Carboplatin and etoposide chemotherapy
This information is about a chemotherapy treatment for small cell lung cancer using carboplatin and etoposide.
The drugs that are used
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The treatment involves two chemotherapy drugs:
etoposide, which is also known as Etopophos® or Vepesid®.
How treatment is given
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Carboplatin and etoposide chemotherapy treatment can usually be given to you as a day patient.
Before you start treatment you'll need to have a blood test – either on the same day, or a few days beforehand. You'll 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 the chemotherapy drugs for you. This may take a couple of hours.
When you begin treatment 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 then be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, central line or PICC line, which is connected to a drip (infusion). Some anti-sickness drugs may be given as tablets.
The chemotherapy drugs are then given separately:
Carboplatin (a colourless fluid) is given as an infusion over 30–60 minutes.
Etoposide (a colourless fluid) is given as an infusion over 60 minutes.
Etoposide can also be given to you by mouth (orally) as 50mg and 100mg pale pink capsules. The capsules should be taken on an empty stomach. They should be swallowed whole with a full glass of water. If you have trouble swallowing the 100mg capsules, which are fairly large, tell your doctor so that you can be given the smaller (50mg) ones.
If you're being treated as a day patient, you can go home when it has finished 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 your next cycle of chemotherapy. You'll be shown how to look after the line.
You'll 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 better at preventing sickness than stopping it once it starts.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the carboplatin etoposide regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular chemotherapy treatment.
On the first day of treatment (day one) you'll be given the carboplatin and etoposide as infusions as described. On the next day (day two) you'll be given another infusion of etoposide, or you'll be given etoposide capsules to take. Day three is a repeat of day two. After this, you'll have a rest with no chemotherapy for 18 days. This completes what is called a cycle of treatment. Each cycle takes 21 days (three weeks).
You'll start the next cycle of your treatment after the rest period, which will be three weeks after your first infusion. Usually 2–6 cycles are given, depending on how well your cancer is responding to the treatment and how well you are able to tolerate the side effects. This makes upbna 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 having carboplatin and etoposide 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
Carboplatin and etoposide 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 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
You'll 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
Carboplatin and etoposide 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.
Carboplatin and etoposide can reduce the number of red blood cells, which carry oxygen around the body.
A low red blood 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.
Your kidneys 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, you will have a blood test to check your kidneys 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.
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.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Less common side effects
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Numbness or tingling in the hands or feet
This is due to the effect of carboplatin 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 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 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 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.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve, you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
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 know about any side effects you have.
Carboplatin and etoposide can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
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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Very rarely, etoposide may cause a second cancer, usually a type of acute leukaemia, to develop years later. Your nurse or doctor can discuss this with you.
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 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.
Pain at injection site
Etoposide can cause pain along the vein that is used to give you your chemotherapy. If you feel any pain, tell your doctor or nurse straight away so that they can check the infusion site. They may slow the infusion down to reduce pain.
Your ability to become pregnant or father a child may be affected by 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 having carboplatin and etoposide as it may harm the developing baby. It's important to use effective contraception whilst taking this drug, and for up to a year 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.
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.
Things to remember about etoposide capsules
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It's important to take your capsules at the right times as directed by your doctor.
Take the capsules whole with water. Do not open the capsules.
Always tell any doctors treating you for non-cancerous conditions that you are taking a course of chemotherapy tablets that should not be stopped or restarted without advice from your cancer specialist.
If the capsules leak, it is important not to touch their contents.
Keep the capsules in a safe place, out of the reach of children.
Keep the capsules in the original container and store them at room temperature, away from heat and direct sunlight.
If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
If you are sick just after taking the capsules, let your doctor know. You may need to take another dose. Don't take another capsule without telling your doctor first.
If you forget to take a capsule, don't take a double dose. Tell your doctor and keep to your regular dose schedule.
If you have difficulty swallowing the capsules, talk to your pharmacist.
This section is based upon our carboplatin and etoposide chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including: