Biological therapies

Erythropoietin (EPO) (Eprex®, NeoRecormon®)

This section gives information about the use of erythropoietin for people with cancer. You may want to discuss it with a nurse or doctor involved in your treatment, or with one of CancerBACUP’s Cancer Support Service nurses.

  • What is Erythropoietin?
  • Why it is given
  • What it looks like
  • How it is given
  • Possible side effects
  • Length of treatment
  • Additional information
  • References

What is Erythropoietin?

Erythropoietin is a type of protein that occurs naturally in the body. It stimulates the bone marrow, which makes blood cells, to make red blood cells.

Erythropoietin can be given as a treatment for a low red blood cell count (anaemia) as an alternative to a blood transfusion. Our red blood cells contain haemoglobin, which carries oxygen around the body. If your haemoglobin level falls too low after treatment with certain types of chemotherapy or radiotherapy, your doctor may recommend a course of erythropoietin. There are two types of erythropoietin, epoetin and darbepoetin, which work in similar ways.

Why it is given

One of the main side effects of chemotherapy is to slow the production of blood cells by the bone marrow. At first, only white blood cells seem to be affected. This is because red blood cells live much longer in the circulating blood. Therefore it takes longer for the effects of the chemotherapy on red blood cell production to show up in the blood.

Towards the end of your treatment, particularly if you have had a lot of chemotherapy, your red blood cell count may fall. If you have too few red blood cells, you will feel very tired and may also be breathless.

Erythropoietin will help your red blood cell count to increase and so can relieve the symptoms of anaemia. It takes about 2–3 weeks for the treatment to begin to raise your red blood cell level. You will have regular blood tests while you are having treatment with erythropoietin, to make sure that your red blood cell levels stay within a normal range.

What it looks like

Erythropoietin is a clear liquid in a small glass bottle or pre-filled syringe.

How it is given

Erythropoietin is normally given by an injection under the skin (subcutaneously), most often in the thigh or abdomen. It can be given from 1–5 times a week, depending on advice from your doctor. You, or a person caring for you, can be taught how to give the injections so that you can continue the treatment at home, or it may be given by a district nurse or GP practice nurse.

Possible side effects

Like almost all drugs, erythropoietin may cause side effects. Each person’s reaction to any drug is unique. Some people have very few side effects, while others may experience more. 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 in the factsheet, please discuss them with your doctor or nurse.

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

Some people may have some of the following side effects.

Flu-like symptoms  Some people have flu-like symptoms, such as headaches, joint pains, weakness, dizziness and tiredness. These are more likely to occur at the start of your treatment. Your doctor may prescribe a painkiller, such as paracetamol, to help with these symptoms.

Skin rash  You may develop a skin rash, which may be itchy.

High blood pressure can occur  Your doctor will closely monitor your blood pressure while you are receiving erythropoietin.

Tiredness and a general feeling of weakness  It is important to allow yourself plenty of time to rest.

Let your doctor or nurse know if you have any side effects.

Length of treatment

EPO is often started as soon as your anaemia has been diagnosed. The injections are given 1–5 times a week and may continue until one month after your chemotherapy course has finished, or until you are no longer anaemic.

Additional information

  • You may be given iron tablets to help with production of new red blood cells.
  • Your erythropoietin should be stored in the fridge.

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.

GCSF and GMCSF (Neupogen®, Granocyte®, Leucomax®)

This section gives information about the use of haematopoietic growth factors for people with cancer. You may want to discuss it with a nurse or doctor involved in your treatment, or with one of CancerBACUP’s Cancer Support Service nurses.

  • What are growth factors?
  • What they look like
  • How they are given
  • How often are they given?
  • Possible side effects
  • Additional information
  • References

What are growth factors?

Haematopoietic growth factors stimulate the bone marrow (where blood cells are made) to make the different types of blood cells. Growth factors are special proteins which are produced naturally in the body. They can also be produced in a laboratory.

G-CSF and GM-CSF are particular growth factors that work by encouraging the bone marrow to produce more white blood cells. White blood cells are essential for fighting infection.

One of the main side effects of chemotherapy drugs is a reduction in the number of white blood cells. This makes your body less able to fight infection. There is a risk that you could develop a serious infection, which may have to be treated in hospital. If the number of blood cells (your blood count) in your blood is low when your next dose of chemotherapy is due, the chemotherapy may have to be delayed, or the dose lowered.

In this situation growth factors can be given, to stimulate the bone marrow to produce new white cells more quickly after chemotherapy.

