Chemotherapy Medicines
Nausea
Chemotherapy room
Coping with hair loss
Chemo delivery methods

Chemotherapy Medicines

Methotrexate
Hydroxyurea (Hydrea)
Taxol (Paclitaxel)
Adriamycin (Doxorubicin)
Carboplatin (Paraplatin)
Cisplatin (Cisplatinum)
Cytoxan (Cyclophosphamide)
5-Fluorouracil (5-FU)
Ifosfamide (Ifex)
Doxil (doxorubicin liposome injection)
Etoposide (VP-16)
Topotecan
Bleomycin, Etoposide and Cisplatin (BEP) for ovarian germ cell tumors
Doxorubicin (Adriamycin) and Paclitaxel (Taxol)
Paclitaxel (Taxol) and Carboplatin
Paclitaxel (Taxol) and Cisplatin

METHOTREXATE (top)

How drug is given: By injection either in a vein (I.V.) or into a muscle.

Early side effects:
Nausea: Some people get sick to the stomach (nauseated) after taking Methotrexate, but this is more common with higher doses.

Kidney damage: While taking methotrexate, it is important to drink a lot of fluid every day (8 glasses) so that the drug is flushed through the kidneys. There is a chance of kidney damage if the methotrexate is not flushed through.

Later side effects:
Skin changes: Methotrexate will make your skin and eyes more sensitive to the sun. You will be more likely to get a bad sunburn. Until about a month after you are finished with Methotrexate, wear sunscreen, hats, and sunglasses when you are out in the sun. Some people get a rash, which is not due to the sun. Some people have watery eyes, which is not due to the sun, and will clear up after you are all done taking Methotrexate.

Bone marrow: While you are taking Methotrexate, your blood counts will go down. This is mainly a problem with higher doses of Methotrexate. This is because Methotrexate causes your bone marrow to make fewer blood cells. When you are done taking Methotrexate, your bone marrow should get back to normal. Blood counts are checked by a blood test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells: Red blood cells carry iron and oxygen, which give you strength and energy. Methotrexate should not make your red blood cell count low.

White blood cells: White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. It is important to call if you get a fever higher than 100.5 F, because you may need antibiotics.

Platelets: Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you take Methotrexate.

Fatigue: You may feel more tired than usual while taking Methotrexate.

Mouth sores: People taking higher doses are more prone to mouth sores. There may be sore spots in the mouth, or just a sore feeling. Call if this happens to you. Rinse your mouth with a pinch of baking soda and salt in warm water 4 times a day.

HYDROXYUREA (Hydrea) (top)

How drug is given: Capsules

Side effects:
Bone marrow: While you are taking Hydroxyurea, your blood counts will go down. This is because the Hydroxyurea causes your bone marrow to make fewer blood cells. If you are also getting radiation therapy to areas that include bones, the bone marrow is affected even more. Your blood counts should get back to normal after all your treatment is finished. It is important to have blood tests on schedule to check on your blood counts. The following blood counts will be affected:

Red blood cells carry iron and oxygen, which give you strength and energy. When your red blood cells are low, you may feel tired.
White blood cells fight infection. You will be more likely to catch an infection if your white blood count is low. You should try to avoid infection by staying out of crowds and washing your hands before eating. People who are sick should stay away from you. Call the office if you get a fever above 100.5 F while you are taking Hydroxyurea.

Skin: Some people develop a rash, itchiness or skin pigment darkening. These are temporary, but should be reported during office hours.
Blood tests: There may be some changes in kidney or liver tests. These should get back to normal when you are finished taking Hydroxyurea

Caution: The capsules must be kept out of the reach of children.

TAXOL (Paclitaxel) (top)

How drug is given:
Through a vein (I.V.) over three hours, every 3-4 weeks.

Early side effects:
Allergic reaction: While the Taxol is going into your vein, you might have an allergic reaction. You might have trouble breathing, your face may get red, your blood pressure might go down or you may have chest or back pain. We will give you medicine before each treatment to prevent an allergic reaction.

Nausea: Taxol may cause mild nausea. If you are also getting other chemotherapy drugs, you might be more likely to have nausea.

Fatigue: For a few days to a week after each treatment, you may be very tired, with no energy. You should plan ahead for each treatment, so that you have more time to rest those days. Often, there are people who want to do something for you, and this is a good time. Ask someone to walk your dog, pick up your children at school, or bring a meal.

Nervous system: Taxol can affect the nerves that go to your hands and feet, and the nerves in your legs. You may have an achy pain in your legs for a few days after each Taxol treatment. We will have you take medicine on a schedule for a few days to prevent this pain. You may start to notice a tingly feeling in your fingers and toes on both sides (not just one side), or they may feel numb. This usually starts after you have had Taxol two or three times, and goes back to normal when you are all done with chemotherapy. Some people may begin having trouble moving or walking (although this is unusual), which might mean nerve damage. If you ever have trouble moving or walking, call the office.

