Photodynamic Therapy (PDT)

What is photodynamic therapy?

PDT is a treatment for some types of cancer. It may also be used to treat some non-cancerous conditions of the skin or eye.

How PDT works

PDT uses laser, or other light sources, combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy cancer cells.

A photosensitising agent is a drug that makes cells more sensitive to light. Once in the body the drug is attracted to cancer cells. It doesn’t do anything until it is exposed to a particular type of light. When the light is directed at the area of the cancer, the drug is activated and the cancer cells are destroyed.

 

When PDT is used

PDT is still quite a new treatment. Doctors are working to identify the types of cancer for which it is most effective. Research trials are taking place to look at new photosensitising agents, new laser and non-laser light treatments and ways of reducing the side effects.

Your doctor can advise you whether PDT is an appropriate treatment in your situation, and whether you may be able to take part in any research trials.

PDT is used mainly to treat cancers of the skin or those that are on, or near, the lining of internal organs, such as cancers of:

  • the head and neck area
  • the lining of the mouth
  • the lining of the lung
  • the lining of the gullet (oesophagus)
  • the lining of the stomach
  • the lining of the bladder

In cancers that are being treated at an early stage, the aim of treatment may be to try to cure the cancer.

The aim of PDT for advanced cancer is usually to reduce symptoms by shrinking the tumour. In this situation PDT cannot cure a cancer.

Photodynamic therapy treatment for some cancers, such as prostate and pancreas, is still the subject of research. Some research studies have used PDT to treat conditions that may develop into a cancer, such as one which affects the vulva known as vulval intraepithelial neoplasia (VIN).

PDT can safely be given to patients who have had other cancer treatments such as surgery, radiotherapy and chemotherapy.

How PDT is given

The treatment is normally in two stages.

Stage 1

A light-sensitive drug is given. For cancers of the skin, the drug is usually applied to the skin as a cream.

For the types of cancer mentioned above that are inside the body, the drug is usually given by injection into a vein.

There is a delay between the cream being applied or the drug being given, and the next stage of treatment. This allows time for the drug to concentrate in the cancer cells.

Stage 2

The second stage of treatment involves shining light directly on to the cancer. A laser delivers energy in the form of light in a very precise way. Special non-laser lamps may also be used in some situations. For skin cancers the light is shone directly on to the skin. For internal cancers a flexible tube (an endoscope) may need to be passed into your body to deliver the light to the tumour.

PDT and possible side effects

As with all kinds of treatment, the experience of PDT can vary from person to person. How the treatment is given and the side effects that it may cause vary according to:

  • the area of the body affected by the cancer
  • the type of photosensitising drug given
  • the time between giving the drug and applying the light
  • the amount of skin sensitivity to light following treatment

However, the main differences are seen when PDT is used to treat skin cancer as opposed to a cancer elsewhere in the body. For this reason we have divided this information into two: firstly for people being treated for skin cancers, and secondly for people with cancer in any other part of the body.

1000caloriesdiet.com

PDT for skin cancer

A photosensitising cream will be applied to your skin. You will then need to wait for approximately 4-6 hours before being treated. Treatment with the light will last 20-45 minutes, after which a dressing will be put on to cover the area and protect it from light. Usually only one treatment is needed, but occasionally two or three further treatments may be given.

Possible side effects of PDT for skin cancer

Pain  You will be given a local anaesthetic before your PDT, to prevent any possible pain. For many people this is all that they will need. You may be given steroid cream to apply to the area if it hurts when you are at home.

Sensitivity to light  The treated area of skin will be sensitive to daylight and bright, indoor lighting. This effect will probably last for about 24 hours. You will need to keep the treated area of skin covered during this time. After that you can wash, bathe or shower as usual, but you will still need to treat your skin gently and not rub the area until it has healed.

Healing  Because PDT heals quickly, and without scarring, the appearance is usually very good.

PDT for cancers of the head and neck

The photosensitising drug is given as an injection into a vein through a small tube (cannula) inserted into a vein. This takes a few minutes and the tube is then removed.

You will then have to wait about four days before the light treatment is given. Generally only one treatment is given although it is possible to have a second treatment a few weeks after the first.

Possible side effects of PDT for head and neck cancers

Sensitivity to light  Although photosensitising drugs are mostly taken up by the cancer cells and are concentrated there, they can also make your ordinary skin cells or your eyes highly sensitive to light. People who have had PDT are advised to protect themselves from exposure to sunlight and bright indoor lighting. The duration of sensitivity to light (photosensitivity) varies depending upon which drug is used. The drug, Foscan®, is commonly used to treat head and neck cancers and will make you sensitive to direct sunlight for two weeks.

While your skin is photosensitive, it is advisable to avoid going outside during the day. However, you do not need to stay in total darkness during this time. If you need to go out, use clothing to cover your skin: for example, wear a brimmed hat, scarf, long-sleeved shirt or blouse and trousers, gloves and dark glasses. Using sunscreens will not give you any additional protection.

You can go out uncovered very early in the morning or after sunset, and you can use low-level artificial light indoors. It is possible to get ‘sunburn’ even on a dull winter day. You will not notice that you are getting burnt while you are out in the sun as, like sunburn, the damage to your skin can take a few hours to show up.

You can even get burnt through glass if the light is strong. Remember to draw curtains during the day if the sun is bright. Bright artificial lights can also cause a skin reaction so spot lamps are best avoided. It is important to be aware of unexpected sources of light – for instance, warming your hands over a fire could result in being burnt. It is also a good idea not to use a computer during this time and not to watch the television from less than about 2 metres (6 feet) away. You may be given a light meter to use at home, to check that the light intensity is at a safe level.

It is also advisable to avoid opticians’ appointments around the time of your treatment, as the retinas inside your eyes will be more vulnerable to light than usual, and you should not have light shone into your eyes.

Towards the end of the period of photosensitivity, a small area of skin can be exposed to brighter light for a few minutes and the reaction assessed 24 hours later. Your doctors will advise you on how to do this. After this time you will be able to gradually increase the amount of light you are exposed to and most people are able to go outside as usual after approximately three weeks. Your doctor or specialist nurse can let you know for exactly how long you will need to protect your skin.

