The drugs used
Cisplatin, capecitabine and trastuzumab can also be called HCX. This is named after the initials of the drugs:
Cisplatin and capecitabine are chemotherapy drugs. Trastuzumab (Herceptin®) is a monoclonal antibody.
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 when the cancer has high levels of HER2. There are several tests that can measure HER2 levels. Tests on the cancer cells can be done using tissue taken during a biopsy or surgery to remove the cancer.
You will be given HCX in a chemotherapy day unit or during a 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, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist 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 your blood cells are at a safe level to have the treatment.
You will see a doctor or nurse before you have your treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your treatment. Your nurse will tell you when it is likely to be ready. Your nurse usually gives you anti-sickness (anti-emetic) drugs before the treatment. Cisplatin and trastuzumab can be given through:
- a short thin tube the nurse puts 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).
You take capecitabine as tablets.
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 (called 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 need to stay in hospital for a few hours afterwards so the nurses can check you for any reaction to trastuzumab. After this it’s usually given over about 30 minutes.
You can have this treatment over one or two days at the outpatient clinic. Some people stay overnight in hospital to have it.
Your course of treatment
You usually have a course of several cycles of treatment over a few months. Your nurse or doctor will tell you how many cycles you will have. Each cycle takes 21 days (three weeks). You will have the cisplatin and trastuzumab as separate drips at the start of each cycle. The nurse or pharmacist will then give you the capecitabine tablets to take home. It can be given in two different ways:
- You may be given capecitabine to take for 14 days. You then have a rest period with no treatment for the next seven days.
- Or, you may be given capecitabine to take every day of your treatment.
Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. They may also give you anti-diarrhoea tablets if you need them. Take all your capsules or tablets exactly as they have been explained to you.
Taking capecitabine tablets
You will 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.
Tell your doctor if you find it difficult to swallow the tablets. They may suggest that you dissolve the capecitabine tablets in water. In this case, dissolve the tablets in a 200ml glass of warm water. Stir the water 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 forget to take a tablet, do not take a double dose. Take the next dose when it is due and let your doctor or nurse know.
Other things to remember about your capsules:
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose.
- If your treatment is stopped return any unused capsules or tablets to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Rarely, capecitabine can cause severe side effects in people who have low levels of an enzyme called DPD. This is called having a DPD deficiency. You will not know before you start treatment whether you have a DPD deficiency as there are no symptoms. There is a test available but it only tests for the more common types of DPD deficiency. This means that the test will detect most cases of DPD deficiency but not all cases. The test is not widely available on the NHS. Talk to your doctor if you are worried about having a DPD deficiency.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Both trastuzumab and cisplatin can cause an allergic reaction in some people. This is more likely to happen with the first treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection.
If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is 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 that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
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. This is called a blood transfusion.
Capecitabine may cause diarrhoea. This can be severe. Your nurse or doctor may give you anti-diarrhoea drugs to take at home.
If you have diarrhoea:
- follow any advice you have been given about taking anti-diarrhoea drugs
- drink at least two litres (three and a half pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
Contact the hospital straight away if:
- you have diarrhoea at night
- you have diarrhoea more than six times in a day
- the anti-diarrhoea drugs don’t work within 24 hours.
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 the dose is reduced.
This treatment can cause constipation. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
You may feel sick in the first few days after this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24-hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Watery, sore eyes
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Capecitabine 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. Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Very rarely, a much more serious skin condition can occur. You may have a skin rash which then blisters and your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If you have these symptoms, you must stop taking the capecitabine and contact your doctors immediately.
Soreness and redness of palms of hands and soles of feet
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Feeling anxious, dizzy or having difficulty sleeping
Changes in the way the heart works
Capecitabine can affect the way your heart works. You may have tests to see how your heart is working before, during and sometimes after treatment. But, it is still possible for your heart to be affected even if these tests are normal. Very rarely, this can lead to heart failure or a heart attack. The risk of this happening is very low (less than 1 in 100 or 1%) but it is important that you know about it. Tell a doctor immediately if you have any of these symptoms at any time during treatment:
- pain or tightness in your chest
- changes to your heartbeat.
If you experience any of these symptoms, you should stop taking the capecitabine tablets until you have spoken to your doctor. If you cannot get through to your doctor or the 24-hour number the hospital has given you then call the NHS urgent advice number which is 111.
Your hair may get thinner but you are unlikely to lose all the hair from your head. Hair loss usually starts after your first or second treatment. It is almost always temporary and your hair will usually grow back after treatment ends. Your nurse can talk to you about ways to cope with hair loss.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may 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 for some people they may never go away. Talk to your doctor if you are worried about this.
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and become unable 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.
Effects on the kidneys
Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this.
Before and after each treatment, your nurses will give you extra fluids through a drip. This is to protect your kidneys. It is also important to drink at least 2 litres (3½ pints) of fluids each day.
If you pass less urine than usual, tell your nurse.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for at least 6 months afterwards. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.
This treatment can affect if you can get pregnant or make someone pregnant.
If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.