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Aflibercept and irinotecan 5 floroucracil

This leaflet provides information on a treatment known as aflibercept and irinotecan, 5 fluorouracil (5-FU) and folinic acid.  It will explain what this is and when and how it will be given.  It will also tell you about common side effects that you may experience.  Contact telephone numbers and details of how to obtain further information on this treatment are given at the end of the leaflet.

What is aflibercept and irinotecan, 5 fluorouracil (5-FU) and folinic acid?

This is a treatment which consists of a combination of drugs which work in different ways to treat your cancer.

  1. Aflibercept - This is an artificially made antibody which attaches itself to cancer cells and stops them from growing.  It is not chemotherapy.  It works by stopping the cancer from making new blood vessels. This reduces the supply of oxygen and nutrients to the tumour, so it stops growing or shrinks.     
  2. Chemotherapy treatment - This part of your treatment consists of three drugs.  There are two chemotherapy drugs called irinotecan and 5-FU.  The other drug is called folinic acid.  This is not a chemotherapy drug but it helps the 5-FU work better.  Together these drugs are called irinotecan and modified deGramont or IrMdG for short. 

Why am I having this treatment?

Your doctor has prescribed this treatment because it is believed to be effective in treating your type of cancer.

How often will I receive this treatment?  

For this treatment to be most effective it will be given at specific time intervals.  These are known as cycles.  It is usual to have a cycle every 2 weeks.  Your doctor will discuss the number of cycles you will receive. 

How will my chemotherapy be given?

To receive your chemotherapy you will need to have a fine tube put into a large vein in your upper arm.  This tube is called a PICC line.  Your PICC line is usually put in about a week before you start your chemotherapy.  It will stay in for the whole course of your treatment.  Your doctor will explain this to you in more detail.  We also have a leaflet that tells you more about PICC lines.

All of your treatment will be given through a drip connected to your PICC line.  

How often will I need to come to the hospital?

To receive this chemotherapy you will need to visit the hospital 3 times in every 2 week cycle.

1st visit - Outpatient clinic appointment  

You will have blood samples taken and we will check how you are feeling and discuss any problems you may have.  This is so we can check how the chemotherapy is affecting you.  If your blood results are satisfactory, your chemotherapy will be prescribed.  This appointment is usually a few days before your chemotherapy appointment.

2nd visit - Chemotherapy appointment

At this appointment you will spend about 3 - 4 hours on one of the day case treatment areas.  Please allow up to an hour longer for your first visit. If you are having scalp cooling, please allow an extra hour, also.  We will give you anti sickness medication and your chemotherapy in a drip. You will go home with a portable pump containing 5-FU.  We will give you information about how to look after your pump at home.

3rd visit - Pump disconnection

This appointment is 2 days after your chemotherapy appointment.  You will return to one of the day case treatment areas to have your portable pump disconnected.  This should take about half an hour.


Can I bring relatives and friends with me?

You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person.  Treatment areas are not suitable for young children.

What are the possible side effects?

There are a number of possible side effects which can occur.  The doctor, nurses and pharmacists can give you advice or answer any questions you may have.

Hair loss

You may lose your hair with this chemotherapy.  This is only temporary.  Your hair will grow back when your treatment has finished.  We can arrange a wig if you would like one, please ask your nurse for more information.  We have a leaflet that tells you more about coping with hair loss.  Please ask your nurse for a copy. A method known as ‘scalp cooling’ or ‘cold capping’ can sometimes be used to prevent hair loss.  


Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective.  If you are sick more than once in 24 hours despite taking regular anti-sickness medicine when you are at home after your treatment, contact Velindre Cancer Centre for advice.  The telephone number is at the end of the leaflet. 


You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.  

If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening. 

Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or below 35.5°CThe telephone number is at the end of the leaflet. 


Diarrhoea is a recognised side effect of both irinotecan and 5-FU.  This can either occur within 24 hours following treatment or from about five days after starting treatment.


Tiredness and fatigue

This treatment may make you feel more tired than usual.  It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able.  Some people find it beneficial to take gentle exercise as well as rest.

High blood pressure  

Aflibercept can cause an increase in blood pressure in some people.  Your blood pressure will be checked regularly during your treatment.  If you have headaches, nosebleeds or feel dizzy let your doctor know.  High blood pressure can usually be controlled with tablets prescribed by your doctor. 

Protein in the urine

This can occur due to effects of aflibercept on the kidneys.  It doesn’t normally cause symptoms but requires careful monitoring.  Before each dose of treatment you will have your urine tested for protein.  If protein is identified you may need to have a 24-hour urine collection to assess how well your kidneys are working.  Aflibercept may be stopped until the protein found in the urine has resolved.

Sore mouth

Your mouth may become sore or you may notice small ulcers.  Please follow the advice on caring for your mouth in the general chemotherapy leaflet.  Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.

Soreness to your hands and feet

You may experience mild pain, redness and swelling of your hands or feet.  If this occurs we recommend using a non perfumed cream or lotion regularly.  Please contact Velindre Cancer Centre if your hands or feet become painful.

Slow wound healing  

Wounds may take longer to heal while you are having treatment with aflibercept. 

Bowel perforation

A small number of patients can develop a small hole in the wall of the bowel (perforation). This is rare, but if you develop any abdominal pain or swelling contact Velindre Cancer Centre for advice.

Blood clots

A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further.  It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.  

Blood clots can be very serious.  However, most clots can usually be successfully treated with drugs to thin the blood.  Your doctor or nurse can give you more information.

Other information

It is important you do not become pregnant or father a child whilst having this treatment as it could damage the unborn baby. 

Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.  

Manufacturer’s patient information leaflets

Velindre leaflets provide information about very common and common side-effects: for more information regarding the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy

Contact telephone numbers


Velindre Cancer Centre 029 2061 5888

Ask for the treatment helpline if you are unwell at home and need immediate attention at any time of the day or night. For example you should phone if you:

  • Are sick more than once in 24 hours
  • Have a temperature of 37.5°C or above or below 35.5°C
  • Have diarrhoea
  • If your hands or feet are very sore 
  • Have a very sore mouth 

Pharmacy department 029 2061 5888 ext 6223

Monday – Friday 9am – 5pm for queries about your medicines

Tenovus freephone 0808 808 1010

cancer support line 


This leaflet was written by health professionals.  The information contained in this leaflet is evidence based.  It has been approved by doctors, nurses and patients.  It is reviewed and updated every 6 months.

Prepared 2012 renewed April 2016