What carboplatin is

Carboplatin is a chemotherapy drug used to treat some types of cancer. It is most commonly used for ovarian cancer and lung cancer. At the centre of this drug is an atom of the metal platinum. The drug forms DNA cross links via the platinum which damage the cancer cells

How you have treatment

You usually have carboplatin by drip into your bloodstream. You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. Carboplatin is often given over an hour. You usually have chemotherapy as a course of several cycles of treatment. Carboplatin is often given in combination with other chemotherapy drugs. The treatment plan for carboplatin depends on which cancer you have. The dose of carboplatin is usually worked out according to how well your kidneys are working. This is because your kidneys get rid of the carboplatin from your body. There is detailed information about how chemotherapy is planned in this section of CancerHelp UK. We have listed the side effects of carboplatin below. You can use the links to find out more about each side effect. Where there is no link, you can find more information in the cancer drug side effects section or use the search box at the top of the page.

Common side effects

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects * Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. * Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion * Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

Other common side effects include

* Fatigue during and after treatment - most people find their energy levels are back to normal within 6 months to a year * Feeling or being sick is usually well controlled with anti-sickness injections and tablets but can go on for a few days * Kidney damage - you will have blood tests before your treatment to make sure your kidneys are able to cope with the drug * Women may stop having periods (amenorrhoea) but this may only be temporary * Loss of fertility - you may not be able to get pregnant or father a child after treatment with this drug. It is important to talk to your doctor about your fertility before starting treatment. * Carboplatin may have a harmful effect on a baby that is developing in the womb. It is not advisable to become pregnant or father a child if you are having this drug. You should talk about contraception with your doctor before having the treatment. * Hair thinning * Loss of appetite * Loss of taste or a metallic taste * Loss of ability to hear some high pitched sounds, which usually gets better on its own * About 1 in 100 people have ringing in their ears (tinnitus)

* Numbness or tingling in fingers and toes affects about 4 out of every 100 people (4%) and can cause difficulty with fiddly things such as doing up buttons - this starts within a few days or weeks and usually goes within a few months of finishing treatment

Rare side effects

* Hair loss * Some people have an allergic reaction while having carboplatin, usually at the first or second treatment - let your treatment team know immediately if you have any skin rashes, itching, or feeling hot, shivering, going red in the face, feeling dizzy, a headache, shortness of breath, anxiety or a sudden need to pass urine.

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on * How many times you've had the drug before * Your general health * The amount of the drug you have (the dose) * Other drugs you are having Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them. Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.

What paclitaxel is
Paclitaxel is a chemotherapy drug. It is also known by its brand name, Taxol. The drug comes from the bark of one particular type of yew tree. It works by stopping cancer cells separating into two new cells, so it blocks the growth of the cancer. It is a treatment for various types of cancer, including * Ovarian cancer * Breast cancer

* Non small cell lung cancer. Sometimes it is combined with other anti cancer drugs. One type of paclitaxel is combined with albumin to form a drug called Abraxane. This tends to cause fewer side effects than other types of paclitaxel.

How you have treatment

You usually have paclitaxel as an injection into a vein. It can cause an allergic reaction. To try to prevent this, you have a cortico steroid injection, and anti histamine (chlorpheniramine) into a vein about an hour before your treatment. You may also have a drug called ranitidine to prevent heartburn. Abraxane does not usually cause an allergic reaction so you don't need the anti allergy drugs with abraxane. You can have paclitaxel through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for paclitaxel depends on which cancer you are having it for. There is more about how doctors plan chemotherapy in CancerHelp UK. Paclitaxel side effects are listed below. You can use the links to find out more about each side effect. Where there is no link, click on 'search' at the top of the page or go to our cancer drugs side effects section.

Common side effects

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects * Increased risk of getting an infection from a drop in white blood cells it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery * Tiredness and breathlessness due to a drop in red blood cells (anaemia) you may need a blood transfusion * Bruising more easily due to a drop in platelets you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Other common side effects include

* Fatigue during and after treatment most people find their energy levels are back to normal from 6 months to a year after their treatment finishes * Feeling or being sick is generally very well controlled with anti sickness injections and tablets, so tell your doctor or nurse if you are still having sickness they can give you other anti sickness medicines * Hair loss (alopecia) may be complete and includes all body hair but is only temporary and your hair will grow back after your treatment ends a cold cap may help to stop you losing your hair, but is not suitable for all types of cancer, so talk to your doctor about whether it may help you * Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons this starts within a few days or weeks and usually goes within a few months of finishing treatment * Aching joints (arthralgia) and muscles (myalgia) affects about 6 out of 10 people (60%) it may start a couple of days after treatment and last for about 5 days * Mouth sores and ulcers * Diarrhoea drink plenty of fluids and if this becomes severe or lasts more than a couple of days, tell your doctor as you could get dehydrated * This drug may harm a baby developing in the womb so it is not advisable to become pregnant or father a child when having paclitaxel talk to your doctor about contraception before you start treatment if there is any chance that you or your partner could become pregnant

