Is the patient on a targeted therapy?

For example, epidermal growth factor receptor (EGFR) or tyrosine kinase inhibitors (TKI).

Management of diarrhoea

• First episode generally occurs within 14 days. 
• Keep anti diarrhoeal medication close and use at first sign of diarrhoea/change in bowel habit. 
• If grade 3 or 4: Stop EGFRi, do stool culture.  Start loperamide unless high suspicion of infective cause.  Consider other causes, ensure hydrated, consider octreotide (100-200 micrograms daily SC) if symptoms do not resolve after a few days of discontinuation of EGFRi or if becoming dehydrated and seek advice from gastroenterology. 
• Check serum K and Mg levels and replace as needed. 

Treatment of EGFR skin toxicity and adjustments to EGFRi doses pathway

Examine skin, swab wounds, consider FBC/U&Es/LFTs/CRP +/- blood cultures depending on severity/grade.  

Inform consultant/SpR if admitted and review daily.  Ensure well hydrated. De-lineate and record affected area.  Prescribe creams, analgesia, antihistamines, antibiotics +/- steroids if needed