This leaflet provides information about a course of chemotherapy treatment called irinotecan and capecitabine. 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 chemotherapy are given at then 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.
What is irinotecan and capecitabine chemotherapy?
This is a course of treatment which consists of two drugs:
Why am I having irinotecan and capecitabine chemotherapy?
Your doctor has prescribed this chemotherapy because it has been found to be effective in treating your type of cancer.
How often will I have my chemotherapy?
For this treatment to be most effective it will be given at specific time intervals. These are known as cycles.
This treatment can be given in two different ways. These are explained below. Your nurse or doctor will tell you which way your treatment will be given.
Two weekly treatment
In each two week cycle you will be given the irinotecan treatment once. The capecitabine tablets are taken twice a day for nine days, starting on the same day as the irinotecan. This is followed by a rest from treatment for five days.
Or
Three weekly treatment
In each three week cycle you will be given the irinotecan treatment once. The capecitabine tablets are taken twice a day for 14 days, starting on the same day as the irinotecan. This is followed by a rest from treatment for seven days.
How often will I see the specialist team?
You will see the specialist team before each cycle. You will have regular blood tests and we will check how you are feeling and discuss any problems you may be having. This is so we can check how the chemotherapy is affecting you. If your blood results are satisfactory, your chemotherapy will be prescribed.
How should I take the capecitabine tablets?
Capecitabine tablets should be taken twice a day (9-12 hours apart), You should take the tablets within 30 minutes of finishing your meal. The tablets should be swallowed whole with a glass of water. They must not be chewed or crushed.
It is important that you wash your hands thoroughly after taking your tablets.
How many tablets will I need to take?
This will vary for each person. There are 2 different strength tablets which are different sizes. The bigger tablets are 500mg and the smaller tablets are 150mg. You may have to take a combination of big and small tablets. The amount you need to take will be clearly marked on the boxes. Remember to check each box to see how many tablets you need to take.
What should I do if I forget to take my tablets?
Do not take the extra tablets when your treatment should have finished. It is important that even if you have missed any doses you should finish the treatment at the planned time.
What if I take too many tablets?
Please contact Velindre Cancer Centre immediately for advice. The telephone number is on page 11.
How should I store the capecitabine tablets?
You should store the tablets in their original packaging in a safe place away from children. They should be kept in a cool dry place.
Any unused tablets should be returned to the hospital Pharmacy or your local chemist for safe disposal.
How will my irinotecan chemotherapy be given?
First we will give you anti sickness medicine. Then we will give you an injection of a medicine called atropine. The atropine is given to prevent some of the side effects which can occur. This is explained in more detail later in this leaflet.
The irinotecan is given through a drip connected to a small needle which is placed in your hand or arm. Alternatively it may be suggested that a fine tube called a PICC line is inserted into one of the large veins in your upper arm. This line can remain in place for the whole of your treatment. Your doctor or nurse 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 long will I be in the hospital?
Your chemotherapy appointment will usually be on a different day to your clinic appointment. The chemotherapy treatment will take about an hour. Please allow an extra 30 minutes for your first treatment. If you are having scalp cooling, please allow approximately one and a half hours extra for your treatment.
If you live far away your chemotherapy may be arranged for the same day as your clinic appointment. There is always a delay between seeing the doctor and being given your chemotherapy. If your chemotherapy is on the same day as your clinic appointment you should expect to be in the hospital for between four and six hours.
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 chemotherapy. The doctor, nurses and pharmacy team can give you advice or answer any questions you may have.
Hair loss
You may lose your hair with this chemotherapy. This is temporary and your hair will grow back when you finish your chemotherapy. We can arrange a wig if you would like one, please ask your nurse for more information.
We have a leaflet on coping with hair loss. Please ask your nurse if you would like a copy. A method known as ‘scalp cooling’ or ‘cold capping’ can sometimes be used to prevent hair loss.
Sickness
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, you should stop taking your capecitabine tablets and contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
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 a recognised side effect of both irinotecan and capecitabine. This can either occur within 24 hours following treatment or from about five days after starting treatment.
Diarrhoea within 24 hours of irinotecan
Diarrhoea which occurs at the time of treatment or up to 24 hours after irinotecan can come with other symptoms. For example sweating, stomach pains, watering eyes, blurred vision or dizziness. The atropine injection we give you before your treatment usually stops these symptoms.
We do not recommend that you take anti-diarrhoeal tablets with this type of diarrhoea. If you develop diarrhoea or any of the symptoms described within the first 24 hours after treatment please contact Velindre Cancer Centre immediately for advice. The telephone number is at the end of the leaflet.
Diarrhoea starting more than 24 hours after irinotecan
We will have given you medication to help stop diarrhoea. These are called loperamide. You should take these as follows:
It is important that you drink plenty of water and salty type liquids if you have diarrhoea. These include soda water, carbonated water and soups.
Tiredness and fatigue
Chemotherapy can make you feel more tired than usual. It is important to listen to your body and rest if you need to, but to carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as taking rest.
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.
If your mouth becomes very painful, or you are finding it difficult to eat and drink, you should stop taking your capecitabine tablets and 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.
Skin problems
Some patients will develop dry skin or a rash. Usually this can be easily treated with some non perfumed cream or lotion. Very rarely this rash can be severe. If you have a rash with blisters or is painful you should stop taking your capecitabine tablets and telephone Velindre Cancer Centre immediately for advice. The telephone number is at the end of the leaflet.
Heart problems
Very rarely some people having capecitabine chemotherapy experience heart problems. If you have a heart condition or you take any heart medication, please tell your doctor before you start chemotherapy.
If you do have any chest pain you should stop taking your capecitabine tablets and seek urgent medical attention. Do not start taking your capecitabine again until you have spoken to the team at Velindre.
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 side effects
Some patients may experience sore or watery eyes. Please tell your doctor or nurse at your next clinic visit if this occurs.
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.
Capecitabine chemotherapy can increase your skin’s sensitivity to the sun. It is best to avoid strong sunlight and wear a hat and use a sun block when in the sun.
Is it alright to take other medicines with capecitabine?
Please tell your doctor, nurse or pharmacist if you take other medicines. There are a small number of medicines that you may have to avoid. Please tell your doctor, nurse or pharmacist if you take warfarin tablets.
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 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 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
Macmillan freephone Helpline 0808 808 0000
Tenovus freephone 0808 808 1010
cancer helpline
This information is also available in Welsh
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.