Carbo MV chemotherapy
This information is about a chemotherapy treatment for bladder cancer called Carbo MV.
You will see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
The drugs that are used
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Carbo MV is named after the initials of the chemotherapy drugs used, which are:
How treatment is given
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Carbo MV treatment can usually be given to you as a day patient. Before you start treatment you will need to have a blood test - either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. You will also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours, or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
The nurse will insert a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube inserted under the skin into a vein near the collarbone (central line) or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through your cannula, central line or PICC line, which is connected to a drip (infusion).
The chemotherapy drugs are given separately:
vinblastine (a colourless fluid) is given as a drip (infusion) into your cannula or line over about 5-10 minutes
methotrexate (a yellow fluid) is given as an injection along with an infusion of salt water (saline) into your cannula or line
carboplatin (a colourless fluid) is given as an infusion into your cannula or line over about 30-60 minutes..
Once treatment is finished you can go home, and the cannula will be removed before you go. If you have a central or PICC line, it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.
You will be given a supply of anti-sickness drugs to take home with you. It's important to take these as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
How often treatment is given
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Carbo MV chemotherapy can be given in different ways. Your doctor may use the word 'regimen' (eg the Carbo MV regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular chemotherapy treatment.
The following is a description of a commonly used regimen for giving Carbo MV.
On the first day of your treatment (day one) you will be given all three chemotherapy drugs (carboplatin, methotrexate and vinblastine) as described. Two weeks later (day 15) you will be given the methotrexate and vinblastine again. After another week (day 22) you will be given the same two drugs again. You may be given folinic acid tablets to take after your methotrexate to help prevent some of the side effects that it can cause.
After this, you will have a rest period with no chemotherapy for a week. This completes a cycle of your treatment. Each cycle takes four weeks (28 days).
Following the rest period, the same drugs will be given to you again, beginning the next cycle of your treatment. Usually six cycles of treatment are given over six months. This makes up a complete course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone who is having Carbo MV chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Carbo MV can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
Carbo MV can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Carbo MV can reduce the number of red blood cells, which carry oxygen around the body. A low red cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
This is rare with this treatment, but your hair may become thinner. If you lose any hair it will grow back once the treatment has finished. Your nurse can give you advice about coping with hair loss.
Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it's available at your hospital.
Numbness or tingling in hands or feet
This is due to the effect of carboplatin or vinblastine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons, or doing other fiddly tasks.
Peripheral neuropathy is very rare if you receive normal doses of carboplatin, but may occur if you have high-dose treatment. Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This effect usually begins to improve slowly a few months after the treatment is finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Your kidneys function may be affected
This doesn't usually cause any symptoms and the effect is generally mild. If the effect is severe, however, the kidneys can be permanently damaged unless the treatment is stopped. For this reason your kidneys will be checked by a blood test before each treatment.
If necessary, you may be given medicine to help you pass urine. You may be asked to drink extra fluid before and after treatment. It’s important to do this, so let your doctor know if this is a problem, for example, if you are feeling sick.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine to help (laxatives). Your doctor can prescribe these or you can buy them at a pharmacy.
Less common side effects
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Sensitivity of the skin to sunlight
During treatment with methotrexate, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat. You might find our page on taking care in the sun useful.
Methotrexate can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this. Areas of skin that have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.
Methotrexate may cause changes in the way that your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems but your doctor will take regular blood samples to check your liver is working properly.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
Always let your doctor or nurse know about any side effects you have. There are usually ways in which they can be controlled or improved.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Leakage into the tissue around the vein (extravasation)
If this happens when vinblastine is being given, the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central line or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Some painkillers, such as ibuprofen, can make the side effects of methotrexate worse. Before taking any painkillers, check with your chemotherapy nurse, pharmacist or doctor.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while being treated with Carbo MV chemotherapy, as it may harm the developing baby. It's important to use effective contraception during treatment, and for some time afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our Carbo MV chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.