de Gramont and modified de Gramont chemotherapy
de Gramont and modified de Gramont are two chemotherapy treatments used to treat bowel cancer. Both treatments use the same drugs, but they are given in slightly different ways. Your doctor will talk to you about which option is best for you.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
The drugs that are used in de Gramont
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The de Gramont regimens use the following drugs:
Folinic acid is not a chemotherapy drug, but doctors often give it with 5FU. Research shows this makes 5FU work better.
How de Gramont is given
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You have de Gramont treatment in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (a phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. They will give you the drugs and chemotherapy through one of the following:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
If you are having de Gramont treatment, your nurse will give you folinic acid as a drip (infusion) over two hours on the first day. They usually run the drip through a pump, which gives you the chemotherapy over a set time. After this, they give you an injection of 5FU into your cannula or line, which usually takes about five minutes.
You will then have an infusion of 5FU, which takes 22 hours. If you have a cannula, you will need to stay in hospital for this part of the treatment. If you have a line, you can have 5FU through a small portable pump, which you carry on a belt or in a holster. You can go home once the pump is connected to your line and the infusion has started.
The next day (day two of the treatment), you will have exactly the same treatment as you had on day one. If you're having the treatment at home, you will go back to the hospital for the chemotherapy and to have your pump changed.
Sometimes, the infusion pump is filled with enough 5FU to last for 44 hours. In this case, your nurse will stop the pump after the first 22 hours to give you the folinic acid and injection of 5FU. They will then restart it.
A nurse will disconnect the pump when your treatment is finished on day three. You may need to go back to the hospital to have this done. Sometimes, a district nurse can do this at your home. If you have your treatment in hospital, you can go home when your treatment is finished. After this, you will have a rest period with no chemotherapy for the next 11 days.
modified de Gramont
If you are having modified de Gramont treatment, your nurse will give you folinic acid as a drip (infusion) over two hours on the first day. They usually run the drip through a pump, which gives you the chemotherapy over a set time. After this, they give you an injection of 5FU into your cannula or line, which usually takes about five minutes.
You will then have an infusion of 5FU. This takes 46 hours. If you have a cannula, you need to stay in hospital for this part of the treatment. If you have a line, you can have 5FU through a small portable pump, which you carry on a belt or in a holster. You can go home once the pump is connected to your line and the infusion has started.
A nurse will disconnect the pump when your treatment is finished on day three. You may need to come back to the hospital to have this done. Sometimes, a district nurse can do this at home. If you have your treatment in hospital, you can go home when your treatment is finished. After this, you will have a rest period with no chemotherapy for the next 11 days.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Rarely, the drug 5FU may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Pain or tightening in your chest
Tell your nurse or doctor straight away if you have either of these symptoms.
Your course of de Gramont
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of de Gramont or modified de Gramont takes 14 days (two weeks).
At the end of the 14 days, you start your second cycle. This is exactly the same as the first cycle. You can have up to 12 cycles over six months. Your doctor or nurse will tell you the exact number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as explained.
Possible side effects of de Gramont
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We explain the most common side effects of de Gramont here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Your hair may thin but you’re unlikely to lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. The drug 5FU can cause a rash, which may be itchy.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
Your skin may also darken. It will return to its normal colour after you finish treatment.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Your eyes may feel dry and sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops.
Treatment may also cause blurry vision. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.
Your nails may become brittle and break easily. They may get darker or discoloured, and/or you may get lines or ridges on them. These changes grow out after treatment finishes. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
Effects on the nervous system
de Gramont can affect the nervous system. You may feel drowsy or confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if they become a problem for you. It’s important not to drive or operate machinery if you notice these effects.
Less common side effect of de Gramont
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Changes in the way the heart works
The drug 5FU can affect the way the heart works, but this is usually temporary. You may have tests to see how well your heart is working before treatment. If you have pain or tightness in your chest or feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
Other information about de Gramont
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
The drug 5FU interacts with certain drugs including phenytoin (Epanutin ®) and may affect the way drugs such as warfarin work. Medicines you can buy in a shop or chemist may also be harmful when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Chemotherapy may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using information from a number of reliable sources including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
With thanks to Elin Gwyn, Macmillan Pharmacist, who reviewed this edition.
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