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Information leaflet on Pembrolizumab, Carboplatin, Paclitaxel, Epirubicin and Cyclophosphamide chemotherapy
This leaflet provides information on Pembrolizumab, Carboplatin, Paclitaxel, Epirubicin and Cyclophosphamide chemotherapy. It will explain what this is and when and how it is given. It will also tell you about possible side effects. Contact telephone numbers and details of how to obtain further information on Pembrolizumab, Carboplatin, Paclitaxel, Epirubicin and Cyclophosphamide are given at the end of the leaflet.
This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ folder. If you haven’t received this folder please ask your nurse for a copy.
Your ‘specialist team’ refers to your oncology team at Velindre Cancer Centre which includes doctors, specialist nurses and non-medical independent prescribers which may be a nurse or a pharmacist.
What is Pembrolizumab, Carboplatin, Paclitaxel, Epirubicin and Cyclophosphamide?
This is a course of treatment made up of 5 drugs:
Pembrolizumab, Carboplatin and Paclitaxel for up to 4 cycles, followed by Pembrolizumab, Epirubicin and Cyclophosphamide (EC) for up to 4 cycles. Pembrolizumab is then continued after surgery.
Pembrolizumab is an artificially made antibody which attaches itself to cancer cells and stops them from growing. It is an immunotherapy and works by helping the immune system to attack the cancer cells. It is not chemotherapy.
All the treatments discussed above are given in a drip.
Why am I having Pembrolizumab, Carboplatin, Paclitaxel, Epirubicin and Cyclophosphamide?
Your team has prescribed this chemotherapy because it has been found to be effective in treating your type of cancer.
How often will I receive Pembrolizumab, Carboplatin, Paclitaxel, Epirubicin and Cyclophosphamide?
For this treatment to be most effective it is given at specific time intervals. These are known as cycles.
You will be given Paclitaxel every week, alongside Pembrolizumab and Carboplatin every 3 weeks for up to 12 weeks. You will then be given Pembrolizumab, Epirubicin and Cyclophosphamide (EC) every 3 weeks for up to 4 cycles.
After you have your surgery, you will then have Pembrolizumab every 6 weeks for 5 cycles. The date this starts will be dictated by the surgery.
Your specialist team will confirm how many cycles you are to have.
How often will I see the specialist team?
You will be reviewed by your specialist team before each cycle. You will either see your specialist team in clinic or you will speak to them virtually.
You will have blood tests before each treatment 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.
How will my treatment be given?
Your treatment will be given through a drip into a vein. We
may suggest that a fine tube called a PICC line, or alternative central line is inserted. These lines will remain in place throughout your treatment. Your doctor or nurse will discuss this with you and give you a leaflet, if required.
Where will my treatment be given?
The treatments will be given in the day case treatment areas at Velindre Cancer Centre, or in one of our SACT Outreach Clinics.
How long will I be in the hospital?
Your treatment will be on a different day to your clinic appointment. Your treatment will take approximately:
Please allow extra time for your first treatment. If you choose to use scalp cooling you will need to allow an extra 1.5 hours for each treatment visit.
Can I bring relatives and friends with me?
What are the possible side effects?
There are a number of possible side effects which can occur. The team can give you advice or answer any questions you may have.
Pembrolizumab is a new drug so there may be some side effects which are rare. If you feel unwell and are unsure if it is related to this treatment, please contact the treatment helpline at Velindre. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.
If you are admitted to another hospital, you must inform the doctors and the nurses that you are receiving pembrolizumab. It is possible you could be having an immune reaction and may require specific medication. The doctors and nurses need to contact Velindre Cancer Centre for advice. They can either telephone the treatment helpline or speak to your oncologist.
You will be given an alert card, please show this to the nurses or doctors if you are admitted to any hospital.
Hair loss
Both EC and Paclitaxel cause hair loss. This is only temporary. Your hair will grow back when your treatment has finished. A method known as ‘scalp cooling’ or ‘cold capping’ can be used to prevent hair loss. We can arrange a wig if you would like one. If you would like more information about wigs or scalp cooling please speak to your nurse.
Sickness
Infection
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 if your temperature is below 35.5°. The telephone number is at the end of the leaflet.
Diarrhoea
Diarrhoea is not common with this treatment. However, if you have 4 or more bowel movements in 24 hours above what is normal for you, contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
Tiredness and fatigue
You may 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.
Allergic type reaction
A small number of patients experience an allergic type reaction to paclitaxel. If this occurs you may feel hot or flushed, itchy, light-headed or generally unwell whilst receiving paclitaxel. This can be easily treated. Please tell your nurse immediately if you experience any of the above symptoms.