Pain  Treatment with PDT can cause pain in the tumour area . Your specialist nurse should be able to tell you how much pain you might expect and see that you are given appropriate painkillers. The amount of pain will vary according to where your tumour is, and which light-sensitising drug has been used, and can range from mild to severe. For some treatments aspirin or paracetamol may be enough. However, for others a morphine-type drug may be necessary to control the pain. If you have pain, it is important to let your doctor know so that you can be given effective and appropriate painkillers.

Swelling  Some photosensitising drugs can cause swelling of the treated area. This varies from one person to another. If you have had treatment in your mouth or throat, the swelling may make it difficult to swallow. It is important to let your nurse or doctor know if swallowing becomes very difficult. The swelling is only temporary but can be treated with steroid injections or drugs that help to reduce inflammation.

Constipation  This is a fairly common side effect of PDT and you may need to ask your doctor for medication.

Nausea  Some people may feel sick, which can be controlled with mild anti-sickness tablets if necessary. CancerBACUP has further information on controlling nausea.

Healing  PDT causes much less scarring than surgery. However, the time taken for PDT-treated areas to heal can vary a lot. It may be several weeks, depending on the area treated and how deeply the light has penetrated into the body tissues.

PDT for other cancers

Other than skin cancer, and cancers of the head and neck, the cancers most commonly treated with PDT are cancers are those found in the inner lining of the digestive system, the lungs and the bladder. However, as PDT is a new treatment, it may start to be used for other cancers. If the cancer is on the lining of an internal organ such as the gullet (oesophagus), stomach or lungs, it may be necessary for a thin, flexible tube to be passed into the windpipe or gullet to bring the laser light as close to the cancer as possible.

If the cancer is inside the bladder, a tube will be passed into the bladder. You would be given a drug to make you sleepy (sedated) while this part of the treatment is given.

There are several drugs that can be used as the photosensitising agent. The most common of these are ALA®, Foscan® and Photofrin®. The drug that is used will depend on the type of cancer that you have and which is best for your situation. These drugs may be given as a drink or tablets or as an injection. The way that the drug is given will depend on which one is best for your treatment.

The length of time you need to wait for treatment after having the drug can vary from 90 minutes to four days. You will be told which drug will be used, how it will be given and whether your treatment is to be as an outpatient or if you will need to stay in hospital.

Possible side effects of PDT for other cancers

Drugs for cancers in other parts of the body are usually given by injection into a vein. Many of the side effects will be similar to those that people who have had PDT for head and neck cancers may experience. The time of sensitivity to light (photosensitivity) varies, ranging from one or two days to several months. This difference depends on which photosensitising drug is used. Your doctor or specialist nurse can let you know how long you will need to protect your skin for.

You may also experience some pain, nausea and constipation. Other side effects will depend upon the part of the body that is treated.

Cancer of the gullet (oesophagus)  Swelling and inflammation can occur around the area that is treated and may cause nausea and chest pain, and may make it difficult to swallow.

Cancer of the stomach  The lining of the stomach may become inflamed and swollen causing abdominal discomfort and nausea.

Cancer of the lung  The PDT may cause swelling and inflammation in the lung which may cause some chest pain, a cough and breathlessness. Occasionally there may be a build-up of fluid in the lining of the lung (a pleural effusion) which can be drained if necessary.

Cancer of the bladder  It is likely that the PDT will cause symptoms of an inflamed bladder. Common problems include pain, the need to pass urine frequently, slight leakage of urine (incontinence), and passing small amounts of blood in the urine. These side effects usually last for only two to four weeks following treatment.

References

This section has been compiled using information from a number of reliable sources including;

  • Oxford Textbook of Oncology (2nd edition). Souhami et al. Oxford University Press, 2002.
  • Cancer and its Management (4th edition). Souhami and Tobias. Oxford Blackwell Scientific Publications, 2003.
  • The Textbook of Uncommon Cancers (2nd edition). Raghavan et al. Wiley, 1999.

For further references, please see the general bibliography.

Iodine 131 tositumomab (BEXXAR)

Understanding cancer research trials

When a drug is being developed it has to go through various stages of research, called clinical trials or studies. These are intended to establish a safe dosage, the side effects the drug may cause and which cancers it may be used to treat. The trials also find out how effective the drug is, and whether it is better than the existing treatments or has extra benefit when given with these drugs.

At this stage BEXXAR is available only to a small number of people in the UK, usually those taking part in clinical trials. In certain circumstances it may also be given to individual patients who have been selected by their doctor as suitable (this is called a named patient basis).

Many drugs that are thought to be promising may be found not to be as good as existing treatments, or to have side effects that outweigh any benefits. For this reason, doctors and other medical staff carry out frequent and careful checks on the progress of each patient who is having one of these developmental drugs. If you are taking a developmental drug your doctor will explain all about the drug, the procedures being used, and how you will be looked after while you are taking it. If at any time you have concerns you should ask your doctor or nurse for information and advice.

BEXXAR

BEXXAR is a new type of cancer treatment that involves a group of drugs called monoclonal antibodies. At the moment it is used only in clinical trials to treat a type of B-cell non-Hodgkin’s lymphoma (NHL) that has come back after previous treatment.

What is a monoclonal antibody?

Monoclonal antibodies recognise certain proteins that are found on the surface of some cancer cells. They are used to try to destroy the cancer cells, while causing little harm to normal cells. The monoclonal antibody recognises the protein on the surface of the cancer cell and locks on to it (like a key in a lock). Some monoclonal antibodies can then trigger the body’s immune system to attack the cancer cells and can also cause the cells to destroy themselves. Sometimes monoclonal antibodies, such as BEXXAR, have a cancer drug or radioactive substance attached to them. They can be used in this way to deliver treatment directly to the cancer cell: this is known as targeted therapy.

How does BEXXAR work?

BEXXAR has a radioactive substance called iodine131 attached to it. The monoclonal antibody in BEXXAR, tositumomab, targets a protein found on the surface of the B-cells. The radioactive iodine delivers radiation directly to these cells. This destroys the lymphoma B-cells. Unfortunately it may also affect some normal cells.

