Cisplatin, capecitabine and trastuzumab (herceptin ®)
Cisplatin, capecitabine and trastuzumab (Herceptin ®) are chemotherapy treatments used to treat cancer in the stomach (gastric cancer). They are also used to treat cancer in the part of the gullet that joins with the stomach, if it has spread to other parts of the body (advanced gastro-oesophageal cancer).
This information should ideally be read with our general information about chemotherapy and the type of cancer you have.
The drugs used in this treatment are:
Trastuzumab is not a chemotherapy drug. It belongs to a group of drugs called monoclonal antibodies.
Trastuzumab works by targeting specific proteins (receptors) on the surface of cells. Some stomach cancers have too much of a protein called human epidermal growth factor receptor 2 (HER2) on the surface of their cells. These are called HER2 positive cancers. The extra HER2 receptors help the cancer cells to divide and grow. Trastuzumab blocks the HER2 receptors and stops the cells from dividing and growing.
Trastuzumab only works for people whose stomach cancer has high levels of HER2. There are several tests that can measure HER2 levels. Testing can be done when you first have surgery for your cancer. Or samples of cancer cells from previous biopsies or surgery may be used.
How this treatment is givenBack to top
You have treatment in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During the 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 (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have the treatment.
You will also see a doctor or nurse. 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 the drugs. Your nurse will tell you when your treatment is likely to be ready.
Before your treatment, your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. Then they will give you cisplatin and trastuzumab, and any extra fluids, through one of the following:
- a short thin tube put into a vein in your arm or hand (cannula)
- 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).
Your nurse will give you cisplatin as a drip (infusion). They usually give the drip through a pump, so that it is given over a set time. You’ll have a drip of extra fluids (known as hydration) before and after the cisplatin. This is to protect your kidneys. It usually takes six to eight hours to have the cisplatin and fluids.
Your nurse will also give you trastuzumab as a drip (infusion). It may be given before or after the cisplatin drip. The first dose is usually given slowly over 90 minutes. You then need to stay in hospital for about four to six hours, so the nurses can check you for any reaction to the drug. If you have no problems with the first or second infusion, later infusions will normally take about 30 minutes. You'll be able go home soon after each treatment finishes. Your nurse will explain more about this.
You may stay overnight to have your treatment. Or you may have your cisplatin, then go home and have the trastuzumab on the next day.
You take capecitabine as tablets – see ‘Taking your your cisplatin, capecitabine and trastuzumab tablets’ below.
When cisplatin, capecitabine and trastuzumab are being given
Some people might have side effects while they are having this treatment.
You may experience flu-like symptoms during your infusion of trastuzumab. These may include a headache, a high temperature (fever) and chills, feeling sick (nausea) or being sick (vomiting). Your doctor can prescribe medicines that can control or reduce these symptoms. They generally get better within a few hours of the infusion finishing.
Trastuzumab can cause an allergic reaction when it’s being given, although this is uncommon. Rarely, cisplatin may cause an allergic reaction.
Your nurse will check you for signs of a reaction. 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
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
Taking your cisplatin, capecitabine and trastuzumab tablets
You have capecitabine as tablets. Before you leave hospital, the nurse or pharmacist will give you capecitabine tablets to take when you are at home. Always take your tablets exactly as explained. This is important to make sure they work as well as possible for you.
You take capecitabine tablets twice a day. Swallow them whole with a glass of water within half an hour of eating a meal. Capecitabine works best if it's broken down in the stomach with food. Take them in the morning after breakfast and then after your evening meal. Make sure the doses are 10 to 12 hours apart.
Tell your doctor if you find it difficult to swallow tablets. They may suggest that you dissolve the tablets in water. In this case, dissolve the tablets in a 200ml glass of warm water, stir with a spoon until the tablets are completely dissolved and then drink it immediately. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.
If you are sick just after taking the tablets, contact the hospital for advice. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
- Keep them in their original package at room temperature away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
- Return any remaining tablets to the pharmacist if your treatment is stopped.
Your course of treatment
You have your treatment as a course of several sessions (or cycles) over a few months. Each cycle takes 21 days (three weeks). It may be given in different ways. We explain two ways you might have it. Your doctor or nurse will be able to give you details of your treatment course.
14-day course of capecitabine
On day 1 you have cisplatin and trastuzumab. Sometimes in the first cycle, trastuzumab is given on day 2 instead. On day 1 you also start taking capecitabine tablets for 14 days.
After you have finished your tablets you will have a rest period with no treatment for the next seven days.
At the end of the 21 days, you start your second cycle of treatment. This is the same as the first cycle. You will have up to six cycles over 18 weeks. Your doctor or nurse will tell you the number of cycles you are likely to have.
21-day course of capecitabine
On day 1 you have cisplatin and trastuzumab. Sometimes in the first cycle, trastuzumab is given on day 2. On day 1 you also start taking capecitabine tablets for 21 days.
At the end of 21 days, you start your second cycle of treatment. There is no rest period. Each cycle is the same as the first. You will have up to six cycles over 18 weeks. Your doctor or nurse will tell you the number of cycles you are likely to have.
You may have further cycles of trastuzumab on its own. It’s given every 21 days (three weeks). Your doctor will talk to you about this.
Before you go home, the nurse or pharmacist will give you anti-sickness tablets drugs to take. They may also give you anti-diarrhoea tablets if you need them. Take all your tablets exactly as your nurse or pharmacist has explained.
Possible side effects of this treatmentBack to top
We explain the most common side effects here. 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 them. It is 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.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
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 mobile phone or keep them somewhere safe.
More information about these drugs
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
Your treatment 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 – these 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. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
Your 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 can sometimes be severe. Your doctor can prescribe drugs to control it. They may give you these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explains. Make sure you drink at least two litres (three and a half pints) of fluid every day if you have diarrhoea.
If you have diarrhoea more than four to six times a day, or at night, contact the hospital straight away on the numbers your nurse gave you. Your doctor may ask you to stop taking capecitabine. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes they reduce your dose.
Your treatment may make you constipated and cause tummy pain. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
Your treatment may cause sickness. 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 to you. 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.
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.
You may get a bitter or metallic taste in your mouth or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. You may need antibiotic eye drops.
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.
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.
Capecitabine 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.
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.
Sore and red palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome and can happen with capecitabine. 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.
Trastuzumab may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.
Effects on the heart
Trastuzumab and capecitabine may affect the way your heart works.
Your doctor will ask whether you have any history of heart problems and you’ll have tests to check your heart and blood pressure before starting treatment. You’ll continue to have blood pressure and heart checks during treatment and possibly for a few years after stopping 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.
Less common side-effects of this treatmentBack to top
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 treatment. It is almost always temporary and your hair will grow back after your treatment ends. Your nurse can give you advice about coping with hair loss.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Changes in the way the kidneys work
Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. You’ll have extra fluids through a drip before and after chemotherapy. This is to protect your kidneys.
Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about this treatmentBack to top
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.
Some other medicines can interact with chemotherapy. Capecitabine interacts with phenytoin (Epanutin ®), allopurinol (Zyloric ®), interferon alpha (IntronA ®, Roferon-A ®) and some antacids. It may also affect the way blood-thinning drugs such as warfarin work. The vitamin folic acid can increase the side effects of capecitabine. Tell your doctor if you are taking any of these.
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.
The treatment 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 treatment. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having cisplatin or trastuzumab, or during your course of capecitabine tablets, 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
This treatment 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 treatment with cisplatin, capecitabine and trastuzumab. Explain you are taking capecitabine tablets that should not be stopped or restarted without advice from your cancer doctor. 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 page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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