Dostarlimab, carboplatin and paclitaxel

You usually have dostarlimab, carboplatin and paclitaxel in a chemotherapy day unit or clinic as an outpatient. You have each drug as a drip into a vein (intravenously). 

During your course of treatment, you will meet someone from your cancer team, such as a:

• cancer doctor
• chemotherapy nurse or specialist nurse
• specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of each treatment, you will have a blood test. This is to check that it is safe for you to have treatment. 

You will meet with a doctor, nurse or pharmacist before you have treatment. They will talk to you about your blood test results and ask how you have been feeling. 

If your blood results are okay, the pharmacy team will prepare your cancer drugs. 

You will have your cancer treatment through 1 of the following: 

• a cannula – a short, thin tube the nurse puts into a vein in your arm or hand
• a central line – a fine tube that goes under the skin of your chest and into a vein close by
• a PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
• an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.

Your nurse will give you each drug through a drip using a pump machine. You have dostarlimab first, which usually takes about 30 minutes. You then have the chemotherapy drugs paclitaxel and carboplatin as separate treatments. Before you have the chemotherapy, your nurse may give you anti-sickness medicine and other drugs to prevent any allergic reaction.

Your cancer team may also give you anti-sickness drugs and other medicines to take home to help manage side effects. Take these exactly as they tell you to.

Your cancer team will discuss your treatment plan with you. They may give you a copy of the plan to take home.

You usually have a course of several cycles of treatment over a few months. 

• Cycle 1 to 6 – you have dostarlimab, paclitaxel and carboplatin once every 3 weeks.
• Cycle 7 onwards – you have dostarlimab once every 6 weeks. 

You may keep having treatment for up to 3 years if it is effective and side effects are manageable.

Some people have an allergic reaction while having this treatment. Before treatment, you will have medicines to help prevent or reduce any reaction. 

Signs of a reaction can include: 

• feeling hot or flushed
• shivering
• itching
• a skin rash
• feeling dizzy or sick
• a headache
• feeling breathless or wheezy
• 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, they can treat it quickly. 

Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.

Always call 999 if swelling happens suddenly or you are struggling to breathe.

Sometimes cancer drugs that are given into a vein may leak outside the vein. If this happens, some drugs can damage the tissue near the vein. This is called extravasation. Extravasation is not common, but it is important that it is dealt with quickly. If you have any of the following symptoms around the vein during or after your treatment, tell your nurse straight away:

• stinging
• pain
• swelling
• if you have white skin, the area may become red
• if you have black or brown skin, the area may become darker.

This treatment can cause pain:

• at the place where the drip (infusion) is given 
• along the vein. 

If you feel pain, tell your nurse straight away. They can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C  
• a temperature below 36°C 
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough 
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

Your white blood cell count 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, until your cell count increases.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• a sore mouth or throat affects how much you can drink or eat 
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

Feeling tired is a common side effect of this treatment. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired.

Sometimes, this treatment can affect glands that make hormones. This can make you feel tired. Contact the hospital on the 24-hour number if either of these things happen during treatment or after it ends:

• your tiredness gets worse or stops you doing your usual daily activities
• you feel weak or shaky.

If you feel sleepy, do not drive or use machinery.

You usually lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.

Scalp cooling is a way of lowering the temperature of your scalp to help reduce hair loss. Your nurse can tell you whether this is an option for you.

If you want to cover up hair loss, there are different ways to do this. Your nurse can give you information about coping with hair loss. Remember to protect your skin from the sun. Use suncream with a sun protection factor (SPF) of at least 30 on your scalp. Or cover up with a hat or scarf.

Hair loss is usually temporary. Your hair will usually grow back after treatment ends. Very rarely, hair may not grow back. Or it may grow back thinner than before. If you are worried about this, talk to your doctor, nurse or pharmacist.

This treatment can cause sore or weak muscles. Your joints may also be stiff, sore or swollen. This is called arthritis. If you already have problems with joint pain, this may become worse.

Contact the hospital on the 24-hour number if you have any of these symptoms during treatment or after it ends:

• new or worsening aches or pains
• new or worsening stiffness in a joint
• swollen joints or muscle weakness.

You may have diarrhoea or tummy (abdominal) pain. Sometimes it can cause serious inflammation of the bowel called colitis.

Contact the hospital straight away on the 24-hour number if you have any of the following symptoms during treatment, or after treatment ends:

• passing more stools (poo) than is normal for you
• passing stools at night
• if you have a stoma, it is more active or needs emptied more often than usual
• watery or loose stools
• uncomfortable tummy cramps or pain
• a temperature over 37.5°C
• blood or mucus (slime) in your stool.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. 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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

This treatment can affect how the kidneys work. It may cause kidney inflammation called nephritis. You will have regular blood tests to check how your kidneys are working.

Contact the hospital straight away on the 24-hour number during treatment, or after it ends, if you:

• have blood in your urine (pee) 
• are passing less urine or peeing less often than usual.

This treatment can cause inflammation of the lungs. This is called pneumonitis. Contact the hospital straight away on the 24-hour number if you notice any of these changes during treatment or after it ends:

• breathlessness
• a cough that does not go away
• wheezing
• a fever, with a temperature over 37.5°C.

You should also tell them if any existing breathing problems get worse. You may have:

• tests to check your lungs
• treatment, if needed.

This treatment may raise your blood sugar levels and increase the risk of diabetes.

You will have regular blood tests to check this. 

Contact the hospital on the 24-hour number if you have these symptoms during treatment or after it ends:

• feeling thirsty all the time
• needing to pass urine (pee) more often than usual
• feeling more tired than usual.
• losing weight without trying.

If you have diabetes, your blood sugar levels may be higher than usual. You may need advice and support from your GP or diabetes team about managing this.

This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• breathlessness
• dizziness
• changes to your heartbeat (palpitations)
• swollen feet and ankles.
• flu-like symptoms, such as body aches, pains and tiredness.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

Always call 999 if you have:

• chest pain, pressure, heaviness, tightness or squeezing across the chest
• difficulty breathing.

This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes usually get better after this treatment ends. But some can be permanent. Tell your doctor if you notice any changes in your hearing. If you have changes in your hearing, do not drive or operate machinery.

This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor, nurse or pharmacist can give you more information.

Rarely, this treatment can affect the brain and nerves. These effects may be mild at first but can become serious if not treated. Symptoms may include:

• weakness, numbness or tingling in your arms, legs or face
• a headache that does not get better
• seeing double or having drooping eyelids
• difficulty turning or bending your nec
• drowsiness or confusion
• problems with moving or speaking
• fits (seizures).

If you have any of these symptoms during treatment or after it ends, it is important to either:

• contact the hospital straight away on the 24-hour number
• go to the hospital straight away
• call 999.

Do not drive yourself to hospital.

This treatment can affect your eyes and eyesight. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during treatment or after it ends:

• dry, itchy, painful, or swollen eyes
• eyes that are sensitive to light
• changes to your eyesight.

   

This treatment may cause low blood pressure. This is called hypotension. Less commonly, this treatment can cause high blood pressure. This is called hypertension. 

Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check it regularly during treatment. Let them know if you feel dizzy or light-headed. If you feel this way, do not drive or operate machinery.