Skin and tissue damage
Some chemotherapy drugs may damage the skin and surrounding area if they leak outside of your vein. This is known as extravasation. It is extremely rare but it is important that you tell us immediately if you notice any swelling, pain or burning at the site of the drip. If this occurs whilst the chemotherapy is being given, tell your nurse. If you notice pain, swelling, or redness when you’re at home please contact us immediately. The telephone number is at the end of the leaflet.
Skin reactions
Use a non-perfumed body wash and moisturising cream to help to prevent skin reactions.
A skin reaction with pembrolizumab may cause a rash which is 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.
If you develop a severe rash you should contact the treatment helpline; the number is at the end of the leaflet.
Vein pain and phlebitis
The epirubicin chemotherapy can cause some irritation to the vein as it is injected. If you are having treatment through a drip needle in your hand or arm you may notice some discomfort at the time of the injections of chemotherapy. Please tell your nurse immediately if this occurs.
For a small number of patients this vein irritation can result in some tenderness, hardness and scarring of the vein which can last for weeks or months after the treatment. The risk of this can be reduced by alternating the arm in which the chemotherapy is given. Having chemotherapy through a PICC line will prevent this problem
Colour changes to your urine
Epirubicin will harmlessly discolour your urine red for a day after your chemotherapy. If this lasts for more than 24 hours please contact the treatment helpline. The number is at the end of the leaflet.
Effects on your heart
Epirubicin can cause heart problems for a small number of patients. If you have an existing heart problem please tell the team before you start treatment. If you experience any new problems with breathlessness, palpitations or chest pain you should seek urgent medical attention.
Effects on the nerves of your hands and feet
Paclitaxel can affect the nerves of your hands and feet. This may lead to a loss of sensation, tingling or pins and needles. If this occurs please tell your doctor or nurse at your next clinic visit as we may need to change your treatment.
These symptoms may increase as you have more cycles of chemotherapy. If you have these symptoms, it is important to be extra careful when exposing your hands and feet to hot or cold temperatures. These symptoms usually go away within a few months of finishing your treatment
Fluid retention
You may experience fluid retention which can result in swelling of your ankles and legs. Rarely this can result in breathlessness because of fluid on the lungs. Please tell your doctor or nurse if this is a problem.
Effects on your thyroid hormone
Pembrolizumab may either increase or decrease the level of thyroid hormone. We will be monitoring this regularly with blood tests. If your thyroid hormone is increased, you may feel more anxious and have difficulty sleeping, have hot flushes or have a fast heart beat and feel very tired. If your thyroid hormone is decreased you will feel tired, feel the cold easily, you may put on weight and become constipated.
Myalgia (pain in the muscles)
After paclitaxel some patients may experience myalgia which is muscle or joint pain. This can sometimes be severe but will only last for a few days. If you already have painkillers at home you may find they relieve the pain. If this does not work please contact Velindre Cancer Centre. The telephone number is at the end of the leaflet.
Pregnancy and breastfeeding
It is important that you do not become pregnant or father a child during your course of chemotherapy treatment, or for at least six months after treatment. This is because chemotherapy can harm an unborn child.
Breastfeeding during chemotherapy is not advised as the drugs could be passed to a baby through breast milk.
Risk of 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 seek medical help 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
Alcohol content of paclitaxel
Paclitaxel contains alcohol. If having alcohol is a problem for you, tell your doctor, nurse or pharmacist. It is possible that your blood alcohol level may be above the legal limit after you have paclitaxel. Do not drive or operate machinery for a few hours after having this treatment, even if you feel okay.
Other side-effects related to chemotherapy:
Your team will monitor your bloods to check how your kidneys are working, as Carboplatin can sometimes affect your kidneys
Carboplatin may also affect your hearing, please inform your team if you have any ringing in your ears or hearing loss.
Other side effects related to Pembrolizumab
A small number of people may experience lung problems following pembrolizumab treatment. If you develop a dry cough or notice that you are short of breath, please inform your specialist team.
Some patients may find that this treatment can affect your vision.
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.
Sometimes cancer drugs can have very serious side effects which can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.
Side effects may continue for up to 18 months after treatment. If you have any side effects, please contact the treatment helpline. If you are admitted to hospital or see your GP during this period, inform the doctor you have had Pembrolizumab, an immune therapy and give them your alert card.
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and 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 advice 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
Macmillan freephone Helpline 0808 808 0000
Tenovus freephone cancer helpline 0808 808 1010
This information is also available in Welsh
This leaflet was written by health professionals. The information is evidence based and has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.
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