Heart changes: While the Taxol is going into your vein, your heart rate will slow somewhat. Some people have an increase or decrease in their blood pressure. You probably will not feel any different due to these changes.

Pain at I.V. area: If the Taxol leaks out of the vein into your arm, you may have pain. Later, this area might turn red, or look like a burn. Over time, your skin will heal.

Later side effects:
Hair loss: You will probably lose all of your hair, starting about two weeks after your first treatment. Your hair will grow back when you are all done taking Taxol. If you are planning to wear a wig, it is best to see a hairdresser before you lose your hair. He or she can see what you look like with your natural hair, and then help you find a wig.

Bone Marrow: After your Taxol treatment, your blood counts will go down. This is because the Taxol causes your bone marrow to make fewer blood cells. This happens from about 7-14 days after each treatment, and then blood counts go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call if you get a fever higher than 100.5 F.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you are taking Taxol.

Unborn Child: If you become pregnant while taking Taxol, your unborn child may have birth defects. You should use good birth control to prevent pregnancy.

ADRIAMYCIN (Doxorubicin) (top)

How drug is given: Through a vein (I.V.) over 10 minutes to an hour.

Early Side Effects:
Nausea: To keep from getting sick to your stomach (nausea), you will need to take anti-nausea medicine on a schedule. Nausea, if it occurs, is more likely in the first 24 hours after Adriamycin.

Skin damage: If Adriamycin leaks out of the vein and into the skin, it can cause serious skin damage. The skin area may look and feel like a bad burn, and you may have permanent damage. You should tell your nurse if you have pain while your chemotherapy is going in.

Allergic Reaction: Allergic reactions are not common. You should tell your nurse if you have chills, itching or trouble breathing.

Red Urine: Adriamycin is red. The first few times you pass urine after getting Adriamycin, your urine may be a light red color. This is not blood, just the color from the Adriamycin.

Irregular Heart Beat: There have been some reports of abnormal heart rhythm after Adriamycin.

Later Side Effects:
Heart problems: Adriamycin can cause heart damage. About 2-3% of people taking Adriamycin can develop permanent heart damage, called cardiomyopathy. This can be serious enough to cause congestive heart failure. Your heart will be tested with a special scan called a MUGA scan prior to taking Adriamycin. This will help to see if you can be treated safely. However, you can still develop heart damage even if the MUGA scan is normal.

Bone Marrow: After Adriamycin, your blood counts will go down. This is because the Adriamycin causes your bone marrow to make fewer blood cells. This happens from about 7-14 days after each treatment, and then blood counts go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call if you get a fever higher than 100.5 F.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you are taking Adriamycin.

Mouth Sores: About the time that your white blood count is low, the lining of your mouth may feel sore. You may get open sore areas in your mouth (mouth sores). Your mouth should heal in a few days. Your mouth rinses with baking soda and salt 4 times a day will help. Call the office if your mouth gets sore because we would want to order a special prescription mouthwash for you, called Miracle Mouthwash.

Fatigue: For a few days to a week after each treatment, you may be very tired, with no energy. You should plan ahead for each treatment, so that you have more time to rest those days. Often, there are people who want to do something for you, and this is a good time. Ask someone to walk your dog, pick up your children at school, or bring a meal.

Skin: After you get Adriamycin a few times, you may see dark creases in the palms of your hands, and dark ridges on your nails. This will slowly go away when you are done taking Adriamycin.

Hair Loss: You will probably lose all of your hair, starting about 2 weeks after your first treatment. Your hair will grow back when you are all done taking Adriamycin. If you are planning to wear a wig, it is best to see a hairdresser before you lose your hair. He or she can see what you look like with your natural hair, and then help you find a wig. Then your wig can be fitted after your hair comes out.

Unborn Child: If you become pregnant while taking Adriamycin, your unborn child may have birth defects. You should use good birth control to prevent pregnancy.

CARBOPLATIN (Paraplatin) (top)

How drug is given: Through a vein (I.V.) over 30-60 minutes.

Early Side Effects:
Nausea: You may feel sick to your stomach (nausea) after taking Carboplatin. Usually, nausea is gone in a day. You will be given medicine on a schedule to prevent nausea.

Allergic reaction: While the Carboplatin is going into your vein, you might have a reaction. You might have trouble breathing, your blood pressure might go down, and you might get an itchy rash. This is not common.

Later Side Effects:
Bone Marrow: After Carboplatin, your blood counts will go down. This is because the Carboplatin causes your bone marrow to make fewer blood cells. This happens from about 7-14 days after each treatment, and then blood counts go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call if you get a fever higher than 100.5 F.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you are taking Carboplatin.

Nervous system: You may have mild tingling and numbness in your hands or feet after a few treatments. You should not have any trouble moving your hands or feet. Call the office if you have trouble moving. The tingling and numbness should go away after all the treatments are over.

Blood test results: We may see a change in some of your blood tests that check your liver function. This is usually a temporary effect of the chemotherapy, but there might be permanent changes in your liver function.