How is it given?

BEXXAR is given as a drip (infusion) into the vein, through a fine tube (cannula) inserted into the vein. It is usually given in the nuclear medicine department of your hospital. You will usually need to make four visits over one to two weeks. The first three visits are needed to decide how much radioactivity you will be given and the fourth will actually be the treatment.

Before you start treatment and for two weeks after you are given the treatment dose of BEXXAR, you will need to take a daily iodine supplement. This is taken either as tablets or as liquid drops and helps to protect the thyroid gland from the radioactive iodine.

On the first day of treatment you will be given two separate drips. Before these drips you will be given paracetamol and an antihistamine to help reduce any side effects that may occur. The first drip is an infusion of the monoclonal antibody without any radioactive iodine which is given to you over an hour. This is given to ensure that when you have the second infusion, which contains the radioactivity, it will be evenly spread throughout your body.

The second drip contains the monoclonal antibody with a small amount of radioactive iodine131. This small dose of radioactivity is given to see how the radiation is spread around the body and to help the doctors to decide exactly how much radioactive iodine to give you. Soon after this second infusion you will have the first of three body scans. This takes between 15–30 minutes and shows how much radioactivity is still in the body and where it is.

On the second visit (day 2, 3 or 4) you will have another body scan to see whether there is any radioactivity left in the body.

The third visit on day 6 or 7 involves another body scan. After this the doctors can calculate exactly how much radioactivity to add to the monoclonal antibody to ensure that you get the best possible dose.

The fourth visit (between days 7 and 14) is when you actually have the treatment dose of BEXXAR. You will receive two drips into your cannula, the first one of just the monoclonal antibody, over an hour, and the second containing the dose of radioactive antibody, given over 20 minutes.

After the fourth visit you will need to stay in hospital for a few days because of the possibility of unnecessary radiation exposure to other people. The risk to other people is small and lasts for up to a week until the radiation has been got rid of from your body through your sweat and urine. Certain restrictions will be needed during this time.

You will probably be looked after in a room of your own or with someone else having similar treatment. Lead screens will be placed at either side of your bed to absorb any radiation that is given out. Visiting times will be restricted and pregnant women and children will not be allowed to visit. However, you should feel well and can bring books and magazines into your room, watch TV or listen to the radio to help pass the time.

CancerBACUP’s general information on radiotherapy explains more about treatment with a radioactive substance.

Possible side effects

The known side effects of BEXXAR are not usually severe. However, as it is still a relatively new drug it is too early to know all about the possible side effects. The following appear to be the most common.

Flu-like symptoms These may include fever and chills, headaches, itching and joint and muscle aches. These effects may occur a few hours after the drug is given but do not usually last for more than a day or two.

Temporary reduction in production of blood cells by the bone marrow This can result in a lowering of the number of white cells (which fight infection) in your blood making you more prone to infection. It can also result in bruising or bleeding if your platelets (cells which clot the blood) are reduced, or anaemia if your red cells are low. Your doctor or nurse will advise you about this and any precautions you should take. The blood cells usually recover in three to four weeks.

Allergic reactions  The drug does not usually cause many problems. However, it is possible to have a slight allergic reaction to the monoclonal antibody in BEXXAR. Signs of this include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness.

You will be monitored closely during your treatment, but tell the nurse or doctor if you have any of these symptoms. To reduce the chance of developing an allergic reaction certain drugs (anti-histamines) can be given before the drip. The drip can be slowed down or stopped until the reaction is over.

Other side effects include weakness and nausea (feeling sick). Your doctor can prescribe anti-sickness drugs to help reduce this.

References

This section has been compiled using information from a number of reliable sources including:

  • Oxford Textbook of Oncology (2nd edition). Souhami et al. Oxford University Press, 2002.
  • Treatment of Cancer (4th edition). Price and Sikora. Arnold, 2002.

For further references, please see the general bibliography.

Cetuximab (Erbitux©)*

What is Cetuximab

Cetuximab is a type of drug known as a monoclonal antibody. It is not currently licensed for use in the UK and is only available to a small number of people, usually those taking part in research trials. In certain circumstances it may be given to patients if their cancer specialist thinks that it may help them and the drug manufacturer agrees (this is called prescribing on a named patient basis).

Cetuximab is being used in the USA in early trials to treat many different types of cancer, including colon cancer, kidney (renal) and bladder cancers, cancer of the head and neck, breast cancers, pancreatic cancer, non-small cell lung cancer, and ovarian cancer. These studies are being carried out on cancers that have come back after initial treatment, or have spread to other parts of the body (advanced or metastatic cancer).

Cetuximab can be given as a treatment on its own or in combination with chemotherapy or radiotherapy.

What is a monoclonal antibody?

Monoclonal antibodies are used to try to destroy some types of cancer cells while causing little harm to normal cells. They are designed to recognise certain proteins (receptors) that are found on the surface of particular cancer cells. The monoclonal antibody recognises the protein and locks onto it. This may trigger the body’s immune system to attack the cancer cells and can sometimes make the cells destroy themselves.

On the surface of some cancer cells are receptors known as epidermal growth factor receptors or EGFR. When growth factors (such as transforming growth factor alpha and epidermal growth factor) bind to the receptor, the cancer cell is stimulated to grow, divide and spread. New blood vessels may grow to feed the cancer cells.

Cetuximab locks onto the EGFR, preventing the growth factors from stimulating the cancer cell to grow, divide and spread. It may do this by preventing the cancer cell from producing the network of new blood vessels that it needs to grow. It stops the cancer cells from growing and spreading to other parts of the body and can sometimes kill the cells.

Cetuximab may also make the cancer cells more sensitive to chemotherapy.

Tests may be done to find the level of EGFR in the body before cetuximab is given. This can help the doctors to know whether you are likely to benefit from this treatment. Testing can be done at the same time as diagnosis of the cancer, or samples of cancer cells from previous biopsies or surgery may be used.

What it looks like

Cetuximab is a colourless liquid.

