that individual responses vary, and an open dialogue with your oncology care team or a registered dietitian is the most effective way to personalize your nutrition plan and ensure you receive the best possible supportive care. For more nutritional guidance during cancer treatment, consult your hospital's resources or visit trusted sites like the one at MD Anderson Cancer Center.
