VAPEC-B chemotherapy

This information is about a chemotherapy| treatment for Hodgkin lymphoma and non-Hodgkin lymphoma (cancers of the lymphatic system) called VAPEC-B. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support specialists|.

The drugs that are used Back to top

VAPEC-B is named after the initials of the chemotherapy drugs used, which are vincristine|, doxorubicin|, which was originally known as Adriamycin®, prednisolone, which is a steroid|, etoposide|, cyclophosphamide| and bleomycin|.

How treatment is given Back to top

VAPEC-B chemotherapy may be given to you as a day patient and also with some overnight stays in hospital. Before you start treatment you will need to have a blood test, either on the same day or a day or two beforehand. You will 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. All of this may take a couple of hours.

VAPEC-B is usually given through a thin plastic tube that is inserted under the skin, into a vein near the collarbone (central line|), or passed through a vein in the crook of your arm (PICC line|). Your doctor or nurse will explain more about this to you.

If you don't have a central line, the nurse will put a fine tube (cannula) into the vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long.

You will be given anti-sickness (antiemetic) drugs by injection through your central line, PICC line or the cannula.

The chemotherapy drugs are then given separately:

• Vincristine (a colourless fluid) is given as a drip (infusion) into your line or cannula.
• Doxorubicin (a red fluid) is given as an injection along with an infusion of saline (salt water).
• Cyclophosphamide (a colourless fluid) and bleomycin (a colourless fluid), are both given as infusions.

The etoposide (pale pink capsules) and prednisolone (a steroid| tablet) are both given by mouth. Prednisolone tablets are white. It's important to take these drugs as prescribed by your doctor.

When you are having treatment as a day patient, you will be given a supply of antisickness 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 has started.

How often treatment is given Back to top

Your doctor may use the word 'regimen' (eg the VAPEC-B regimen) when talking about your chemotherapy. This means the whole plan or schedule of the chemotherapy treatment that you are receiving.

VAPEC-B involves a weekly infusion or injection of chemotherapy and a course of capsules and tablets. When your treatment begins (day 1), you will be given doxorubicin and cyclophosphamide (as described above) for one day only. On the same day of the next week (day 8) you will be given vincristine and bleomycin. A week after this (day 15) you will be given doxorubicin and will start a four-day course of etoposide capsules. Another week later (day 22) you will be given vincristine again. This completes what is called a cycle of chemotherapy (each cycle lasts four weeks).

Usually, three cycles of VAPEC-B are given over a period of 11–12 weeks. This makes up a course of treatment.

Prednisolone is given at the start of treatment and will be taken for 11 weeks. After six weeks, the dose is halved. On your third course of treatment, the second week of vincristine may not be given.

Possible side effects Back to top

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having VAPEC-B chemotherapy.

We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but that are not listed here, please let your nurse or doctor know.

Lowered resistance to infection VAPEC-B can reduce the production of white blood cells by the bone marrow, making you more prone to infection|. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels 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 make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding VAPEC-B can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with VAPEC-B you may become anaemic. This may make you feel tired| and breathless|. Let your doctor or nurse know if these effects are a problem.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting|. If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs, which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness Many people feel extremely tired (fatigued)| during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try and get as much rest as you need.

Hair loss This usually starts 3–4 weeks after the first course of treatment. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss| is temporary and your hair will start to grow again once the treatment has finished. Your nurse can give you advice about coping with hair loss.

Sore mouth and ulcers 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. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.

Taste change You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Irritation of the stomach lining Prednisolone may irritate the lining of your stomach and should be taken with meals or a glass of milk. Tell your doctor if you have indigestion or any other stomach problems. Your doctor can prescribe medicine to relieve these symptoms.

Increased appetite You may notice that you feel hungrier than usual while taking prednisolone. This will stop when you are no longer taking the drug.

Numbness or tingling in hands or feet This is due to the effect of vincristine on nerves and is known as peripheral neuropathy|. Tell your doctor if you notice these symptoms. This problem usually improves slowly a few months after treatment has finished.

Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink plenty to help prevent this (2–3 litres per day, if you can). If you notice any blood in your urine tell your doctor. Doxorubicin is coloured red, and due to this your urine may become a pink-red colour. This may last up to 24 hours after your treatment and is quite normal.

Skin changes Rarely, your skin may darken, but it usually goes back to normal a few months after the treatment is finished. Some of the drugs can cause a rash that may be itchy and your doctor can prescribe medicine to help with this.

During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes. Sometimes areas that have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.

Changes in the level of sugar in your blood Occasionally prednisolone may cause your blood-sugar level to rise. During treatment you will have regular blood and urine tests to check this. Tell your doctor if you get very thirsty or if you are passing more urine than usual.

Changes in nails They may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.

Changes in the way your heart works This is very rare with usual doses of doxorubicin but may occasionally happen when high doses are used. Tests to see how well your heart is working may be carried out before you start treatment.

Fevers and chills These may happen several hours after bleomycin is given but do not usually last long. Your doctor may give you a steroid drug (hydrocortisone) before you are given bleomycin with your next course of treatment to prevent them from happening again.

Fluid retention Prednisolone may affect the salt and water balance in your body. You may notice that your ankles and/or your fingers swell. Let your doctor know if this happens. This is usually only a problem with long-term treatment.

Changes to the lungs Bleomycin may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness|.

Behavioural changes Occasionally prednisolone may cause irritability, intense feelings and mood swings. You may have difficulty sleeping. Taking the prednisolone earlier in the day can help to reduce problems with sleeping. Let your doctor know if there are any changes in your behaviour that are worrying you.

Always let your doctor or nurse know about any side effects you are having. There are usually ways in which they can be controlled or improved.

Additional information Back to top

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having 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 is important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines (including those you can buy in a shop or chemist) can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Leakage into the tissue around the vein If this happens when doxorubicin or vincristine are being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given, tell the doctor or nurse immediately. This is unlikely to happen if the chemotherapy is given through a central or PICC line.

Fertility Your ability to conceive or father a child may be affected by this treatment. It's important to discuss fertility| with your doctor or nurse before starting treatment.

Contraception It's not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception during treatment and for a few months afterwards. Again, discuss this with your doctor or nurse.

Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular, and they may eventually stop. In younger women this may be temporary, but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.

Things to remember about etoposide capsules Back to top

• It's important to take your capsules at the right times. You must take them as directed by your doctor.
• 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, as etoposide could harm them.
• The capsules should be kept in the original container and stored 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 as you may need to take another dose. Don't take another capsule without first informing your doctor.
• If you forget to take a capsule don't take a double dose. Let your doctor know and keep to your regular dose schedule.
• If you have difficulty swallowing the capsules, talk to your pharmacist.

References Back to top

This section is based upon our VAPEC-B chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Chemotherapy Source Book (4th edition). Ed. Perry. Lippincott, Williams and Wilkins, 2007.

For further references, please see the general bibliography|.