Administration
of chemotherapy
National guidelines and NICE
Chemotherapy drugs
- 5FU
- Oxaliplatin
- Capecitabine
- Tegafur Uracil
- Irinotecan
- Cetuximab
- Bevacizumab
Will you suffer from side effects
FREE
BOOKLET. 'Treating Bowel Cancer:Your Pathway'. Click
to download
Chemotherapy drugs kill cancer cells throughout the body. In contrast, most surgery and radiotherapy is directed to where the cancer started from. Chemotherapy works by interfering with cancer's ability to grow. If your cancer is advanced when it is first diagnosed you may be offered chemotherapy to keep it under control. You may have just one drug or a combination of drugs. Ask your specialist about the choices available to you, and the combination options.
Administration of chemotherapy
Chemotherapy can be given at different stages of your treatment, and through different means. It can be given in hospital by intravenous injection or infusion (drip or pump). Some treatments can be given at home by disposable pumps or even as a pill. You will hear lots of new words used when discussing chemotherapy:
Neo-adjuvant - is chemotherapy given prior to surgery of the tumour, usually to reduce the size of the tumour in order to get a better outcome
Adjuvant - is chemotherapy given after surgery, for early stage bowel cancer, and means that all known cancer has been removed and your doctors are trying to reduce the risk of cancer returning.
1st Line treatment - is the first chemotherapy course given to a patient with advanced disease. Sometimes this may be the first chemotherapy a patient receives.
2nd Line treatment - is the chemotherapy given to patients after relapse or progression of their disease, following first line treatment.
Palliative - is chemotherapy treatment given to alleviate symptoms but not to cure the cancer.
Latest developments and availability of drugs
In this country, we have an organisation called NICE (National Institute of Clinical Excellence) that was set up to produce national guidelines on the treatment of diseases and the use of medicinal products. NICE recommends how different bowel cancer drugs can be used and once they license a drug for a particular use, all hospitals are required to follow their guidance. Although some of NICE's recommendations suggest certain drugs can only be used for advanced cancer and at certain stages, there is research being carried out to look at these drugs also being used for adjuvant treatment, which could prove very beneficial to patients. Ask about clinical trials. The drugs mentioned here are licenced for use in the UK. You may be asked to participate in clinical trials with drugs not mentioned here or with unlicensed combinations of the drugs below.
Chemotherapy drugs
Chemotherapy treatment for bowel cancer is improving dramatically. Although the commonest chemotherapy is 5-fluorouracil (5-FU) with folinic acid which has been the main treatment for over 40 years, there have been several new drugs developed to help fight bowel cancer which have improved the results set by 5FU/FA.
Sometimes two or more chemotherapy drugs are given together. This is known as combination therapy. Studies have shown that patients receiving combination therapy have significant advantages both in response rate and survival.
Brand (drug) name - 5-FU (Fluorouracil) Generically produced
At what stage is this treatment used?
At all stages of bowel cancer
What are NICE's recommendations for use of this treatment?
5-FU is generally available and currently the main 1st Line treatment recommended for bowel cancer. However, combinations of 5-FU and some of the newer drugs (see following pages) are being trialled and show increased patient survival times in many cases.
Which other drugs is it commonly combined with?
5-FU may be used alone, or in combination for its palliative (pain killing) action in the management of bowel cancer, either as a single agent or in combination with other cytotoxic agents. It is usually combined with leucovorin (LV) and this treatment course is known as 5-FU/LV , or 5FU/FA
How is the treatment administered?
5-FU is given as an
infusion or injection. Infusions are given through a central line which
is a rubber tube inserted under the skin of your chest into a vein. This
line is known as a Hickman or Groshong line . Alternatively the drug may
be given through a PICC line which is inserted into
one of the large veins of the arm near the bend of the elbow.
What are the common dosages/length of course?
A course of treatment will be recommended by your specialist usually 3 to 6 months.
What are the main side effects?
5-FU can cause tiredness, nausea, mouth ulcers, drop in blood count, hair thinning, soreness and redness on palms of hands and soles of feet, diarrhoea. Not everyone will get these side effects - you may have none or several.
drug (Brand) name - oxaliplatin (Eloxatin)
Produced by Sanofi-Synthelabo Ltd
At what stage is this treatment used?