How it is given

Cetuximab is given by a drip into the vein (intravenously) through a fine tube (cannula) inserted into a vein. The first dose is given slowly, usually over two hours. After this doses are given weekly and this normally takes about an hour. The first dose is usually larger than the weekly ‘maintenance’ treatments. You may be given other medicines before cetuximab to lessen the side effects during treatment.

Possible side effects

Each person’s reaction to a cancer drug is unique. Some people have very few side effects, while others may experience more. If you do notice any effects which you think may be due to the drug, but which are not listed here, please discuss these with your doctor.

The side effects of cetuximab are generally mild and some of these can be reduced with medicines. As it is still a new drug it is too early to know about all the possible side effects.

Skin changes Mild skin rashes are very common. They begin during the first two weeks of treatment and usually go away completely when the treatment stops. Some people have more severe skin changes, which can include reddening of the skin and red pimples and spots on the face. The skin of the face may also become flaky and scaly. Some people have dry skin eczema on their fingertips, elbows and extremities, which is sore and itchy. If you have any of these skin changes let your doctor know straight away. If you have very severe skin problems the length of time between the treatments may be extended or the dose may be lowered.

Treatment can be prescribed by your doctor to reduce the rash. To help reduce the reddening it is best to avoid foods that make the skin go red, such as chillies and alcohol.

To help reduce the dry skin eczema it is helpful to avoid things that make your skin dry, such as too much central heating, and soap. Your doctor can prescribe creams to moisturise your skin.

To reduce scaly or flaky skin it is helpful to moisturise the skin and also avoid things that make you go red.

Tiredness (fatigue) and a general feeling of weakness. It is important to allow yourself plenty of time to rest. CancerBACUP has a section on coping with fatigue.

Nausea (feeling sick) and less commonly vomiting. There are now very effective anti-sickness drugs to prevent or greatly reduce this effect. If the sickness is not controlled or continues tell your doctor, who can prescribe other anti-sickness drugs which may be more effective. CancerBACUP has information on managing nausea and vomiting.

Diarrhoea. This can usually be controlled with medicine but tell your doctor if it is severe or continues. It is important to drink plenty of fluids if you do have diarrhoea.

Fever may occur. If your temperature goes above 38°C (100.5°F), contact your doctor or the hospital straight away.

Less common side effects

Allergic reactions. Signs of a reaction include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness. You will be monitored closely during your treatment, but tell your nurse or doctor if you have any of these symptoms. To reduce the chance of developing an allergic reaction, certain drugs (antihistamines) can be given before the infusion. The drip can also be slowed down or stopped until the reaction is over.

Headaches. If you have headaches, let you doctor know.

Sore mouth. Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of this happening. Tell your doctor if you do have any of these problems. Special mouthwashes and medicines can be prescribed to prevent or clear any mouth infection.

Constipation. Your doctor can prescribe laxatives if constipation occurs.

Lowered resistance to infection Cetuximab can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This is rare if cetuximab is given on its own.

Contact your doctor or the hospital straightaway if:

  • Your temperature goes above 38°C (100.5°F)
  • You suddenly feel unwell (even with a normal temperature)

CancerBACUP has information on how to avoid infection when you have reduced immunity, which you may find helpful.

Anaemia (low number of red blood cells) While having treatment with cetuximab you may become anaemic. This may make you feel tired and breathless. Let your doctor know if you feel tired or breathless or are very pale.

Tiredness and weakness Some people feel weak and tired, and as though they have no strength while having treatment with cetuximab. This gradually disappears once the treatment is finished.

Aching or pain in the muscles or bones can usually be controlled with mild painkillers which your doctor can prescribe.

Your liver may be temporarily affected Cetuximab may cause changes in the way that your liver works, which go back to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver function.

Additional information

Cetuximab is not given to people who are allergic to mice.

References

This section has been compiled using information from a number of reliable sources including;

  • Website of the American Cancer Society – www.cancer.org
  • BASELGA, J (2001) The EGFR as a target for anticancer therapy – focus on cetuximab. European Journal Of Cancer. 37, S16-S22.
  • Robert F et al (2001) Phase I study of anti-epidermal growth factor receptor antibody cetuximab in combination with radiation therapy in patients with advanced head and neck cancer. Journal Of Clinical Oncology. 19 (13), p3234-3243.
  • McCarthy M (2003) Anti-angiogenesis drug promising for metastatic colorectal cancer. The Lancet. 361 (June 7), p1959/
  • Mendelson J and Baselga J (2003) Status of epidermal growth factor receptor antagonists in the biology and treatment of cancer. Journal Of Clinical Oncology. 21 (14), p2787-2799.
  • Ransom M and Sliwkowski M X (2002). Perspectives on anti-HER monoclonal antibodies. Oncology. 63 (supplement 1), p17-24

For further references, please see the general bibliography.

Alemtuzumab (MabCampath®)

What is alemtuzumab?

Alemtuzumab is one of a new group of cancer drugs known as monoclonal antibodies. It is mainly used to treat people with B-cell chronic lymphocytic leukaemia (CLL). It is sometimes used as part of research trials to treat other types of leukaemia. Currently alemtuzumab is usually given to people whose CLL has come back after previous treatment or if it is not responding to chemotherapy.

When a drug is being developed it has to go through various stages of research, called clinical trials or studies. These are intended to establish a safe dosage, the side effects the drug may cause and which cancers it may be used to treat. The trials also find out how effective the drug is, and whether it is better than the existing treatments or has extra benefit when given with these drugs.

What is a monoclonal antibody?

Monoclonal antibodies are used to try to destroy some types of cancer cells while causing little harm to normal cells. They recognise certain proteins that are found on the surface of some types of cancer cells. The monoclonal antibody recognises the protein and locks on to it (like a key in a lock). This may then trigger the body’s immune system to attack the cancer cells and cause the cells to destroy themselves.

Alemtuzumab locks on to a protein called CD52. This is found on the surface of certain white blood cells (lymphocytes), including those affected by the leukaemia. The leukaemic lymphocytes are known as malignant lymphocytes. Alemtuzumab attacks both malignant and normal lymphocytes. However the body quickly replaces any normal white blood cells that are damaged, so the risk of side effects from the treatment is small.

