Procarbazine, lomustine and vincristine 95

Information leaflet on procarbazine, lomustine and vincristine chemotherapy 95

This leaflet provides information on a course of chemotherapy called PCV.  It will explain what this is and when and how it is 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 PCV 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, please ask your nurse for a copy.

What is PCV chemotherapy?

This is a chemotherapy treatment which consists of three drugs:
  
•    Procarbazine (capsules) 
•    Lomustine, also known as CCNU (tablets) 
•    Vincristine (given as a drip) 

Why am I having PCV chemotherapy? 

Your doctor has prescribed this chemotherapy because it can be effective in treating your type of cancer.

How often will I receive my chemotherapy?

•    The vincristine will be given to you once every six weeks.
•    The lomustine tablets are taken for one day after the vincristine.
•    The procarbazine capsules are taken for 10 days after the vincristine injection.

This treatment is repeated every six weeks up to a maximum of six treatments.  Each six week period is known as a cycle.  Your doctor will discuss with you the exact number of cycles you will receive.

It is usual to have an MRI scan to assess the effect of your treatment.  You will have the scan at the end of your chemotherapy treatment.  Some patients will also have one during their treatment.  Your doctor will discuss this with you before your treatment starts.

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 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 vincristine chemotherapy be given?

The vincristine chemotherapy will be given through a drip connected to a small needle which is placed in your hand or arm.  We will also give you some anti sickness medicine before your chemotherapy. 

How long will I be in the hospital?

Your chemotherapy appointment will usually be on a different day to your clinic appointment.  The anti sickness medicine and vincristine will take about 30 minutes to give.  Please allow an extra 30 minutes for your first treatment.

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. 

How should I take the chemotherapy tablets?

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.

Lomustine should be taken just before you go to bed, on an empty stomach (at least an hour after eating).  You should take the anti sickness tablet (ondansetron) 30 minutes before taking the lomustine.  This will reduce the risk of vomiting.  

Procarbazine capsules should be taken once a day for 10 days starting on the same day as vincristine.  You can choose what time to take them but try to keep to approximately the same time each day.  You should not drink alcohol whilst taking the 10 days of procarbazine tablets, or for a few days after.  This is because procarbazine with alcohol may cause severe vomiting and make you feel very unwell. 
Some foods can cause an unpleasant reaction if eaten whilst you are taking procarbazine and for two days after.  Although this is rare’ you will need to avoid foods containing Tyramine, for example: mature cheeses, cottage cheese, ricotta cheese, salami, yeast or beef extracts (oxo, marmite or Bovril). Try to avoid foods that are not fresh, for example, processed, pickled, smoked or matured foods.
If you feel unwell after eating, for example, vomiting, headaches, drowsiness, or problems breathing, contact Velindre.

How many tablets will I need to take?

This will vary for each person.  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?

•    If it’s within 4 hours of the normal time take them now.
•    If it’s more than 4 hours late, miss this dose and contact Velindre for advice.

What if I take too many tablets?

Please contact Velindre Cancer Centre immediately for advice.  The telephone number is at the end of the leaflet.

How should I store my chemotherapy tablets?

Your tablets should be stored 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.  

What are the possible side effects?

This type of chemotherapy is usually very well tolerated and most patients don’t have many side effects.

Hair loss

You should not lose your hair with PCV chemotherapy. However, a very small number of patients experience some hair thinning.

Sickness

Some patients experience nausea (feeling sick) with this treatment.  You may be sick especially for the first day or two after the lomustine chemotherapy.  We will give you anti-sickness medicine to help prevent this.  

If you are sick more than once in 24 hours despite taking regular anti sickness tablets, you should 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.

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.

You must report to the doctor if you are sleeping a lot more than usual.  Remember though that if you have recently finished a course of radiotherapy it can also make you feel very tired so it can be difficult to decide what is affecting you.  You can discuss this with your doctor at your appointments. 

Flu like symptoms

Some patients experience flu like symptoms with this treatment.  This is usually mild and short lived.  Symptoms may include fever, chills, aching muscles, headaches and tiredness.  If your temperature is above 37.5oC please contact Velindre Cancer Centre immediately.  The telephone number is at the end of the leaflet.

Effects on your nerves

Vincristine may damage the nerves in your fingers and toes.  You may experience numbness or pins and needles.  The nerves to your bowel may also be affected.  This may result in constipation.  Some patients experience jaw pain or headaches if the nerves to the head are affected.  If you develop any of these symptoms please tell your doctor or nurse at your clinic appointment.

Rare side effects

Procarbazine tablets can cause unusual side effects in a small number of people. 

If you notice that you feel giddy, are sleeping more than usual, or you experience any headaches or hallucinations, it is important to contact the treatment helpline, the number is at the end of the leaflet. 

Other information

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

This chemotherapy can affect your ability to have children.  You will have the opportunity to discuss this with your doctor before the treatment starts.

Women sometimes find that chemotherapy treatment affects their periods.  These 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 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 chemotherapy pager 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:
•    Are sick more than once in 24 hours
•    Have a temperature of 37.5°C or above or below 35.5°centigrade

Pharmacy department 029 2061 5888 ext 6223
Mon – Fri 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 contained in this leaflet is evidence based.  It has been approved by doctors, nurses and patients.  It is reviewed and updated every 2 years.