1st and 2nd line treatment of advanced colorectal cancer.
What are NICE's recommendations for use of this treatment?
As from August 2005, Oxaliplatin is recommended in combination with 5-FU and FA as first-line or subsequent therapy.
Which other drugs is it commonly combined with?
5-FU or drugs in clinical trials
How is the treatment administered?
Into the veins via a tube
What are the common
dosages/length of course?
Dose: 85mg/m2 every
two weeks.
Average length of treatment is 18 weeks.
What are the main side effects?
As with other chemotherapy agents it may cause a temporary reduction in the number of blood cells, nausea and vomiting. Specific side effects include pins and needles, and numbness in the hands and feet, which usually fades away over a few months.
Other Information
Recent trials have reported a benefit of using oxaliplatin as adjuvant treatment for bowel cancer.
drug
(Brand) name - capecitabine (Xeloda)
Produced by Roche Products Ltd
At what stage is this treatment used?
1st Line treatment for metastatic bowel cancer
What are NICE's recommendations for use of this treatment?
Oral therapy with Xeloda is recommended as an option for the 1st Line treatment of metastatic bowel cancer. Licensed in May 2004 and approved by NICE in April 2005
Which other drugs is it commonly combined with?
Capecitabine is not licensed for use in combination with other drugs although combinations are being trialled.
How is the treatment administered?
Orally (by mouth) in tablet form. Once absorbed, the body converts these tablets into 5-FU.
What are the common dosages/length of course?
Tablets should be taken twice daily for 14 days, followed by a 7 day rest period, making a treatment cycle of 21 days. The number of tablets taken depends on body surface area and is based on a standard dosage of 1250mg/m2 twice daily.
What are the main side effects?
Gastrointestinal disorders, especially diarrhoea, nausea, vomiting and stomatis (mouth ulcers), and hand-foot syndrome (pain, swelling and redness of the hands and/or feet) are the commonest side effects.
Other information
A booklet for patients prescribed Xeloda 'Y our guide to Xeloda® (capecitabine) therapy' is available from Roche. It has sections on Frequently asked questions, Looking out for possible side-effects, a Treatment diary and sources of Further information.
drug
(Brand) name - tegafur uracil with folinic acid (Uftoral)
Produced by Bristol-Myers-Squibb (BMS)
At what stage is this treatment used?
Uftoral, a combination of two chemotherapy drugs called tegafur and uracil, is indicated for 1st Line treatment of advanced metastatic bowel cancer in combination with folinic acid.
What are NICE's recommendations for use of this treatment?
Oral therapy with Uftoral (in combination with folinic acid) is recommended as an option for the 1st Line treatment of metastatic bowel cancer, as an alternative to intravenous 5-FU/FA regimens.
Which other drugs is it commonly combined with?
Uftoral is usually taken with a folinic acid tablet (leucovorin) which helps it to work more effectively. Other combinations are being trialled.
How is the treatment
administered?
Orally (by mouth) in tablet form. Once absorbed, the body converts these tablets into 5-FU.
What are the common dosages/length of course?
Uftoral is taken 3 times a day for 28 days. You then have a 7 day break. This cycle is repeated about 6 times. Tablets should be taken on an empty stomach.
What are the main side effects?
As with all chemotherapy
drugs, you may experience side effects. The most common side effects are
diarrhoea, nausea/vomiting, abdominal pain,
weight loss and asthenia.
drug
(Brand) name - irinotecan (Campto)
Produced by Aventis Pharma Ltd
At what stage is this treatment used?
1st or 2nd line treatment for metastatic bowel cancer.
What are NICE's recommendations for use of this treatment?
As from August 2005, Irinotecan is recommended in combination with 5-fluorouracil (5-FU) and folinic acid (FA) as first-line therapy, or irinotecan alone in subsequent therapy
Which other drugs
is it commonly combined with?
5FU or drugs in clinical trials.
How is the treatment administered
Into the veins via a tube.
What are the common dosages/length of course?
180mg/m2 in combination every two weeks for ~11 cycles. 300mg/m2 in 2nd line every 3 weeks for ~ 4 cycles.
What are the main side effects?
As with other chemotherapy agents Campto may cause a temporary reduction in the number of blood cells, nausea and vomiting and some hair loss. Specific side effects include delayed diarrhoea (occurring >24 hours after administration) and acute cholinergic syndrome. All the side effects are predictable, manageable and reversible.
drug
(Brand) name - cetuximab (Erbitux)
Produced by Merck Pharmaceuticals Ltd
At what stage is this treatment used?
For Epidermal Growth Factor Receptor (EGFR)-expressing advanced bowel cancer that is no longer responding to an irinotecan-containing therapy.
What are NICE's recommendations for use of this treatment?
There is no existing NICE recommendation. NICE will review Erbitux as part of its appraisal on the treatment of advanced bowel cancer which is due for publication in 2006.
Which other drugs is it commonly combined with?
Irinotecan. This innovative combination therapy offers a further treatment option to patients with metastatic bowel cancer
How is the treatment administered?
Erbitux is administered as an intravenous infusion over 2 hours for the first infusion and 1 hour for subsequent infusions. Irinotecan is subsequently administered, after a one hour interval, at the recommended dose and infusion time determined by your doctor. Erbitux is a colourless liquid.
What are the common dosages/length of course?
The dosing schedule is an initial dose of 400mg/m 2 on week 1, with subsequent doses of 250mg/m 2 at weekly intervals. Average treatment is for 18 weeks.
What are the main side effects?
Erbitux is not a traditional chemotherapy, it is classified as a monoclonal antibody that targets cancer cells (an "anticancer biological agent"). A monoclonal antibody is a protein that targets very specific receptors associated mainly with some cancer cells. The main side-effect which may present is a skin reaction, of a variable nature. Your doctor will have guidelines for the management of this skin reaction. Skin reactions generally resolve following appropriate intervention by dose delay, reduction or completion of treatment.
Other information
Erbitux is an innovative,
targeted biological agent, and is the only agent of this kind (an EGFR-targeting
monoclonal antibody) currently licensed in the UK for advanced colorectal
cancer.
[top]
drug (Brand) name - bevacizumab (Avastin)
Produced by Roche Products Ltd
At what stage is this treatment used?
Used for the first-line treatment of advanced bowel cancer in combination with intravenous 5-FU with or without irinotecan
What are NICE's recommendations for use of this treatment?
As Avastin is a new drug, there is no existing NICE recommendation. NICE will review Avastin as part of its appraisal on the treatment of advanced bowel cancer which is due for publication in 2006.
Which other drugs is it commonly combined with?
Avastin is licensed for use with 5-fluorouracil/folinic acid, alone or in combination with irinotecan. Other combinations are being clinically trialled.
How is the treatment administered?
Via a drip into a vein, usually in the arm or hand, on the same day as chemotherapy. Second time, this may be decreased to around 60 and then 30 minutes, either before or after chemotherapy.
What are the common dosages/length of course?
5mg/kg of body weight is usually given once every 2 weeks, on the same day as chemotherapy, and will continue for as long as the medical team feels it is is helping.
What are the main side effects?
Generally, the addition of Avastin will not worsen the side effects of chemotherapy. The most common side effects are tiredness, diarrhoea, nausea or pain. Also, some patients may experience a rise in blood pressure, nosebleeds, easy bruising or a delay in wound healing.
Other information
Avastin is not the same as chemotherapy - it is an immunotherapy known technically as a monoclonal antibody. It is designed to complement chemotherapy and make treatment more effective.
Will
you suffer from side effects?
Chemotherapy drugs cause different side effects in different people. Some
people may experience very few side effects, and even those who do suffer
from side effects will only have these temporarily during treatment. Some
of the more common side effects include tiredness, hair loss, mouth ulcers
and nausea. You should talk to your specialist about the side effects
to specific chemotherapy drugs that he or she is recommending as part
of your treatment plan. Try to weigh up the side effects against the overall
benefits of the treatment.
[top]