This can shorten the period during which you are at risk of developing a serious infection.

Growth factors may sometimes be used before high-dose chemotherapy, to make the bone marrow produce more stem cells. These extra stem cells can then be collected and given back to you after high-dose chemotherapy treatment. The stem cells then go back into the bone marrow and produce blood cells. CancerBACUP has a section on stem cell and bone marrow transplants, which discusses these treatments.

You may hear about growth factors called filgrastim and lenograstim which are types of  G-CSF (granulocyte colony stimulating factor) or molgramostim which is a type of GM-CSF (granulocyte macrophage colony stimulating factor).

A newer growth factor called pegfilgrastim is a type of G-CSF in which the molecules of the drug are coated in a substance that helps the drug to work for longer.

A growth factor called erythropoietin is occasionally given to correct anaemia (a shortage of red blood cells) in some patients having chemotherapy drugs.

What they look like

Growth factors are available as a white powder which is dissolved in liquid. They are also available as a clear solution in a small glass bottle or pre-loaded syringe.

How they are given

Usually by an injection under the skin (subcutaneously), most often in the thigh, arm or abdomen. You, or people caring for you, can be taught how to give these injections so that you can continue the treatment at home, or it may be given by a district nurse or GP practice nurse.

How often are they given?

Most growth factors are usually started a few days after the chemotherapy has been given, and are given daily for up to 14 days. Pegfilgrastim is given once with each cycle of chemotherapy.

Possible side effects

As with almost all drugs, growth factors may cause side effects. These depend on which growth factor you have, and may vary from one person to another.

Bone pain Some people have a dull ache or discomfort in the bones of the back, pelvis, arms or legs. This is usually mild and goes away when the growth factor injections stop.

Red, itchy skin  Your skin may become red and itchy around the area in which the injection is given. This will disappear once the course of injections is over.

Fever, chills and fluid retention  Molgramostim may cause fever, chills and fluid retention. Fluid retention may lead to swelling of the ankles or breathlessness.

Occasionally you may experience nausea, vomiting and diarrhoea.

Let your doctor or nurse know if you have any side effects. Your doctor may prescribe painkillers such as paracetamol to help reduce you temperature and prevent chills.

Additional information

You will need to have the levels of white blood cells in your blood checked regularly (possibly twice a week) while you are having growth factor injections.

Filgrastim, pegfilgrastim and molgramostim need to be stored in the fridge. Lenograstim can be stored at room temperature. Follow any storage instructions given by your pharmacist.

For more information contact CancerBACUP’s Cancer Support Service.

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.

Interferon alfa (IntronA®, Roferon® -A)

  • What is interferon?
  • What it looks like
  • How it is given
  • How it works
  • Possible side effects
  • Less common side effects
  • Additional information
  • References

What is interferon?

Interferon is a protein that occurs naturally in the body in very small amounts. There are three main types: alpha, beta and gamma. This factsheet describes alpha interferon.

Interferon is used as a treatment for some types of cancer. These include cancer of the kidney, malignant melanoma, multiple myeloma, carcinoid tumours and some types of lymphoma and leukaemia. Interferon is also used to treat diseases other than cancer.

What it looks like

Interferon alpha is a white powder that forms a clear, straw-coloured liquid when mixed with water. It can also be supplied ready-diluted in small glass vials (bottles), pre-filled syringes, and special injection-pen devices.

How it is given

Interferon is given to stimulate the body’s own immune system to fight some types of cancer. The exact way in which it works is not fully understood. It is thought to have a wide range of biological effects. It may do one or more of the following:

  • slow down or stop cancer cells dividing
  • reduce the ability of cancer cells to protect themselves from the immune system
  • strengthen the body’s immune system.

How it works

Interferon is given to stimulate the body’s own immune system to fight some types of cancer. The exact way in which it works is not fully understood. It is thought to have a wide range of biological effects. It may do one or more of the following:

  • Slow down or stop cancer cells dividing
  • Reduce the ability of cancer cells to protect themselves from the immune system
  • Strengthen the body’s immune system

Possible side effects

The amount of interferon that occurs naturally in the body is very small. When interferon injections are given the amount in the body increases greatly. For this reason, it causes side effects, even though it is a naturally occurring substance. However, the side effects of interferon are not usually severe. People react to drugs in different ways, so it is not possible to predict who is going to have side effects or which they will have. The most common side effects are listed here.