Unborn child: If you become pregnant while taking Carboplatin, your unborn child may have birth defects. You should use good birth control to prevent pregnancy.

CISPLATIN (Cisplatinum) (top)

How drug is given: Through a vein (I.V.), or through a special catheter in your abdomen, over 3-4 hours.

Early Side Effects:
Allergic reaction: While the Cisplatin is going into your vein, you might have a reaction. You might have trouble breathing, your blood pressure might go down, and you might get an itchy rash. This is not common.

Nausea: In order to prevent you from becoming sick to your stomach (nausea), you will need to take anti-nausea medicine for several days. Nausea will be a problem unless you take these medicines on schedule.

Kidney damage: Your body needs to flush Cisplatin out through your kidneys. If Cisplatin sits too long in your kidneys, it can cause damage. You need to drink 2-3 quarts of fluid per day for about 4 days after each treatment to help flush your kidneys. Also, we give you a lot of fluid in your I.V. the day you get Cisplatin. Before each treatment, we will draw blood to check how well your kidneys are working. Good fluids to drink to flush your kidneys are water and juice. Tea, coffee and soda are fine, but you shouldnÅft have more than 2 drinks with caffeine per day.

Taste changes: During, or soon after each treatment, you may notice a metal-like taste in your mouth. Things may smell and taste wrong. This may last for a few days to a week. Drinking plenty of water or juice can help. DonÅft try to treat yourself with your favorite foodsÅ\ you may not want to eat them ever again.

Fatigue: For a few days to a week after each treatment, you may be very tired, with no energy. You should plan ahead for each treatment, so that you have more time to rest those days. Often, there are people who want to do something for you, and this is a good time. Ask someone to walk your dog, pick up your children at school, or bring a meal.

Later Side Effects:
Hair Loss: You will probably lose hair, but not all of it. Usually, hair thins out over time. You may not feel you need a wig. It is best to treat your hair very gently. Use a mild shampoo. Perms or hair color may damage the scalp, and cause infection, or will make the hair weaker. If you are taking other chemotherapy drugs also, you will probably lose more hair.

Bone Marrow: After Cisplatin, your blood counts will go down. This is because the Cisplatin causes your bone marrow to make fewer blood cells. This happens from about 7-14 days after each treatment, and then blood counts go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call if you get a fever higher than 100.5 F.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you are taking Cisplatin.

Nervous system: Cisplatin can affect the nerves that go to your hands and feet, and the nerves that help you hear. You may notice a tingly feeling in your fingers and toes on both sides (not just one side), or they may feel numb. This usually starts after you have had Cisplatin two or three times, and goes back to normal when you are all done with chemotherapy. Some people may begin having trouble moving or walking, which might mean nerve damage. If this happens, you should call the office.

You may have some hearing loss with Cisplatin. This is usually high frequency hearing loss; high-pitched sounds such as bird calls, or high young childrenÅfsÅf voices. You may not notice hearing loss, but it could be detected by a hearing test.

Unborn child: If you become pregnant while taking Cisplatin, your unborn child might have birth defects. You should use good birth control to prevent pregnancy.

CYTOXAN (Cyclophosphamide) (top)

How drug is given: Sometimes in pill form, but usually through a vein (I.V.) over about _ hour.

Early Side Effects:
Bladder: You may develop irritation of the bladder lining the day you take Cytoxan. This may cause bleeding. Even if there is no bleeding, you may develop scarring of the bladder lining. The best way to prevent this is to drink 2-3 quarts of fluid the day you take Cytoxan, so that you pass urine often.

Sinuses: While the Cytoxan is going into your vein, you may feel like your nose or sinuses get stuffy. This should not last long, but some people get a headache. This is not an allergic reaction. Tylenol should help the headache.

Nausea: Cytoxan can make you sick to your stomach (nauseated), but nausea medicine will be given to you to prevent this. If nausea is going to happen, it is usually 8-24 hours after your treatment.

Later Side Effects:
Bone Marrow: After Cytoxan, your blood counts will go down. This is because the Cytoxan causes your bone marrow to make fewer blood cells. This happens from about 7-14 days after each treatment, and then blood counts go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call if you get a fever higher than 100.5 F.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you are taking Cytoxan.

Mouth sores: If you are also taking other chemo drugs, you may develop a sore mouth or mouth sores about a week after treatment. Keeping your mouth clean by brushing or flossing is important. Regular mouthwash will dry your mouth out. Rinse your mouth 4 times a day with a pinch of salt and a pinch of baking soda in a cup of warm water.

Hair loss: Cytoxan usually causes hair loss, called alopecia. Hair loss usually happens slowly, starting several weeks after the first treatment. It may happen more quickly if you are also taking other chemo drugs that cause hair loss. Your hair will start growing back about a month after all treatments are finished. Perms or hair color treatments while you are getting Cytoxan may cause scalp damage and infections, and also will make hair weaker.

