Irinotecan & de Gramont

This information is offered as a guide to you and your family. Your treatment will be fully explained by your doctor or nurse, who will be happy to answer any questions. 

Your treatment: Your doctor has prescribed for you chemotherapy drugs known as: 

Irinotecan, 5FU & Folinic Acid

They will be administered as an infusion over a 3-day period every 2 weeks. Irinotecan will be given on Day 1 only of each regime, Folinic Acid will be given on Day 1 & 2 and 5FU will be given as both an IV injection and a continuous infusion over 24 hours on Day 1 & 2. A special longline catheter will be needed to administer the 24hr infusions. As each patient is an individual your experience will be different to other patients receiving chemotherapy. Common side effects that you MAY experience during treatment are: 

Nausea and Vomiting (sickness)
A small number of patients may experience some nausea as a result of this treatment. You will be given some anti-sickness tablets to take home. If you continue to feel sick contact the day unit or your GP as your anti-sickness medication may need to be changed or increased.

Bone Marrow Suppression. 
Your bone marrow is where your blood cells are made (these are the red cells, white cells, and platelets) to replace those naturally worn out by the body. Chemotherapy interferes with this process and the number of the cells in your blood can become lower than normal. This means following your treatment you could become:  

• Prone to infection: White cells fight infection a low white count can make you prone to infection. You may develop a sore throat, cough, high temperature, shivering or other symptoms, which may be due to infection. If you develop a high temperature, shivering or any symptoms, which may be due to an infection, immediately contact your GP or NCCT. 
  A raised temperature is:
  Above 38C (100.4F) at any time 
  or Above 37.5C (99.5F) at any two readings, taken an hour or more apart. 
• Anaemia: Red cells carry oxygen around your body a shortage of these cells is called anaemia. You may feel unusually tired, feel dizzy or out of breath and you may look pale.
• Prone to bleeding: Platelets help to clot your blood and slow down bleeding. A low platelet count may make you prone to bleeding, this usually takes the form of nose- bleeds, bruising or bleeding gums. You will have a routine blood test prior to each treatment to monitor the effects of the chemotherapy. Please contact your GP or the unit if you experience any of these symptoms. 

Sore Mouth
Following your treatment your mouth may become sore and you may notice mouth ulcers, your doctor or nurse will be able to recommend a suitable anti-bacterial mouthwash.

Hair loss 
Unfortunately, as a result of your treatment you will experience hair loss. This is temporary and your hair will grow back on completion of your treatment. (You may notice some hair loss approximately 2-3 weeks from the start of your treatment). Your nurse will arrange for you to be provided with a wig if required. 

Diarrhoea 
If you develop diarrhoea after your treatment you should immediately take Loperamide 4mg (2 capsules) after the first loose stool. Continue to take 2mg (1 capsule) every 2hrs for 12hrs, then one capsule with each stool for a maximum of 48hrs. You need to drink large amounts of water and fluids during this period to replace the fluid and salts lost. If diarrhoea persists for more than 24hrs despite following the above Loperamide schedule, you must contact your ward to start the oral antibiotic therapy provided - Ciproxin 500mg twice a day for 7 days. You may need to be admitted for a short period until your diarrhoea is controlled. 

Hand - Foot Syndrome
You may experience some changes in your nails and skin during treatment. Your skin may become quite dry when having treatment over a prolonged period. Skin on hands and feet can become red and tender. Occasionally blistering and numbness can occur. Please mention any of these symptoms to your doctor or nurse. 

Abdominal Cramp
If you do experience any abdominal cramp and/or sweating during or after your infusion, please let your doctor or nurse know immediately so that the appropriate treatment can be administered. An antidote will then be given at the beginning of each treatment so that this side effect is no longer a problem. 

Extravasation 
The drugs you are about to receive are known as “ cytotoxic “ or “chemotherapy” drugs. Very few of these drugs may be given by mouth and most need to be administered directly into the blood stream. It is therefore very important that good venous access is found so that chemotherapy may be given directly into a vein. It should not cause pain on administration and often the only sensation you may experience is a “coldness “ running up your arm. If the drip had displaced itself from the vein an “extravasation” could occur where chemotherapy is administered outside the vein, causing damage to the surrounding tissues. This happens very rarely. Indications are pain around the cannula site, redness or swelling. Your nurse will of course be looking for any signs of extravasation throughout the time your chemotherapy is in progress but it is essential that you inform your nurse if problems arise. Very occasionally patients may notice pain and discomfort around the area only after their chemotherapy has been completed. This also must be reported immediately so that appropriate treatment may be prescribed. 

Fatigue
One of the more common side effects of chemotherapy is a feeling of tiredness and fatigue. You may find having low energy levels tedious and frustrating but there is little you can do to alleviate this feeling as treatment continues. Accept it as a temporary side effect: give yourself time to rest and accept any offers of help from family and friends with routine housework or chores. 
Please remember side effects are usually temporary. If you experience any of them, discuss them with your doctor or nurse.

If you have any questions or concerns regarding your treatment please contact: 

Chemotherapy Day Unit on Ward 36
Mon - Tuesday 8.00am - 6.00pm,
Wednesday – Thursday 8am – 6pm
Fri. 8.00am - 4.30pm
0191-2563536 or 0191-2563682

After hours Wards 37/38 tel. 0191-2563537/8 
Or switchboard 0191-2336161 and ask for the doctor on call.

 

N.B. If you require further information regarding the drugs you receive, the British Association of Cancer United Patients and their Families and Friends (BACUP) produce an information booklet free of charge. The telephone number is Freephone 0800 800 1234