This leaflet provides information on a course of chemotherapy called paclitaxel and ramucirumab.
The leaflet 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 Taxol and ramucirumab 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 Paclitaxel?
Paclitaxel is also known as Taxol. Taxol is a chemotherapy drug which originates from the bark of the European Yew tree.
What is Ramucirumab.
Ramucirumab is an antibody which attaches itself to cancer cells and stops them from growing. It is not chemotherapy. It works by blocking receptors, which prevents the cancer from dividing as well as making new blood vessels. This reduces the supply of oxygen and nutrients to the tumour, so it stops growing or shrinks.
Why am I having Taxol and ramucirumab chemotherapy?
Your doctor has recommended this treatment because it has been found to be particularly effective in treating your type of cancer.
How often will I receive my chemotherapy?
For this treatment to be most effective it will be given at specific time intervals. These are known as cycles. Your doctor will discuss the number of cycles you will receive, and the time intervals between the cycles.
You will be given Taxol on day 1, 8 and 15, therefore it is given every week for 3 weeks and one week rest on a 28 day cycle. You will have a blood test taken before each treatment, Your blood test will usually be arranged for the day before your chemotherapy, apart from when you are reviewed in clinic. We will give you your blood forms and written information to explain this.
Ramucirumab is usually given with your chemotherapy on day 1 and day 15 of a 28 day cycle
How often will I see the specialist team?
You will see the specialist team every 4 weeks. 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. You will also have your bloods checked in clinic.
How will my treatment be given?
Your treatment is given through a drip into a vein in the back of your hand or arm. If needed it may be suggested that a fine tube called a PICC is inserted into a large vein in your upper arm. This will remain in place throughout the course of your treatment. Your doctor or nurse will discuss this further with you if required, and we have a leaflet that tells you more about PICC lines, if needed.
Before your treatment we will give you medication through your drip which will reduce the risk of you being sick or developing an allergic reaction to your chemotherapy.
How long will I be in the hospital?
Your treatment appointment will be on a different day to your clinic appointment. Your treatment will be given on one of the day case treatment areas. Please allow an extra 30 minutes for your first treatment.
The Ramucirumab is administered on day 1 and 15 of the 28 day cycle. It will be administered on the same day as the Taxol (Paclitaxel) chemotherapy. The Taxol may take approximately 3 hours to administer, in addition the Ramucirumab will take approximately 1 hr to administer. You should allow up to 5 hours on days 1 and 15 of the cycle. On day 8 – Taxol alone will given, which should take approximately 3 hours.
You are welcome to bring someone to stay with you during your treatment. Space is limited in the waiting areas and treatment room 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
Taxol may cause hair loss or thinning. Most patients will experience hair thinning. However for some patients hair thinning may be considerable, and you may lose your hair. However this is only temporary. Your hair will grow back when your treatment has finished. A method known as ‘scalp cooling’ or ‘cold capping’ can sometimes be used to prevent hair loss. If you decide to have scalp cooling, you will need to allow an additional hour on to your treatment time.
We can arrange a wig if you would like one. If you want to know more about scalp cooling or wigs 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 chemotherapy treatment, contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
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.
Sore mouth
Ramucirumab may cause your mouth to 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.
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. The telephone number is at the end of the leaflet.
Diarrhoea
Ramucirumab can cause diarrhoea. If you experience diarrhoea, it is important to drink plenty fluids, and to ring the chemotherapy pager, especially if you have 4 or more episodes in 24 hours, 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 carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as taking rest.
Effects on the nerves of your hands and feet
Taxol 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. 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.
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 number is at the end of the leaflet.
Allergic type reaction
A small number of patients experience an allergic type reaction to Taxol. If this occurs you may feel hot or flushed, itchy, light-headed, back pain or generally unwell whilst receiving your chemotherapy. This can be easily treated. Please tell your nurse immediately if you experience any of these symptoms.
A small number of patients develop an itchy rash between treatments with Taxol. If this occurs it is important that you tell your doctor or nurse at your next clinic appointment.
A small number of patients may also have an allergic type reaction to Ramucirumab. If this occurs it will be whilst Ramucirumab is infusing or immediately afterwards. Symptoms include feeling:
This can be easily treated. Please tell your nurse if you experience any of these symptoms.
High blood pressure
Ramucirumab 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 Ramucirumab 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. Ramucirumab may be stopped until the protein found in the urine has resolved.
Bleeding
Ramucirumab may cause bleeding problems. Tell your doctor if you take any medicines that may affect bleeding, such as aspirin, warfarin or vitamin E. If you vomit coffee ground vomit, pass black motions at any time, have any abdominal pain, or if you notice excessive bruising or bleeding, for example nose bleeds, ring the chemopager, the telephone number is at the end of the leaflet.
Slow wound healing
Wounds may take longer to heal while you are having treatment with Ramucirumab.
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 (tummy) pain or swelling contact Velindre Cancer Centre for advice.
Other side effects and information
You are at risk of blood clots whilst on ramucirumab, if you notice any shortness of breath or swollen legs, please ring the chemotherapy pager, the telephone number is at the end of the leaflet.
Sometimes patients can have swollen ankles or limbs with the treatment , if this occurs inform your specialist team.
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. It is not advisable to breast feed whilst having this treatment, and for a minimum of 3 months afterwards.
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.
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.
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.
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 support line
7 days a week 8am – 8pm for general queries on cancer
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.