What it looks like

Alemtuzumab is a clear fluid after being diluted.

How is it given

Alemtuzumab is given as a drip (infusion) through a fine tube (cannula) inserted into a vein in the arm or back of the hand. Each drip takes approximately two hours.

Some people have an allergic reaction to alemtuzumab. To reduce the risk of a reaction the first few doses are given slowly. You may also be given some antihistamines, paracetamol and sometimes a small dose of steroids before the infusion. These will help to reduce the risk of reactions. If you do have a reaction, the infusion can be stopped and started again once the symptoms are over.

You will be asked to stay in hospital for a few hours after the infusion, or possibly overnight, to be monitored. The dose of alemtuzumab is increased over a few days until the recommended dose is achieved. This usually takes 3–7 days and is known as dose escalation. Once the recommended dose is achieved the treatment is given three times a week (e.g. on Monday, Wednesday and Friday). Most people have treatment for 4–12 weeks.

Side effects

Each person’s reaction to a cancer drug is unique. Some people have very few side effects, while others may experience more. We have outlined the commonest side effects, so that you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or nurse.

Most side effects of alemtuzumab fall into two groups:

  • early side effects – those which occur during or immediately after the drug has been given (which include allergic-type reactions)
  • later side effects – tthose which occur after a few weeks of treatment, of which the main one is infection.

Early side effects

Allergic reactions It is common to have a slight allergic reaction to alemtuzumab, although some people have a more severe reaction. Signs of a reaction include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness. You will be monitored closely during your treatment but it is very important to tell your nurse or doctor if you have any of these symptoms.

To reduce the chance of developing an allergic reaction certain drugs (antihistamines) are given before the infusion. The infusion can also be slowed down or stopped until the reaction is over. Generally the reaction gets better within a few hours, once the treatment has ended, and is almost always more severe with the first few doses of alemtuzumab.

Flu-like symptoms  This can include a high temperature and chills, weakness, sweating, muscle aches, tiredness, dizziness and headaches. These effects can occur while the drug is being given, but do not usually last long.

Feeling sick (nausea) and occasional vomiting  There are now very effective anti-sickness drugs to prevent or substantially reduce this. If the sickness is not controlled, or continues, let your doctor know so that he or she can prescribe other anti-sickness drugs which may be more effective.

Low blood pressure  This may happen during the infusion, so your blood pressure will be regularly checked. People who normally take medicines to lower their blood pressure need to discuss with their doctor whether any adjustments should be made to their usual medicines during this time.

Later side effects

After a few weeks of treatment the following effects may occur.

Reduction in white blood cells  Healthy white cells fight off infection and so alemtuzumab may increase your risk of developing infections. This risk is usually at its highest whilst you are having the treatment and for about two months afterwards. It is recommended that antibiotic and antiviral medication is taken during alemtuzumab treatment and for at least two months afterwards. In some people the production of white blood cells by the bone marrow may be reduced for up to a year following treatment.

Problems with blood clotting  This is caused by a reduction in the production of platelets by the bone marrow. It may lead to an increased risk of bleeding, although this usually only lasts a short time. You will have your blood checked regularly to monitor this.

Less common side effects

You may also have diarrhoeaabdominal painsskin rashesbreathlessness or a cough. Let your doctor or nurse know if you have any of these so that effective treatment can be prescribed.

Additional Information

Alemtuzumab may worsen heart problems in people who already have them. For this reason it will be used with caution if you have had heart disease.

It is unknown what effect alemtuzumab may have on an unborn baby. It is recommended that women able to become pregnant, and men who are sexually active, use effective birth control whilst having alemtuzumab and for at least one year after the treatment has ended. It is recommended that women should not breastfeed during the treatment and for at least four weeks afterwards.

References

This section has been compiled using information from a number of reliable sources including:

  • Martindale: The Complete Drug Reference (33rd edition). Sweetman et al. Pharmaceutical Press, 2002.
  • British National Formulary (46th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2003.

For further references, please see the general bibliography.

ADEPT (Antibody Directed Enzyme Pro-drug Therapy)

Drugs in development

When a drug is being developed it has to go through various stages of research called clinical trials or studies. These are intended to establish a safe dosage, the side effects that the drug may cause and which cancers it may be used to treat. The trials also find out how effective the drug is, and whether it is better than the existing treatments, or has extra benefit when given with these drugs.

Many drugs that are thought to be promising may be found not to be as good as existing treatments, or to have side effects that outweigh any benefits. For this reason, doctors and other medical staff carry out frequent and careful checks on the progress of each patient who is taking one of these developmental drugs. If you are having a developmental drug your doctor will explain all about the drug, the procedures being used, and how you will be looked after while you are taking it. If at any time you have concerns, you should ask your doctor or nurse for information and advice.

 

ADEPT

ADEPT (Antibody-Directed Enzyme Pro-drug Therapy) is a new type of cancer treatment that involves a group of drugs called monoclonal antibodies. At the moment ADEPT is being used only in clinical trials. The trials aim to find out whether ADEPT may be useful as a new type of treatment for bowel cancer in the future.

 

What is a monoclonal antibody?

Monoclonal antibodies recognise certain proteins that are found on the surface of some cancer cells. They are used to try to destroy the cancer cells, while causing little harm to normal cells.

The monoclonal antibody recognises the protein on the surface of the cancer cell and locks on to it (like a key in a lock). Some monoclonal antibodies can then trigger the body’s immune system to attack the cancer cells and can also cause the cells to destroy themselves.

Sometimes monoclonal antibodies have a cancer drug or radioactive substance attached to them. They can be used in this way to deliver treatment directly to the cancer cell which is known as targeted therapy.

 

How does ADEPT work?

ADEPT is a type of targeted therapy. It uses a monoclonal antibody to carry an enzyme directly to the cancer cells. A few hours after the monoclonal antibody is given (with the enzyme attached) a pro-drug is given. The pro-drug is an inactive anti-cancer drug. When this pro-drug comes into contact with the enzyme, which is now attached to the cancer cell, a reaction takes place which activates the anti­cancer drug. The anti-cancer drug is then able to destroy the cancer cells. As normal cells do not have the antibody with the enzyme the treatment does not affect them.

 

What it looks like

ADEPT is a clear fluid.

 

How it is given

ADEPT is given by a drip (infusion) into the vein through a small tube (cannula) inserted into the vein. It is usually given in two separate doses on the same day.

 

Possible side effects

Trials are looking at the side effects that may occur. As ADEPT is still a relatively new treatment it is too early to know all of the possible side effects. However, the following appear to be the most common.

Flu-like symptoms  These may include fever and chills, headaches, itching and joint and muscle aches. These may occur a few hours after the drug is given, but do not last for more than a day or two.

Allergic reaction  Signs of an allergic reaction include skin rashes and itching, high temperatures, shivering, redness of the face, dizziness, a headache, breathlessness, anxiety and a need to pass urine.

You will be monitored for any sign of an allergic reaction during your treatment. Tell your doctor or nurse if you have any of these signs. Before you receive your treatment you will be given medication to reduce the chances of an allergic reaction.

Increased risk of infection  A temporary reduction in your white blood cells can occur a few days after the treatment is given. If this happens you are more likely to get an infection during this period. Your doctor or nurse will advise you about this and any precautions that you should take. Your white cells usually recover in three to four weeks.

Nausea (feeling sick) and vomiting  There are now very effective anti-sickness drugs to prevent or greatly reduce nausea and vomiting. If it does happen it may begin a few hours after the drug has been given, and may last for a few days. If the sickness is not controlled, or continues, tell your doctor. He or she can prescribe other anti-sickness drugs which may be more effective.

If you have any questions about these or any other side effects do talk to your doctor or nurse. It is also important to let them know if you have any symptoms or side effects that may be related to the treatment.

back to top

 

References

This section has been compiled using information from a number of reliable sources including:

  • Martindale: The Complete Drug Reference (33rd edition). Sweetman et al. Pharmaceutical Press, 2002.
  • British National Formulary (46th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2003.

For further references, please see the general bibliography.

Cyproterone acetate (Cyprostat®)

What is cyproterone?

Cyproterone acetate is a drug which is used in the treatment of prostate cancer. It is a type of hormonal therapy. Hormonal therapies interfere with the production or action of particular hormones in the body. Hormones are substances produced naturally in the body. They act as chemical messengers and help to control the activity of cells and organs.

How it is given

Cyproterone acetate is a tablet which is taken two or three times a day. Doses should be evenly spaced throughout the day.

How it works

Most prostate cancers need supplies of the male hormone testosterone to grow. This is produced by the testes and adrenal glands. On the surface of the prostate cancer cells are proteins called receptors. Cyproterone acetate has a structure similar to testosterone. It works by attaching itself to the receptors on the surface of the prostate cancer cells to block and prevent the attachment of testosterone. Without testosterone, the cancer cells either grow more slowly or stop growing altogether.

Cyproterone acetate may be given together with injections of another type of hormonal therapy drug such as goserelin, buserelin, triptorelin or leuprorelin. These drugs block the production of a hormone produced by the pituitary gland (leuteinising hormone), which stimulates the production of testosterone.

Possible side effects

Each person’s reaction to any medication is unique. Many people have very few side effects with cyproterone acetate, while others may experience more. The side effects described in this section will not affect everyone and may be different if you are having more than one drug.

We have outlined the most common side effects. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that he or she can monitor the effects. This section should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, as they are in the best position to help and advise you.

Some people may have some of the following side effects.

Breast tenderness or fullness  Some men may notice slight breast swelling and tenderness known as gynaecomastia. Your doctor can prescribe medicine to reduce any discomfort.

Tiredness and low mood  This is common during the first few weeks of treatment, but reduces with time.

Breathlessness  You may have a feeling of mild breathlessness while you are taking cyproterone acetate treatment. This will disappear if the treatment is stopped.

Nausea (feeling sick), vomiting and diarrhoea  These effects are uncommon and if they occur they are usually mild and easily controlled. Nausea can sometimes be relieved by taking the tablet with food.

Let your doctor know if you have any of these side effects as medication can be prescribed to help.

Lowering of libido (sex drive), and impotence (a loss of ability to have an erection)  This is uncommon. If it occurs sexual function will return to normal after stopping the drug. Your doctor or nurse can discuss this with you.

Effect on liver function  Your doctor will take blood samples to test how well your liver is working, as cyproterone acetate can sometimes cause the amount of particular chemicals produced by the liver to change. If this happens the drug will be stopped and the liver function will return to normal.

Length of treatment

Your doctor will discuss the length of treatment that they feel is appropriate for your situation. It is often given for several months or years.

Things to remember about cyproterone tablets

  • Keep the tablets in a safe place where children cannot reach them, as cyproterone could harm them.
  • If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
  • If you are sick just after taking the tablet tell your doctor as you may need to take another one.
  • If you forget to take your tablet, do not take a double dose. Let your doctor or nurse know. Don’t panic – levels of the drug in your blood will not change very much – but try not to miss more than one or two tablets in a row.
  • Remember to get a new prescription a couple of weeks before you run out of tablets and make sure you have plenty for holidays etc.

Bicalutamide (Casodex®)

What is bicalutamide?

Bicalutamide is a man-made drug that is used in the treatment of prostate cancer. It is a type of hormonal therapy. Hormonal therapies interfere with the production or action of particular hormones in the body. Hormones are substances produced naturally in the body. They act as chemical messengers and help to control the activity of cells and organs.

How it works

Most prostate cancers need supplies of the male hormone testosterone to grow. This is produced by the testes and adrenal glands. On the surface of the prostate cancer cells are proteins called receptors. Bicalutamide has a structure similar to the male sex hormone testosterone. It works by blocking and preventing testosterone from attaching (binding) to the receptors on the surface of the prostate cancer cells. Without testosterone, the cancer cells either grow more slowly,or stop growing altogether. The cancer may shrink in size.

Bicalutamide may be used on its own to treat prostate cancer that is contained within the prostate gland, or in the tissues around the prostate gland. In prostate cancer which has spread to other parts of the body, bicalutamide may be given on its own or together with injections of another type of hormonal therapy drug such as goserelin, buserelin, triptorelin or leuprorelin. These drugs block the production of a hormone produced by the pituitary gland (leuteinising hormone), which stimulates the production of testosterone.

How it is given

Bicalutamide is a tablet, which is taken once a day.

Possible side effects

Each person’s reaction to any medication is unique. Many people have very few side effects with bicalutamide while others may experience more. The side effects described in this section will not affect everyone and may be different if you are having more than one drug. We have outlined the most common side effects. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug but which are not listed here, please discuss them with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that he or she can monitor the effects. This section should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, as they are in the best position to help and advise you.

Some people may have some of the following side effects.

Breast tenderness or fullness  Some men may notice slight breast swelling and tenderness known as gynaecomastia. Your doctor can prescribe medicines to reduce any discomfort.

Hot flushes  These are usually mild and may wear off after a period of time. There are a number of ways to help reduce hot flushes and sweats. It can be useful to avoid or cut down on tea, coffee, nicotine and alcohol. Let your doctor know if hot flushes are causing you any problems as recent research suggests that progesterone or some anti-depressants may be helpful in controlling this side effect.

Some people find that complementary therapies help, and your GP may be able to give you details about obtaining these on the NHS.

Itching and dryness of the skin  This is usually mild. Let your doctor know if it is a problem for you. Sometimes creams or medications can reduce this effect.

Nausea (feeling sick), vomiting and mild diarrhoea  These effects are usually mild and easily controlled. Nausea can sometimes be relieved by taking the tablet with food. Let your doctor know if you have any of these side effects as medicines can be prescribed to help.

CancerBACUP’s section on diet and the cancer patient discusses ways of coping with these effects and CancerBACUP also has a section on managing nausea and vomiting.

Lowering of libido (sex drive), and impotence (loss of ability to have an erection)  If these effects occur, sexual function will return to normal after stopping the drug. Your doctor or nurse can discuss this with you.

Drowsiness and weakness  Occasionally bicalutamide may cause feelings of weakness and drowsiness.

Blood in the urine  A rare side effect of bicalutamide is blood in the urine (haematuria). Let your doctor know if you have this.

Length of treatment

Your doctor will discuss the length of treatment that they feel is appropriate for your situation. Cyproterone acetate is given for as long as it is being effective in controlling your cancer. This may be for several months or years.

Things to remember about bicalutamide tablets

  • Keep the tablets in a safe place where children cannot reach them, as cyproterone acetate could harm them.
  • If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
  • If you are sick just after taking the tablet tell your doctor as you may need to take another one.
  • If you forget to take your tablet, do not take a double dose. Don’t worry, the levels of the drug in your blood will not change very much – but try not to miss more than one or two tablets in a row.
  • Remember to get a new prescription a few weeks before you run out of tablets and make sure you that have plenty for holidays etc.

References

This section has been compiled using information from a number of reliable sources including;

  • Martindale: The Complete Drug Reference (33rd edition). Sweetman et al. Pharmaceutical Press, 2002.
  • British National Formulary (46th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2003.

For further references, please see the general bibliography.

Anastrozole (Arimidex®)

What is anastrozole?

Anastrozole is a man-made drug which is used in the treatment of breast cancer in women who have had their menopause (change of life). It is mainly used to treat women who have advanced breast cancers or breast cancer that has come back after initial treatment (breast cancer that has spread). Sometimes it is used in early breast cancer.

Anastrazole is a type of hormonal therapy. Hormonal therapies work by interfering with the production or action of particular hormones. Hormones are substances produced naturally by the body. They act as chemical messengers and help to control the activity of cells and organs.

How does anastrozole work?

Many breast cancers need supplies of the hormone oestrogen to grow. In women who have passed the menopause the main source of oestrogen is through the conversion of androgens (sex hormones produced by the adrenal glands) into oestrogens. This is carried out by an enzyme called aromatase. This conversion process is known as aromatisation, and happens mainly in the fatty tissues of the body.

Anastrozole blocks the process of aromatisation and preventing this chemical change. This results in a reduction in the amount of oestrogen in the body. For this reason anastrozole is known as an aromatase inhibitor.

How it is taken

Anastrozole is a tablet which is taken once a day. It should be taken at approximately the same time each day.

Possible side effects

Each person’s reaction to any medication is unique. Most people have very few side effects with anastrozole, while others may experience more. The side effects described in here will not affect everyone and may be different if you are having more than one drug.

We have outlined the most common side effects. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects that are not listed in the section, please discuss them with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that he or she can monitor the effects. This section should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, as they are in the best position to help and advise you.

Some people may have the following side effects to varying degrees.

Hot flushes and sweats  These are usually mild and may wear off after a period of time. Sometimes women find that avoiding or cutting down on tea, coffee, nicotine and alcohol can reduce sweats. Recent research suggests that progesterone or some anti-depressants may be helpful in controlling this side effect. Some women find that complementary therapies help, and your GP may be able to give you details about obtaining these on the NHS.

If you are having troublesome hot flushes, discuss these with your doctor.

Vaginal dryness  This may occur while using anastrozole. Gels are available which can help to overcome the dryness. The gels are available from any chemist or can be prescribed by your doctor. CancerBACUP’s section on sexuality and cancer contains more information about how to cope with this effect.

Nausea (feeling sick), vomiting and diarrhoea  These side effects are uncommon. If they do occur they can usually be effectively treated, so let your doctor know. Feelings of sickness can often be relieved by taking your tablet with food or at night. If you have diarrhoea it is important to drink plenty of fluids.

Hair thinning  Some women notice that their hair becomes thinner while taking anastrozole. This is usually mild and the hair goes back to normal at the end of treatment.

Headaches  Some people have headaches whilst taking anastrozole but this is not common. It is important to drink plenty of fluids. Let your doctor know if you are getting headaches as medication can be prescribed.

Skin rashes  Rarely, anastrozole can cause skin rashes.

Vaginal bleeding  Vaginal bleeding (usually in the first few weeks of treatment) has been reported. This is rare and has usually occurred after changing from other hormonal therapies to treatment with anastrozole. If the bleeding continues, tell your doctor or breast care nurse.

Joint pains/stiffness  This side effect is uncommon but some women have pain and stiffness in their joints while taking anastrozole. Let your doctor know if these effects are troublesome. It may be helpful to take mild painkillers.

Tiredness and lethargy  Some people can experience increased tiredness, especially at the start of treatment. It is important to get plenty of rest. If you are very sleepy you should take extra care when driving or operating hazardous machinery.

Length of treatment

Anastrazole may be given over a period of months or a number of years depending on your individual situation. Your doctors will discuss the length of treatment that they feel is appropriate for you.

Things to remember about anastrozole tablets

  • Keep the tablets in a safe place where children cannot reach them, as anastrozole could harm them.
  • If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
  • If you are sick just after taking the tablet tell your doctor or nurse as you may need to take another one.
  • If you forget to take your tablet, don’t worry. The levels of the drug in your blood will not change very much but try not to miss more than one or two tablets in a row. Let your doctor or nurse know.
  • Remember to get a new prescription a few weeks before you run out of tablets and make sure you have plenty for holidays etc.

References

This section has been compiled using information from a number of reliable sources including;

  • Martindale: The Complete Drug Reference (33rd edition). Sweetman et al. Pharmaceutical Press, 2002.
  • British National Formulary (46th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2003.

For further references, please see the general bibliography.

Cancer and complementary therapies

This section has been written to explain the complementary therapies most often used by people with cancer. We hope that it will provide you with a balanced view of what is available so that, if you do want to try a complementary therapy, you will have a realistic idea of what it will involve and what it might do for you. Where the views of doctors and alternative practitioners differ, we will discuss and contrast these views so that you can make up your own mind.

  • Different therapies
  • How do doctors view these therapies?
  • Should I seek complementary or alternative therapy if I have been told I have cancer?
  • Choosing a complementary therapist

Different therapies

Many philosophies of health have developed throughout the world, resulting in different attitudes towards illness and its treatment. In this country most treatments are generally based on Western medicine, which uses a scientific model to prove the benefits of a particular treatment. Some complementary therapies have their roots in Eastern traditions.

You may hear about the following varieties of treatments or therapies. It is important to know the differences between them and what they are each generally understood to mean.

  • Conventional therapies
    Conventional therapies are the treatments which doctors use most often to treat people with cancer. These consist of surgery, radiotherapy, chemotherapy and hormone treatment. All these treatments have usually been tested in clinical trials and through long experience with patients
  • Complementary therapies
    Complementary therapies are generally viewed as treatments which are given alongside the conventional cancer treatments. Some complementary therapies may be available through the NHS.
  •  Alternative therapies
    Alternative therapies are usually viewed as treatments which are intended to be used instead of conventional treatments.

How do doctors view these therapies?

Some treatments, included in alternative therapies have caused a conflict of views between doctors and alternative therapists. In general, doctors do not believe that there is valid scientific evidence available that these alternative treatments can cure cancer or slow its growth. They are concerned that certain therapies may give patients false hope and occasionally may even be harmful. Doctors also worry that patients may turn away from conventional treatments that could help them. People with cancer can be very vulnerable and there have been cases when people have been misled by promises of a miracle cure. However, no reputable alternative therapist would claim to be able to cure cancer.

Certain complementary therapies, such as counselling, are now recognised by doctors for the positive effects they can have on patients’ wellbeing. In many cancer centres counselling is part of conventional treatment for some patients. Other complementary therapies such as relaxation and massage, while not part of conventional treatment, are accepted by doctors because they can help people feel better and cope better with their illness. These too are available in many cancer centres.

The main reason why doctors have been reluctant to accept alternative and some complementary therapies is that most of these treatments have never been scientifically studied or validated. Studies of some complementary therapies such as certain types of psychotherapy, relaxation and hypnotherapy have shown an improvement in patients’ quality of life and treatment side effects. Several studies to evaluate other complementary therapies, such as aromatherapy, are now in progress and will help to determine whether there are real benefits.

Should I seek complementary or alternative therapy if I have been told I have cancer?

It is important not to miss out on the benefits of conventional methods of cancer treatment, which have been scientifically proven. Complementary therapies can offer additional support and help improve your wellbeing. If you are considering using complementary or alternative therapies talk to your doctor for advice and support. Doctors are generally supportive of patients using any complementary therapies which help them cope better with their illness, but may advise caution about using certain alternative therapies.

Sometimes people who seek certain alternative therapies instead of conventional treatments may do so because they are confused, lack information, or feel they haven’t been given enough time to ask questions or talk about their concerns. This sometimes leads to misunderstandings about their treatment, or they may feel there is nothing more their doctor can do for them.

Before making any decisions on these therapies, be sure you have all the information you need from your doctor. Take a friend or relative with you for support and write the questions that matter most to you beforehand. For many people, the more information and support that is available from the health professionals looking after them, as well as from organisations such as CancerBACUP, the less likely it is they will seek help from alternative practitioners.

Choosing a complementary therapist

If you are considering using complementary therapies, the following suggestions may help you:

  • Always use a qualified therapist who belongs to a professional body. The organisations on pages 35-8 can give you names of registered therapists and advice on what to look for.
  • Check the cost of treatment beforehand to make sure you are being fairly charged. The organisations at the back of the booklet should be able to give you an idea of what is usual.
  • Talk it over with your doctor or nurse and ask for their advice, especially if you are going to have a therapy which involves taking pills or medicines.
  • Ask your doctor or nurse if there are complementary therapies available at your treatment hospital, or through your GP’s practice, or if they can recommend any therapies or practitioners.
  • Choose the complementary therapy that suits your individual needs. If you are not sure and would like to know what other patients have found helpful, contact a patient support group. Support groups often offer complementary therapies.
  • Don’t be misled by promises of cures. No reputable therapist would claim to be able to cure cancer.

CancerBACUP’s Cancer Support Service can also give you advice on how to find a suitable therapist and provide information on different complementary and alternative therapies as well as support groups in your area.