This leaflet provides information on a course of chemotherapy known as Docetaxel, Oxaliplatin, 5 fluorouracil (5-FU) and folinic acid, known as FLOT. 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 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 Docetaxel, Oxaliplatin, 5-FU and folinic acid (FLOT) chemotherapy?
This chemotherapy treatment consists of four drugs.
There are three chemotherapy drugs called Oxaliplatin, 5-FU and Docetaxel.
The other drug is called folinic acid. This is not a chemotherapy drug but it helps the 5-FU work better.
The Oxaliplatin , 5FU and Folinic acid is called Oxaliplatin and modified deGramont or OxMdG for short. This is given with Docetaxel. Together this is called FLOT.
What is Docetaxel or Taxotere chemotherapy?
Docetaxel or Taxotere is a chemotherapy drug that originates from the leaves of the European Yew tree. Your doctor has prescribed Docetaxel because it has been found to be effective in treating your type of cancer, alongside OxMdG.
Why am I having Docetaxel and OxMdG chemotherapy?
Your doctor has prescribed this because it has been found to be effective in treating your type of cancer.
How often will I receive my chemotherapy?
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 FLOT every 2 weeks. Your doctor will discuss with you the exact number of cycles you will receive.
How will my chemotherapy treatment 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.
The Docetaxel will be administered first as a drip through your PICC line over 1 hour. This is followed by the Oxaliplatin and Folinic acid given to you at the same time,through a drip over 2 hours.
The 5-FU will be given to you in a pump:
The 5-FU is put into a small portable pump.
The pump is attached to your PICC line
The pump fits into a bag (bumbag) which you wear around your waist on a belt
The pump is set to empty over 24 hours
You return to have the pump disconnected.
How do I look after the portable pump?
We will tell you how your pump works and how to look after it. We will also give you written information.
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 approximately 4.5 hours on one of the day case treatment areas. Please allow 30 minutes to an hour longer for your first visit. We will give you anti sickness medication followed by your chemotherapy through the drip. You will go home with your portable pump.
3rd visit - Pump disconnection
This appointment is 24 hours 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 with this chemotherapy. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.
Hair loss
Hair loss is usually temporary. Your hair will usually grow back after treatment ends. Very rarely, hair may not grow back. Or it may grow back thinner than before. If you are worried about this, talk to your cancer team
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.
We have a leaflet that tells you more about coping with hair loss. Please ask your nurse for a copy.
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 when you are at home after your treatment, 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. You may be given an injection to boost your immune system on days 5-9 post chemotherapy. The injection is called Filgastrim.
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.
Diarrhoea
You may have diarrhoea with this chemotherapy. 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
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.
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.
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.
Docetaxel can also cause tingling or numbness to your fingers or toes, but this is not related to the cold. If you develop loss of sensation or numbness you must inform your consultant or member of the team.
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
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. The steroid tablets usually prevent this from occurring. If it does occur it is usually mild, and will reverse when you finish your treatment. Please tell your doctor or nurse if this is a problem.
Myalgia (pain in the muscles)
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 numbers are at the end of the leaflet.
Allergic type reactions
A small number of patients have an allergic type reaction to Docetaxel. The steroid tablets usually prevent this. If it does occur it is usually while the drip is infusing. Symptoms include feeling:
This can be easily treated. Please tell your nurse immediately if you experience any of these symptoms. Very rarely this can be life threatening.
(Oxaliplatin also sometimes causes an allergic type reaction).
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
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.
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.
This 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.
You may experience discolouration and ridging of your finger and toenails. A few patients may temporarily lose their nails.
Your hands and feet may become dry and flaky. This can usually be managed by using a non-perfumed moisturiser.
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.
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
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.