Paclitaxel/ Trastuzumab
(Paclitaxel(=Taxol), Trastuzumab (=Herceptin))

This information is meant as a supplement to the information you have received from your doctor and/or nurse practitioner. In the first part we will elaborate on the process of the chemotherapy cycles. In the second part you will find information about possible side-effects and advice towards managing those, and in the third part you’ll find information on the departments and people you can get in touch with if necessary.

1. The chemotherapy cycles

The medication you will receive, are:

*the duration of the infusion will be shortened if the first infusion was administered without any problems.

The cycle contains 3 weeks. On day 1 the both of the medications will be administered, on day 8 and 15 (week 2 and 3) only the Paclitaxel. This cycle will be repeated 4 times, to a total of 12 weeks. After the completion of the chemotherapy, the Trastuzumab will be administered every 3 weeks subcutaneously for up to one year after the start of chemotherapy.

Administration

• Every chemotherapy cycle can be administered in an outpatient setting
• The first cycle takes longer than the ones thereafter (4 hours versus 2,5 hours).
• Before the start of every cycle containing Paclitaxel, your blood values will be checked. Depending on the results the decision is made on whether or not the chemotherapy will be administered that day, or if it will be postponed.
• In order to administer the medication, you will receive I.V. line.

Specific measures

• Paclitaxel could cause an allergic reaction. Before the infusion starts you will receive 2 types of medication that will help prevent this possible reaction.
• During the first two administrations of Paclitaxel your blood pressure, heartbeat, breathing and body temperature can be monitored to detect any sudden changes.

2. Side effects

The side effects that are most common with this chemotherapy will be discussed, including advice on how to manage them. The first thing to make clear is that the hereafter named side effects can but don’t have to occur. Some people have a lot of side effects, others slim to none. Most side effects are temporary. The mentioned advices are not individually made, but provide guidelines from our and our patients experiences. The amount of side effects that you are experiencing has no effect on the result of the treatment.

Side effects that are marked with a * are very rare.

Side effects chemotherapy

• Tingling in hands and feet.
• Change of taste
• Bone marrow function
• Tired/loss of energy
• Irritated and/or infected mouth mucosa
• Hair loss
• Influences on sexuality
• Menstruation cycle
• Nausea and vomiting
• Muscle and joint pain
• Anxious feeling
• Irritation of the vein
• Allergic reaction

A “-“ marks a side effect or explanation. A bullet marks an advice.

1. Tingling in hands and feet

• The hand and feet could have tingling sensation, which could process into numbness
• Always tell your doctor or nurse-practitioner about these complaints during your next hospital visit. Otherwise these symptoms can be irreversible!

2. Change of taste

• Changing of taste could lead to loss of appetite. There’s not a lot to do about this.
• Try different food products
• If there’s not a lot of taste function, presentation of food becomes extra important

3. Function of bone marrow

• A lower amount of white blood cells (leukocytes) makes you more prone to developing infections.
• A lower amount of platelets (thrombocytes) makes you more prone to develop bruises, a nosebleed of bleeding gingiva.
• A lower amount of red blood cells (erythrocytes) gives rise to anemia
• This reduced function of the bone marrow is temporary.
• Call the Antoni van Leeuwenhoek in case of;
• Spontaneous bruises
• Hard to stop and/or regular nosebleeds
• Fevers above 38.5 ⁰C
• Dizzy spells
• The use of vitamin or iron supplements does not affect the function of the bone marrow and won’t help.

4. Tired/loss of energy

• You may notice a loss of energy, getting tired quicker and a more emotionally mental state.
• Take necessary precautions in your day planning; give yourself enough time to rest if needed

5. Irritated and/or infected mucosa of the mouth

• You could have a dry mouth, or an overproduction of saliva
• The saliva in your mouth could be of a viscous consistency
• U could develop sores in your mouth
• Good dental and mouth hygiene is very important to prevent and treat any irritation and/or infection of the mouth mucosa
• Brush your teeth regularly, with a soft toothbrush
• Flush your mouth four to six times a day with salt water (one teaspoon in 250cc of water)
• Keep your lips hydrated, to prevent fissures
• Use gum or other candy you can suck on in case of a dry mouth
• When visiting the dentist or oral-hygienist, mention that you’re using chemotherapy
• In case of cold sores, contact your GP. Prevent spreading
• In case of a white, furred tongue, contact your GP

6. Hair loss

• Hair loss usually starts in the third week after the first chemotherapy cycle. This could also give rise to sensitive skin on the scalp
• If you are using a cold cap, hair loss could develop later, or not at all.
• You could consider getting a wig. Your nurse practitioner can give you a note for your insurance, which will cover a part of the costs
• Other body parts containing hairs, may also experience hair loss
• We advise you to visit the hairdresser that you’re considering to use for your wig prior to the start of your hair loss, for optimal visualization
• We offer workshops and books on ‘Look good….Feel better’ that you could utilize in context of wigs, scarfs and make-up. More information on this and other workshops you can find at the Center of Patient-information in our central hall

7. Influences on sexuality

• During chemotherapy it is very well possible to have sexual intercourse. However, a side effect of the chemotherapy may be a decrease of libido.
• Because of irritated vaginal mucosa, sexual intercourse may give a burning or painful feeling
• Using lube could be a helpful solution
• Always use proper contraceptives during chemotherapy 

8. Menstruation

• The menstruation cycle could get disturbed by the chemotherapy. This varies between skipping a menstruation towards experiencing no menstruation at all during the chemotherapy cycles
• You could experience symptoms of menopause
• After the cessation of chemotherapy, your cycle could return.

9. Nausea and vomiting

• Symptoms of nausea and vomiting are rare in this treatment. Medication against nausea and vomiting will be prescribed by your doctor
• Try to figure out what foods do and do not agree with you during the chemotherapy
• Have smaller meals more often during the day. An empty stomach may also cause nausea
• Eat on moments you feel least nauseous, even if it’s during the night (when you’re awake)
• Don’t force yourself to eat, but try to regain any lost meals between chemotherapy cycles
• Certain smells may also cause/worsen nausea
• Make sure you house and room have plenty of fresh air
• Try to drink at least 1,5 liters of fluid daily
• If necessary, consult a dietician

Advice from patient experience

• Slowly wean yourself onto solid foods
• Don’t go to bed or get up on an empty stomach
• Warm food may be hard. Try a cold salad instead.
• Carbonated drinks like Cola or Ginger-ale seem to have a positive effect
• Have your coffee and tea with milk

10. Muscle and joint pains

• These side effects might arise a few days after the administration
• Muscle weakness may also occur
• Ask your doctor or nurse practitioner if these pains need pain medication

11. Anxious feeling

• The Dexamethasone that you are taking could cause an anxious, rushed feeling. This could also lead to sleeplessness and restless legs
• You may also experience hot flashes

12. Irritation of the vein

• The vein used in the I.V. administration of the Paclitaxel might get irritated due to the nature of the infusion. This could lead to swelling, redness and pain at the I.V. site. These complaints will disappear in a week to 10 days.
• Ask the nurses at the out-patient clinic to use a different vein if one is bothering you already

13. Allergic reaction

• If an allergic reaction occurs, it will be short after the start of the Paclitaxel-infusion.
• Complaints could be: shortness of breath, itchiness, rash, low blood pressure, hot flashes and fever.
• The doctor will discuss what measures should be taken to treat these symptoms and prevent them from happening again

Side effects trastuzumab (Herceptin)

• Stomachache and/or diarrhea
• Flu-like symptoms
• Rash
• Influence on the function of the heart*
• Runny nose
• Very rare side effects

1. Stomachache and/or diarrhea

• Get in touch with your doctor or nurse-practitioner about these complaints.

2. Flu-like symptoms

• Some people experience light flu-like symptoms. Taking paracetamol might alleviate these side effects.

3. Rash

• Get in touch with your doctor or nurse-practitioner about these complaints.

4. Influence on the function of the heart

• Complaints could be: shortness of breath, swollen feet at night, heart arrhythmia
• Before and during the treatment your heart will be checked multiple times through a scan called a MUGA scan, to measure and monitor the ‘ejection fraction’ of the cardiac ventricles.
• If you’re experiencing any of the above mentioned complaints, contact your doctor or the doctor on call in the AvL
• If necessary, the heart function will be checked extra

5. Runny nose

• A lot of patients experience a runny nose
• Sometimes using a nasal spray for allergies alleviates these complaints
• These complaints will dissolve within a few months after discontinuation of the treatment.

6. Very rare side effects

• Some of the more rare side effects could be one of the following: palpitations, low blood pressure, troubles with the gastro-intestinal system, dry mouth, hemorrhoids, changes in blood-work, bruises, fluid retention, bone pains, leg cramps, depression, dizziness, sleeplessness, being overly drowsy, tingling feelings, shivering, itching, sweating, dry skin and loss of taste.
• If any of these complaints occur, notify your doctor or nurse-practitioner.

When should you call

Contact your specialist or the doctor on call when the following occurs;

• Nausea and or vomiting that doesn’t react to your anti-nausea medication at hand
• Spontaneous bruising
• Hard to stop and/or regular nosebleeds
• Fevers above 38.5 ⁰C
• Shortness of breath (not being able to walk up one set of stairs)
• Coughing for longer periods of time

3. What to do with remaining questions

If you have questions after reading this information, don’t be afraid to ask these to

• Your doctor/ nurse practitioner
• The nurse on the ward
• The nurse in the out-patient clinic
• The center of Patient information

At the Center for Quality of Life (CKvL) you or people in your surrounding can ask questions concerning;

• The situation you are in
• Your illness or treatment
• How to arrange stuff at home
• The possibility of getting assistance at home
• For a good talk, if needed

More information

All of the employees, caretakers and floors of the Antoni van Leeuwenhoek is reachable by phone through the central line of the hospital at 020 512 9111.