Liver: Cytoxan can cause some changes in your liver function, which usually does not cause symptoms. These changes are looked for during blood tests that are done regularly while you are taking chemotherapy.

Fertility: You may stop having periods while taking Cytoxan, or your cycle may be irregular. You may never be able to get pregnant after taking Cytoxan, but this is not definite.

Unborn child: If you become pregnant while taking Cytoxan, your unborn child may have birth defects. You should use good birth control to prevent pregnancy.

Other cancers: There is a small chance that another kind of cancer or leukemia could form years after taking Cytoxan. This usually depends on the amount of Cytoxan given.

5-FLUOROURACIL (5-FU) (top)

How drug is given: Through a vein (I.V.). 5-FU is given at different speeds, depending on the treatment plan.

Early Side Effects:
Nausea: Some people get sick to their stomach (nausea). It is usually easy to stop nausea with medicine.

Diarrhea: Diarrhea is more likely to happen when 5-FU is given for several days, or if other chemotherapy drugs are given at the same time. If you get diarrhea, it is o.k. to take Imodium one or two times, but if you still have diarrhea, call the office. There is a danger of getting dehydrated, and sometimes people need I.V. fluid.

Nervous System: Very rarely, people who take 5-FU might have problems with their nervous system. The problems may be trouble walking or talking, or headache. This is more likely to happen when high doses of 5-FU are given, but is very rare in any case.

Later Side Effects:
Bone Marrow: After your 5-FU treatment, your blood counts will start to go down. This is because 5-FU causes your bone marrow to make fewer blood cells. This happens from about 7-18 days after starting each week of treatment, and then blood counts start to go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red Blood Cells: Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. Sometimes, a red blood cell transfusion is needed if red blood cells are very low.

White Blood Cells: White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection. It is very important to call if you get a fever higher than 100.5 F. It is dangerous to have an infection when your white blood count is low.

Platelets: Platelets clump up to stop the bleeding when you get cut. You might be more likely to bleed easily when you are taking 5-FU.

Mouth Sores: About the time that the white blood count is low, the lining of your mouth might feel sore. You may get open sore areas in your mouth (mouth sores). Your mouth should heal in a few days. Call the office if you get a sore mouth. You may need a special mouthwash.

Skin Changes: You will be much more likely to get a sunburn when you take 5-FU. You will need to protect your skin when you are out in the sun. Wear clothes that block the sun and put sunscreen on bare skin.

Some people get dark streaks on their arms where the 5-FU went in, or dark streaks on their nails. This will slowly get back to normal over time.

A rare problem, called hand-foot syndrome may happen. The palms of the hands and the soles of the feet may get red and swollen, and feel like they are burning. Sometimes there is peeling of the top layer of skin. This problem will clear up when the 5-fu is stopped.

Eye Changes: While you are taking 5-FU, your eyes will be very sensitive to sunlight. You will need to wear sunglasses when you are out in the bright light.

Some people have watery eyes after treatment. This will stop after you are all done with chemotherapy.

Hair Loss: You may have thinning of the hair with 5-FU, but will probably not lose all your hair.

IFOSFAMIDE (Ifex) (top)

How drug is given: Through a vein, either for 24 hours continuously, or daily over 1 hour for 3 to 5 days.

Early side effects:
Flushing: You may experience a warm flushing sensation during the treatment.

Nausea: Ifosfamide can cause you to be sick to your stomach (nauseated). You will be given medicine on a schedule with your treatment to prevent this.

Bladder Irritation: Ifosfamide has a by-product that is very irritating to the bladder. In order to prevent this problem, you will also be given a drug called Mesna to protect your bladder. You also will be asked to empty your bladder often; make sure you are drinking plenty of fluids.

Pain at I.V. site: Ifosfamide can cause local irritation at the place where it goes into your vein. If you experience pain at the site of your I.V., let your nurse know right away.

Later side effects:
Hair loss: Many people receiving ifosfamide will lose some or all of their hair. This usually begins about 2 weeks after the first dose. Your hair will grow back after the treatments are all done. If you would like to wear a wig, you will want to see a hairdresser before your hair comes out, so that she or he can help you choose a wig that looks like your natural hair.

Skin and nail changes: Some people notice darker skin color, and changes in the color and texture of their fingernails. If you are concerned about what you notice, please speak with your nurse about this.

Bone Marrow: After Ifosfamide, your blood counts will go down. This because the drug causes your bone marrow to make fewer blood cells. This happens at about 10 days after each treatment, and then your blood counts will start to go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call the office if you get a fever higher than 100.5 F.
ss Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily when you are taking Ifosfamide.

Unborn Child: If you become pregnant while taking Ifosfamide, your unborn child can be damaged. You should use good birth control to prevent pregnancy.

