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This information is about a chemotherapy| treatment called VAPEC-B that is used to treat Hodgkin lymphoma| and some types of non-Hodgkin| lymphoma.
VAPEC-B is named after the initials of the drugs used, which are:
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. This may take a couple of hours.
VAPEC-B is usually given through a thin, plastic tube inserted under the skin into a vein near your 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 insert 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.
Before the chemotherapy you will be given anti-sickness (anti-emetic)| drugs by injection through your central line, PICC line or the cannula.
The chemotherapy drugs are then given separately:
The etoposide (pale pink capsules) and prednisolone (a white tablet) are both given by mouth. It's important to take these drugs as prescribed by your doctor.
If you are having treatment as a day patient, you can go home when the infusions are finished. The central or PICC line will usually stay in place, ready for your next cycle of chemotherapy. You'll be shown how to look after the line before you go home. If you have a cannula, the nurse will remove it before you go.
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.
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 your particular chemotherapy treatment.
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 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 for 28 days (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.
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 has VAPEC-B chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Lowered resistance to infection (neutropenia) VAPEC-B can reduce the number of white blood cells produced by the bone marrow|, making you more prone to infection|. This effect can begin seven days after treatment and your resistance to infection usually reaches its lowest point 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:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has recovered. 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. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells) You may become anaemic while having treatment with VAPEC-B. This may make you feel tired and breathless|. Tell your doctor or nurse if you have these symptoms.
Feeling sick (nausea) and 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 may cause constipation|. Let your doctor or nurse know if this is a problem.
Tiredness You may feel very tired (fatigued|), particularly towards the end of treatment. This is a very common side effect and it is important to allow yourself plenty of time to rest.
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|. This is temporary and your hair will start to grow back 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 prescribe mouthwashes and medicine to prevent or clear mouth infections.
Taste change You may notice that food tastes different|. Normal taste usually comes back after 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 the nerves and is known as peripheral neuropathy|. Tell your doctor if you notice these symptoms or have difficulty carrying out fiddly tasks. This problem usually improves slowly a few months after treatment is over.
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.
Discoloured urine Your urine may become a pink-red colour for up to 24 hours after your treatment. This is normal and due to the doxorubicin.
Skin changes Rarely, your skin may darken, but it usually goes back to normal a few months after the treatment finishes. 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 should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
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.
Nail changes Your nails 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 don't 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 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 experience 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 sleeping problems. 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.
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. Most clots can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Other medicines 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|.
Leakage into the tissue around the vein If this happens while 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 your doctor or nurse immediately. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
Fertility Your ability to get pregnant or father a child may be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
Contraception It's not advisable to become pregnant or father a child while having this treatment, as it may harm the developing baby. It is important to use effective contraception while taking these drugs and for a few months afterwards. You can discuss this with your doctor.
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.
This section is based upon our VAPEC-B chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography|.
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