* Mild allergic reactions occur in about 1 in 5 people (20%) this usually shows as a rash or a red face * An immediate severe allergic reaction doctors usually give steroids and other medicines routinely to try to stop this happening * Low blood pressure * Slowing down of the heart rate (bradycardia) * Abdominal pain * Temporary taste alterations * Headaches * Liver changes that are very mild and you are unlikely to notice any symptoms the liver will almost certainly go back to normal when treatment is finished, but your doctor will check your liver with blood tests * Inflammation around the drip site if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately * Loss of fertility you may not be able to get pregnant or father a child after treatment with this drug so it is important to talk to your doctor before starting treatment if having a baby is important to you * Women may stop having periods (amenorrhoea) but this may only be temporary

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered. It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

Bevacizumab
Trade Name: Avastin
Bevacizumab is classified as a "monoclonal antibody" and "anti-angiogenesis" drug.

What Bevacizumab Is Used For:

* Treatment of metastatic colon or rectal cancer, used as part of a combination chemotherapy regimen. * Treatment for non-squamous, non-small cell lung cancer as part of a combination chemotherapy regimen. * As part of a combination chemotherapy regimen in patients who have not recieved chemotherapy for metastatic breast cancer. * Treatment of glioblastoma (GBM) that has worsened following prior chemotherapy. * In combination with interferon alfa for the treatment of patients with metastatic renal cell carcinoma.

How Bevacizumab Is Given:

Bevacizumab is given through an infusion into a vein (intravenous, IV). The first dose is given over 90 minutes. The infusion time can eventually be shortened to 30 minutes if well-tolerated.

The amount of Bevacizumab that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side Effects of Bevacizumab:

* Generalized weakness * Pain * Abdominal pain * Nausea and vomiting * Poor appetite * Constipation * Upper respiratory infection * Low white blood cell count. This can put you at increased risk for infection. * Proteinuria * Nose bleed * Diarrhea * Hair loss * Mouth sores * Headache * Shortness of breath * Dizziness * High blood pressure * Weight loss * Muscle aches and pains

These are rare but serious complications of Bevacizumab therapy:

* Gastrointestinal perforation/ fistula formation/ wound healing complications * Hemorrhage (severe bleeding) * Hypertensive crisis (severe high blood pressure) * Nephrotic Syndrome - a condition marked by very high levels of protein in the urine (proteinuria), low levels of protein in the blood, swelling, especially around the eyes, feet and hands. This syndrome is caused by damage to the glomeruli (tiny blood vessels in the kidney that filter waste and excess water from the blood and send them to the bladder as urine). * Congestive heart failure in patients who have received prior treatment with anthracycline based chemotherapy, or radiation therapy to the chest wall.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: * Fever of 100.5 F (38 C) or higher, chills (possible signs of infection) * Severe bleeding * Shortness of breath, difficulty breathing The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following: * Swelling of the feet or ankles. Sudden weight gain. * Abdominal pain * Nausea (interferes with ability to eat and unrelieved with prescribed medication). * Vomiting (vomiting more than 4-5 times in a 24 hour period).

* Diarrhea (4-6 episodes in a 24-hour period). * Constipation unrelieved by laxative use. * Coughing up blood. * Black or tarry stools, or blood in your stools. * Blood in the urine. * Mouth sores (painful redness, swelling or ulcers). * Swelling, redness and/or pain in one leg or arm and not the other. * Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination. * Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness.

Bevacizumab Self Care Tips:

* Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise. * Bevacizumab causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help. * Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by this medicine. * Wash your hands often. * You may be at risk of infection report fever or any other signs of infection immediately to your health care provider. * To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water. * Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it. * Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. * In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor. * Get plenty of rest. * Maintain good nutrition. * If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

How Bevacizumab Works:

Monoclonal antibodies are a relatively new type of "targeted" cancer therapy. Antibodies are part of the immune system. Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) entering the body. The antibodies attach to the antigen in order to mark it for destruction by the body's immune system. In the laboratory, scientists analyze specific antigens on the surface of cancer cells (target) to determine a protein to match the antigen. Then, using animal and human proteins, scientists work to create a special antibody that will attach to the target antigen. Antibodies will attach to matching antigens like a key fits a lock. This technology allows treatment to target specific cells, causing less toxicity to healthy cells. Monoclonal antibody therapy can be done only for cancers in which antigens (and the respective antibodies) have been identified. Bevacizumab works by interfering with the process of angiogenesis by targeting and inhibiting human vascular endothelial growth factor (VEGF). VEGF is a cytokine (a small protein released by cells that have specific effects on the behavior of cells) which when it interacts with its receptors in the cell leads to new blood vessel formation or angiogenesis.