DOXIL (doxorubicin liposome injection) (top)

How drug is given: Through a vein (I.V.) over 60-90 minutes
Early side effects:
Allergic reaction: While Doxil is going into the vein, some people have had allergic-type reactions. These are best caused hypersensitivity reactions. They are not truly due to an allergy, just the response of the system to an unusual chemical. These reactions have been reported in about 7% of people, and usually only the first time Doxil is given. You may feel flushed, short of breath, facial swelling, headache, chills, back pain, tightness in the chest or throat. To prevent these reactions, we give medicine in the I.V. line before starting the Doxil.

Fatigue: For a few days to a week after each treatment, you may be tired, with no energy.

I.V. related pain: If Doxil leaks out of the vein into the skin, it can cause irritation and pain. If you feel stinging at the I.V. area, tell the nurse. If the I.V. is out of the vein, it will be restarted in another vein.

Later side effects:
Bone Marrow: After Doxil, your blood counts will go down. This because the drug causes your bone marrow to make fewer blood cells. This happens at about 2 weeks after each treatment, and then your blood counts will start to go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call the office if you get a fever higher than 100.5.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily.

Skin reactions: Swelling, pain and redness of the skin of the palms and bottom of the feet have occurred in about 4% of people taking Doxil. This is called hand-foot syndrome, or palmar-plantar erythrodysesthesia. Symptoms are not usually seen until after the third treatment, and are temporary. The reaction is usually mild, but could get more severe if the treatment is continued. It is important to report this problem to the office. Other parts of the skin can be affected, too, mainly areas where the skin is under pressure. We have attached special instructions to prevent this problem in other areas.

Heart- related effects: Some people have had heart- related problems due to Doxil, although this is not common. At some time before or during treatment, we will order a special heart study to check on any underlying heart problem. 1% of people taking Doxil have had serious problems with an irregular heart rhythm, damage to the heart muscle, heart failure, fluid on the heart, and/or rapid heart rate.

ETOPOSIDE (VP-16) (top)

How drug is given:
Sometimes as a pill; sometimes through a vein (I.V.) over 45 minutes daily for several days in a row.

Early side effects:
Lowered blood pressure: While etoposide is going into your vein, your blood pressure may be lower than normal. If it gets very low, you may become dizzy or lightheaded.

Nausea: Not common when etoposide is given all by itself.

Fatigue: For a few days to a week after each treatment, you may be very tired, with no energy. You should plan ahead for each treatment, so that you have more time to rest those days. Often, there are people who want to do something for you, and this is a good time. Ask someone to walk your dog, pick up your children at school, or bring a meal.

I.V. related pain: If etoposide leaks out of the vein into the skin, it can cause irritation and pain. If you feel stinging at the I.V. area, tell the nurse. If the I.V. is out of the vein, it will be restarted in another vein.

Later side effects:
Bone Marrow: After etoposide, your blood counts will go down. This is because the drug causes your bone marrow to make fewer blood cells. This happens at about 2 weeks after each treatment, and then your blood counts will start to go back up. Blood counts are checked by a test called the CBC. Here is what may happen when your blood counts are low:

Red blood cells carry iron and oxygen, which give you strength and energy. When red blood cells are low, you have anemia. You may get tired more easily. You will probably have a lower than normal red blood count until you are all finished with chemotherapy.

White blood cells fight infection. When your white blood cells are low, you can catch infections more easily. Almost always, you need antibiotics if you get an infection while you are taking chemotherapy. It is important to call the office if you get a fever higher than 100.5 F.

Platelets clump up to stop the bleeding when you get cut. You may be more likely to bleed easily

TOPOTECAN (top)

How Topotecan is given:
Topotecan is given into your vein (intravenously-I.V.). First, you will be given medicine through the I.V. to prevent nausea. Then, Topotecan will be given over about 30 minutes. The total treatment time is 45 minutes to 1 hour. This treatment is given by several schedules: once weekly, three times a week, or five times a week.

Side Effects of Topotecan:
Very Likely:
• Fatigue- extreme tiredness a few days after each treatment, lasting for a few days.
• Complete hair loss (will grow back) starting about 2 weeks after the first treatment.
• Lowered white blood count, red blood count, platelets. You may not notice if your blood counts are low. White blood cells fight infection. When they are lower than normal, you have a higher chance of getting an infection. Red blood cells carry oxygen. When they are lower than normal, you may tire more easily, or have shortness of breath. Platelets help your blood clot. If they are low, you are more likely to have bleeding problems. If your blood counts are very low, you could have serious problems with infections, bleeding or weakness. These problems could be life threatening. Transfusions, antibiotics and hospitalization could be needed.
• Constipation or diarrhea.
• Appetite changes.
• Problems with concentration and short-term memory. This may be somewhat due to emotional overload and stress, but may also be partly due to the chemo. Recovery from this may take several months.
• Lowered sex drive, partly due to fatigue. May take months to 1-2 years for sex drive to fully return.

Less Likely:
• Rash.
• Abdominal pain.
• Headache
• Dry, raw feeling in mouth or throat.
• Nausea, usually preventable.
• Shortness of breath.
• Allergic reaction.

