This leaflet provides information on a treatment known as cetuximab with oxaliplatin, 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.
This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ leaflet. If you haven’t received this leaflet please ask your nurse for a copy.
What is cetuximab with oxaliplatin, 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.
Why am I having this treatment?
Your doctor has prescribed this treatment because it has been found to be effective in treating your type of cancer.
How often will I receive this treatment?
For the treatment to be most effective it is given at specific time intervals. These are known as cycles. It is usual to have a cycle of treatment every 2 weeks. Your doctor will discuss with you the exact number of cycles you will receive.
You will be given the chemotherapy and cetuximab on the first day of each 2 week cycle.
How will my chemotherapy treatment be given?
To receive this treatment you will need to have a fine tube put into one of the large veins 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 place throughout the course of your treatment. Your doctor will explain this in more detail.
We have a leaflet that tells you more about PICC lines. Please ask if you would like a copy.
How often will I have to visit the hospital?
You will visit the hospital 4 times in every 2 week cycle:
Outpatient clinic appointment - You will have a blood test and we will check how you are feeling and discuss any problems you may have. This is so we can check how the treatment is affecting you. If your blood results are satisfactory, your treatment will be prescribed. This appointment is usually a few days before your treatment.
Cetuximab and chemotherapy appointment - You should be prepared to spend most of the day at the hospital for your first treatment. Cetuximab is given slowly and we will observe you after the infusion to check your reaction. For the rest of your treatments this appointment will be shorter. You will spend about 6 hours in one of the day case treatment areas. You will go home with your portable pump containing 5-FU.
Pump disconnection - 2 days later you will return 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 with this treatment. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.
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°centigrade. The telephone number is at the end of the leaflet.
You may have diarrhoea. If this occurs it is important that you drink plenty of fluids. Medication is available to control diarrhoea. If you have 4 or more bowel movements in 24 hours above what is normal for you please contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
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.
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.
Most people (more than 80%) experience a skin reaction with cetuximab. This is usually an acne type rash which may be dry and itchy and cause mild discomfort. For a small number of people this reaction may be more severe. A severe rash would affect a large part of your body, may be painful and may become infected.
To reduce the possibility of severe skin reaction we suggest that you:
Your hospital doctor may prescribe antibiotic tablets to help reduce the severity of your skin rash.
If the spots become red and angry, your doctor may give you steroid cream and antibiotic cream to apply to the area. If the spots start to look infected, contact Velindre Cancer Centre.
This skin reaction is temporary and will resolve completely after you have finished treatment. If you develop a severe skin reaction which is causing you pain or stopping you carrying out your normal activities, please contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
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. The telephone number is at the end of the leaflet.
Allergic type reactions
A small number of patients experience an allergic type reaction. If this occurs you may feel hot or flushed, itchy, light-headed or generally unwell whilst receiving your oxaliplatin or your cetuximab. This can be easily treated. Please tell your nurse immediately if you experience any of the above symptoms.
This can be easily treated. Please tell your nurse if you experience any of these symptoms.
Nerve damage in your hands and feet
Oxaliplatin may cause tingling or numbness in your fingers or toes. 85 – 95% of people experience this to some degree. This is often triggered by exposure to cold, for example when you open the fridge or hold a cold drink. It may make it difficult for you to do up buttons or pick up small objects.
This usually lasts for no more than 7 days in between treatments. If you have this problem and if it lasts longer than 7 days please tell us at your next clinic appointment.
Unpleasant feeling in your throat
Oxaliplatin causes an unpleasant sensation in the throat in a small number of patients. This may result in a feeling of tightness in the throat or not being able to catch your breath. This will occur at the time of treatment or within a few hours. It may be brought on by cold so avoid ice-cold drinks for 24 hours after treatment.
We recommend that you wait for 20-30 minutes after your treatment before leaving the hospital. You should not drive yourself home and in cold weather we recommend your friend or relative heat the car before you get into it.
Please tell your nurse if you experience this whilst having your treatment. If it occurs after you leave the hospital please contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
If this happens, try to relax, breathe out through your mouth and in through your nose. Try to move to a warmer area and try a warm drink. This sensation should pass quickly. It is best to relax.
Most people do not lose their hair with this treatment. However some people experience some hair thinning.
We have a leaflet that tells you more about coping with hair loss. Please ask your nurse if you would like a copy.
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 side effects
Some patients may develop conjunctivitis. This is an infection of the eyes which causes sore and sticky eyes. If this happens you will need treatment which can be provided by us or your GP.
Some patients may experience problems with pain, swelling or infection in the nailbed. If this occurs it is usually after several months of treatment. Please tell your doctor at your next clinic visit if this occurs.
You may get headaches whilst on this treatment. Try taking whatever painkillers you would normally take. If these do not work please contact Velindre Cancer Centre or your GP for advice.
A small number of patients experience jaw stiffness in the first few days after the oxaliplatin. Usually this only lasts for a few days. If this occurs please tell us at your next clinic visit.
Rarely patients may experience difficulty with their speech and/or movement of their arms and legs, immediately after, or a few hours after the infusion. If this happens we may keep you for observation on the unit; if you have left the hospital you will need to telephone the chemotherapy pager immediately.
Some patients experience sore or watery eyes. If this happens please tell your doctor or nurse at your next clinic appointment.
Women sometimes find that chemotherapy treatment affects their periods. They could become heavier, lighter or even stop altogether.
It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.
Rarely people on this treatment may experience shortness of breath. This is more likely if you have an existing lung problem. If you wish to discuss this further please speak to your doctor.
Very rarely people on this chemotherapy may experience heart problems such as angina or palpitations. If you wish to discuss this further please speak to your doctor.
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 www.medicines.org.uk. 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:
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Tenovus freephone 0808 808 1010
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 2 years.