This information is about a chemotherapy treatment for lung cancer and mesothelioma called MVP.
MVP is named after the initials of the drugs used, which are:
How treatment is given
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MVP treatment can usually be given to you as a day patient. Before you start treatment you'll need to have a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. This may take several hours.
The nurse will then put 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 fine, plastic tube that is inserted under the skin and into a vein near their 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.
Once your chemotherapy is ready you'll be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, which is connected to a drip. Some anti-sickness medicines may also be given as tablets.
The chemotherapy drugs are then given separately:
Mitomycin (a purple fluid) is given as an injection along with a drip of saline (salt water) into your cannula.
Vinblastine (a colourless fluid) is given as a drip (infusion).
Cisplatin (a colourless fluid) is also given as an infusion.
Before and after the treatment with cisplatin, you'll be given plenty of fluid through your drip to keep your kidneys working normally. Although the mitomycin is often given first, the order in which the drugs are given won't affect their effectiveness.
Altogether, your treatment will usually take approximately 8-12 hours. If you're having your treatment as a day patient you can then go home. 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 also be given a supply of anti-sickness drugs to take home with you.
It's important to take these as directed by your doctor, even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
How often treatment is given
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You may hear your doctor use the word 'regimen' (eg MVP regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the chemotherapy treatment you are receiving.
On the first day of your treatment you'll be given all three drugs - mitomycin, vinblastine and cisplatin - as described. You'll then have a rest period, with no chemotherapy for three weeks. This completes one cycle of the chemotherapy. After the three-week rest period, the next chemotherapy cycle will start.
In some hospitals, the mitomycin may not be given during some cycles because it can cause you to have very low numbers of blood cells.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who is having MVP.
We have outlined the most common side effects but haven't included those that are rareand therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
MVP can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll 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 the number of your blood cells (blood count) is still low.
Bruising and bleeding
MVP 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 may need to have a platelet transfusion if your platelet count is low.
MVP 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) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and 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.
Hair usually thins rather than falling out completely. This usually starts 2-4 weeks after the first cycle of treatment.
You may also have thinning and loss of eyelashes, eyebrows and in other areas of the body. Hair loss is temporary and your hair usually starts to grow again when your treatment is over. You may find our section about coping with hair loss useful.
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.
Less common side effects
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Numbness or tingling in the hands or feet
This is due to the effect of vinblastine and cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
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 side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Pain in joints or muscles
You may have these symptoms a few days after treatment with MVP. This doesn't usually last long and your doctor can prescribe mild painkillers to help.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus), and you maylose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally, your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Your kidneys may be affected
Cisplatin can affect your kidneys. This doesn't usually cause any symptoms and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
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're feeling sick.
Changes to the lungs
Mitomycin may cause some changes to the lungs. Tell your doctor if you notice any coughing or breathlessness, or if existing symptoms get worse.
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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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're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Leakage into the tissue around the vein (extravasation)
If this happens when mitomycin or vinblastine are 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 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're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
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 having MVP as it may harm the developing baby. It’s important to use effective contraception while taking this drug and for at least a few months 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're 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 MVP 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.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).