Effects on unborn child:
This treatment can cause miscarriage or birth defects. If you have not gone through menopause and have not had your uterus and ovaries removed, you must use an effective birth control method.

Reporting side effects:
Please let us know what side effects you have had. Many problems can be helped if we know about them.

If you have a fever higher than 100.5 F call 828-670-8403, even if it is night or the weekend. Fever may be a sign of infection, and you may need antibiotics.

BLEOMYCIN, ETOPOSIDE and CISPLATIN (BEP) (top)
for ovarian germ cell tumors

How Bleomycin, Etoposide and Cisplatin are given: All of these medicines are given into the vein (intravenously-I.V.). First, the patient will be given plain I.V. fluid for about 60 minutes. Patients will also be given medicine through the I.V. to prevent nausea or other reactions. Then Bleomycin will be given for about 15 minutes. Next, Etoposide will be given for about 45 minutes. Then, Cisplatin will be given for about an hour. After all the chemotherapy is finished, the patient will be given I.V. fluid for 2 hours. Etoposide, Cisplatin and I.V. fluid will be repeated each day for 5 days. Bleomycin will be repeated each Monday for two more weeks. This constitutes one course of treatment.

This three-week treatment will be repeated every three weeks for a total of four courses of treatment. It will take 12 weeks to take all the treatment recommended for patient. Treatment delays should be avoided. Sometimes additional treatment is recommended.

Monitoring During Treatment:
The patient may have blood tests weekly during treatment to monitor liver, kidney and bone marrow status. Before the beginning of each course of treatment, the patient will need to see one of our doctors or nurse practitioners for an examination, to monitor progress and side effects.

Side Effects of Bleomycin, Etoposide and Cisplatin:
Very Likely:
• Fatigue- extreme tiredness starting a few days after the beginning of each course of treatment, lasting for about a week after finishing.
• Flu-like symptoms with chills and fever on the days Bleomycin is given.
• Complete hair loss (will grow back) starting about 2 weeks after the first treatment.
• Lowered white blood count, red blood count, platelets. You may not notice if your blood counts are low.
White blood cells fight infection. When they are lower than normal, you have a higher chance of getting an infection.
Red blood cells carry oxygen. When they are lower than normal, you may tire more easily, or have shortness of breath.
Platelets help your blood clot. If they are low, you are more likely to have bleeding problems. If your blood counts are very low, you could have serious problems with infections, bleeding or weakness. These problems could be life threatening. Transfusions, antibiotics and hospitalization could be needed. To prevent a very low drop in the white blood count, you will be given a medicine called Neupogen. Neupogen stimulates the bone marrow to make white blood cells. It is given as a small shot, just under the skin, every day for 7 days, starting the 6th day of each treatment cycle.
• Sores in mouth or throat
• Nerve irritation that may lead to numbness and tingling in the fingers or feet; could lead to difficulty buttoning clothes or walking. Numbness and tingling are usually reversible when you are all done with treatment. Problems with moving fingers or feet may not be. It is important to tell us if you have any problems with numbness, tingling, or moving.
• Constipation
• Taste and appetite changes
• Dry skin, temporary darkening of the skin
• Hypersensitivity to sunlight
• Lowering of magnesium and potassium levels in your blood, which can cause muscle weakness. Magnesium and potassium can be replaced with oral tablets
• Nausea and vomiting, usually preventable. This is not likely on the days when only Bleomycin is given.
• Lowered libido (sex drive) during treatment, usually related to fatigue, but may also be due to hormonal changes. Recovery from this may take several months.
• Problems with concentration and short-term memory. This may be somewhat due to emotional overload and stress, but may also be partly due to the chemo. Recovery from this may take several months.

Less Likely:
• Allergic reactions including a cough, itchy throat, chest or back pain, or trouble breathing
• Rash, itchy skin
• Abdominal pain
• Vision changes
• Lung damage from Bleomycin (rare, with the amount you will be given)
• Kidney damage- acute damage is rare if you drink 2 quarts fluid daily
• Hearing loss

Long Term Changes:
• Sub-clinical damage (not causing side effects or changes in blood tests) to kidney cells causes a higher risk in the future for having kidney damage from other drugs that affect the kidneys. This includes certain antibiotics.
• These drugs, despite protection with birth control pills, may affect fertility. Women of childbearing age should discuss fertility issues with their provider prior to receiving BEP.

Effects on unborn child: This treatment can cause miscarriage or birth defects. If you have not gone through menopause and have not had your uterus and ovaries removed, you must use an effective birth control method.

Reporting side effects: Please let us know what side effects you have had. Many problems can be helped if we know about them.

IMPORTANT
• You will be given a schedule of medicines to take to prevent nausea. If your nausea medicines arenÅft working, please call 828-670-8403.
• If you have a fever higher than 100.5 F call 828-670-8403, even if it is night or the weekend. Fever may be a sign of infection, and you may need antibiotics.

DOXORUBICIN (Adriamycin) and PACLITAXEL (Taxol) (top)

How Taxol and Adriamycin are given: Both Taxol and Adriamycin are given into your vein (intravenously-I.V.). First, you will be given plain I.V. fluid over about 30 minutes. Also, you will be given medicine through the I.V. to prevent nausea or other reactions. Then Adriamycin will be given over 5-10 minutes. After Adriamycin has finished, Taxol will be given over about 3 hours. The total treatment time is about 4 hours. This two-drug treatment is repeated every 3-4 weeks.

Side Effects of Taxol and Adriamycin:

Very Likely:
• Fatigue- extreme tiredness a few days after each treatment, lasting for a few days.
• Muscle or bone pain a few days after each treatment, lasting a few days.
• Complete hair loss (will grow back) starting about 2 weeks after the first treatment.
• Lowered white blood count, red blood count, platelets. You may not notice if your blood counts are low. White blood cells fight infection. When they are lower than normal, you have a higher chance of getting an infection. Red blood cells carry oxygen. When they are lower than normal, you may tire more easily, or have shortness of breath. Platelets help your blood clot. If they are low, you are more likely to have bleeding problems. If your blood counts are very low, you could have serious problems with infections, bleeding or weakness. These problems could be life threatening. Transfusions, antibiotics and hospitalization could be needed.
• Nerve irritation that may lead to numbness and tingling in the fingers or feet; could lead to difficulty buttoning clothes or walking. Numbness and tingling are usually reversible when you are all done with treatment. Problems with moving fingers or feet may not be. It is important to tell us if you have any problems with numbness, tingling or moving.
• Diarrhea; may be severe and lead to ulceration of colon.
• Dry, raw feeling in mouth or throat; may develop sores in mouth or throat.
• Taste and appetite changes.
• Dry skin.
• Nausea, usually preventable.
• Problems with concentration and short-term memory. This may be somewhat due to emotional overload and stress, but may also be partly due to the chemo. Recovery from this may take several months.
• Lowered sex drive, partly due to fatigue. May take months to 1-2 years for sex drive to fully return.
• Red color of urine for 1 or two days after Adriamycin.

Less Likely:
• Allergic reaction- Taxol can cause an irritation reaction, similar to an allergic reaction. You could have a cough, itchy throat, chest or back pain, or trouble breathing. This type of reaction is not common when we give certain medicines before the Taxol (pre-medication).
• Adriamycin can cause heart changes. These changes can be soon after taking Adriamycin, or months or years later. A type of congestive heart failure may develop, and may be irreversible.
• Rash.
• Abdominal pain.
• Vision changes.
• Irritation of the vein used for chemotherapy.
• Ulceration and skin damage if Adriamycin leaks out of the vein while it is being given.
•
Effects on unborn child: This treatment can cause miscarriage or birth defects. If you have not gone through menopause and have not had your uterus and ovaries removed, you must use an effective birth control method.

Reporting side effects:

Please let us know what side effects you have had. Many problems can be helped if we know about them.

• You will be given a schedule of medicines to take to prevent nausea. If your nausea medicines arenÅft working, please call.
• If you have a fever higher than 100.5 F call, even if it is night or the weekend. Fever may be a sign of infection, and you may need antibiotics.

TAXOL (Paclitaxel) and CARBOPLATIN (top)

How Taxol and Carboplatin are given: Both Taxol and Carboplatin are given into your vein (intravenously-I.V.). First, you will be given plain I.V. fluid over about 30 minutes. Also, you will be given medicine through the I.V. to prevent nausea or other reactions. Then Taxol will be given over about 3 hours. After Taxol has finished, Carboplatin will be given over 30 minutes. The total treatment time is about 4_ - 5 hours. This two-drug treatment is repeated every three weeks.

Side Effects of Taxol and Carboplatin:
Very Likely:
• Fatigue- extreme tiredness a few days after each treatment, lasting for a few days.
• Muscle or bone pain a few days after each treatment, lasting a few days.
• Complete hair loss (will grow back) starting about 2 weeks after the first treatment.
• Lowered white blood count, red blood count, platelets. You may not notice if your blood counts are low. White blood cells fight infection. When they are lower than normal, you have a higher chance of getting an infection. Red blood cells carry oxygen. When they are lower than normal, you may tire more easily, or have shortness of breath. Platelets help your blood clot. If they are low, you are more likely to have bleeding problems. If your blood counts are very low, you could have serious problems with infections, bleeding or weakness. These problems could be life threatening. Transfusions, antibiotics and hospitalization could be needed.
• Nerve irritation that may lead to numbness and tingling in the fingers or feet; could lead to difficulty buttoning clothes or walking. Numbness and tingling are usually reversible when you are all done with treatment. Problems with moving fingers or feet may not be. It is important to tell us if you have any problems with numbness, tingling or moving.
• Constipation.
• Taste and appetite changes.
• Dry skin.
• Lowering of magnesium level in your blood, which can cause muscle weakness. Magnesium is replaced with magnesium tablets.
• Nausea, usually preventable.
• Problems with concentration and short-term memory. This may be somewhat due to emotional overload and stress, but may also be partly due to the chemo. Recovery from this may take several months.
• Lowered sex drive, partly due to fatigue. May take months to 1-2 years for sex drive to fully return.

Less Likely:
• Allergic reaction- Taxol can cause an irritation reaction, similar to an allergic reaction. You could have a cough, itchy throat, chest or back pain, or trouble breathing. This type of reaction is not common when we give certain medicines before the Taxol (pre-medication).
• Rash.
• Abdominal pain.
• Vision changes.
• Irritation of the vein used for chemotherapy.
• Dry, raw feeling in mouth or throat.
Effects on unborn child: This treatment can cause miscarriage or birth defects. If you have not gone through menopause and have not had your uterus and ovaries removed, you must use an effective birth control method.

Reporting side effects: Please let us know what side effects you have had. Many problems can be helped if we know about them.

• You will be given a schedule of medicines to take to prevent nausea. If your nausea medicines arenÅft working, please call: 670-8403.
If you have a fever higher than 100.5 F, call, even if it is night or the weekend. Fever may be a sign of infection, and you may need antibiotics.

TAXOL (Paclitaxel) and CISPLATIN (top)

How Taxol and Cisplatin are given: Both Taxol and Cisplatin are given into your vein (intravenously-I.V.). First, you will be given plain I.V. fluid over about 30 minutes. Also, you will be given medicine through the I.V. to prevent nausea or other reactions. Then Taxol will be given over about 3 hours. After Taxol has finished, Cisplatin will be given over 1 _-2 hours, followed by plain I.V. fluid for another 1 _ to 2 hours. The total treatment time is about 7 hours. This two-drug treatment is repeated every three weeks.

Side Effects of Taxol and Cisplatin:

Very Likely:
• Fatigue: extreme tiredness a few days after each treatment, lasting for a few days.
• Muscle or bone pain a few days after each treatment, lasting a few days.
• Complete hair loss starting about 2 weeks after the first treatment. Your hair will grow back after all chemotherapy is finished.
• Lowered white blood count, red blood count, platelets. You may not notice if your blood counts are low. White blood cells fight infection. When they are lower than normal, you have a higher chance of getting an infection. Red blood cells carry oxygen. When they are lower than normal, you may tire more easily, or have shortness of breath. Platelets help your blood clot. If they are low, you are more likely to have bleeding problems. If your blood counts are very low, you could have serious problems with infections, bleeding or weakness. These problems could be life threatening. Transfusions, antibiotics and hospitalization could be needed.
• Nerve irritation that may lead to numbness and tingling in the fingers or feet; could lead to difficulty buttoning clothes or walking. Numbness and tingling are usually reversible when you are all done with treatment. Problems with moving fingers or feet may not be. It is important to tell us if you have any problems with numbness, tingling or moving.
• Kidney damage- if Cisplatin is not flushed through your kidneys with large amounts of fluid, it can cause kidney damage, which could be severe, long lasting and/or permanent. You need to drink 2 to 3 quarts of fluid daily for about 4 days after each treatment. Also, we give a lot of fluid by vein on the days you get chemotherapy.
• Constipation.
• Taste changes- during, or soon after each treatment, you may notice a metal-like taste in your mouth. Things may smell and taste wrong. This may last for a few days to a week. Marinating foods in a vinegar-based marinade may help cut this metallic taste.
• Taste and appetite changes.
• Dry skin.
• Lowering of magnesium, calcium and/or potassium levels in your blood, which can cause muscle weakness. These substances are measured by blood tests and can be replaced by oral tablets.
• Nausea and vomiting, which often can be prevented with scheduled medicines.
• Problems with concentration and short-term memory. This may be somewhat due to emotional overload and stress, but may also be partly due to the chemo. Recovery from this may take several months.
• Lowered sex drive, partly due to fatigue. May take months to 1-2 years for sex drive to fully return.

Less Likely:
• Allergic reaction- Taxol can cause an irritation reaction, similar to an allergic reaction. You could have a cough, itchy throat, chest or back pain, or trouble breathing. This type of reaction is not common when we give certain medicines before the Taxol (pre-medication).
• Rash.
• Abdominal pain.
• Vision changes.
• You may have high-frequency hearing loss due to Cisplatin.
• Irritation of the vein used for chemotherapy.
• Dry, raw feeling in mouth or throat.
• Rare chance of developing leukemia months or years after chemotherapy.

Effects on unborn child: This treatment can cause miscarriage or birth defects. If you have not gone through menopause and have not had your uterus and ovaries removed, you must use an effective birth control method.

Reporting side effects: Please let us know what side effects you have had. Many problems can be helped if we know about them.

• You will be given a schedule of medicines to take to prevent nausea. If your nausea medicines arenÅft working, please call.
• If you have a fever higher than 100.5 F, call, even if it is night or the weekend. Fever may be a sign of infection, and you may need antibiotics.