Flu-like symptoms including a high temperature, chills and muscle and joint pains. They may start 2–3 hours after the drug is given, but they do not last long. Your doctor may prescribe medicine to reduce this side effect. After the first injection these symptoms may be quite severe, but they usually become much less of a problem with further injections. Some people find it helpful to have their interferon before going to bed at night so that the side effects are less noticeable.

Fatigue (a feeling of tiredness and having no energy) can be a problem, and sometimes this worsens over the course of injections. It is important to allow yourself plenty of time to rest. Tiredness can affect many aspects of your life.

Feeling sick, vomiting and loss of appetite This is uncommon. Your doctor can prescribe medicine to help. CancerBACUP’s information on diet and the cancer patient has more information and CancerBACUP also has a section on managing nausea and vomiting.

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Less common side effects

Skin irritation may occur at the injection site This can be reduced by giving the injections in different places. Sometimes a more widespread rash can occur as a result of an allergic reaction.

Dizziness sometimes occurs  It is important to report this to your doctor.

Depression and emotional changes  Interferon can sometimes make people feel depressed. If you feel very low while you are taking it let your doctor know, as help is available.

Hair loss Occasionally hair may be lost but usually the hair just thins. The effect is temporary and the hair will regrow once the treatment is finished.

Fertility  Interferon may affect your ability to have children. In women it may affect the menstrual cycle and in men there may be a lowered sperm count. These effects may be temporary but for some people can be permanent.

Pins and needles in the hands and toes Let your doctor know at your next appointment if this happens.

Temporary reduction in the production of blood cells by the bone marrow This reduces the number of cells in the blood and can make you more vulnerable to infection, bleeding or bruising. It can also lead to anaemia (a lack of red blood cells). It is important to report any signs of bleeding, bruising or infection to your doctor. The bone marrow will return to normal when the treatment is stopped.

Effects on circulation  Interferon may alter the rhythm of the heart or affect your blood pressure, but this will go back to normal when the drug is stopped.

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Additional information

The doctors and nurses looking after you will monitor you closely during your treatment. You will probably be asked to give regular samples of your blood and/or urine. They will also take your temperature, pulse and blood pressure. These tests help to monitor the effects of the interferon on your body. If you are having your injections at home, you may need to attend regular outpatient appointments at your hospital so that the tests can be carried out.

Interferon should be kept in a refrigerator. Portable fridges can be bought from camping shops to store the interferon if you are away from home. There will be instructions about this in the patient information leaflet that you are given with your interferon.

For more information contact CancerBACUP’s Cancer Support Service.

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.

Interleukin-2 (Aldesleukin, Proleukin®)

  • What is interleukin?
  • What it looks like
  • How it is given
  • When is IL2 prescribed?
  • How often is it given?
  • How IL2 works
  • Possible side effects
  • Additional information
  • References

What is interleukin?

Interleukin-2 (IL2) is a protein produced naturally in the body in very small amounts. It is produced by a type of white blood cell called a T-lymphocyte. It works as part of the body’s defence mechanism (immune system) in fighting illness. IL2 can be made in the laboratory and is used as a treatment for some types of cancer.

What it looks like

IL2 is a white powder that forms a clear solution when dissolved in water.

How it is given

IL2 is given as an injection under the skin (subcutaneously). As the amount of IL2 that occurs naturally in the body is very small, IL2 treatment greatly increases the amount in the body.

When is IL2 prescribed?

IL2 can be used to treat a few different types of cancer. These include some kidney tumours and melanoma. It can be given on its own or in combination with other treatments.

How often is it given?

The length of the course of treatment, how often the injections are given and the dosage will vary according to the person’s general health and the type of cancer.

Most people have IL2 as an outpatient.

How IL2 works

IL2 is given to stimulate the body’s own defence mechanism to fight some types of cancer. The exact way in which it works is still not fully understood. However, it can stimulate white cells to recognise and destroy some cancer cells.

Possible side effects

Each person’s reaction to any drug is unique. Some people have very few side effects while others may experience more. The side effects described in this section will not affect everyone having IL2. We have outlined the most common side effects. However, we have not included those that are very rare, and therefore unlikely to affect you. If you notice any effects which you think may be due to the drugs, but which are not listed here, please let your nurse or doctor know.

The side effects of IL2 usually disappear once the treatment has finished and may include any of the following.

Flu-like symptoms  These can occur quite soon after you have had the drug, and some people feel quite unwell. You may have aching joints or muscles, a high temperature, a feeling of no energy (lethargy) and chills. If these symptoms do happen, it is important to drink plenty of fluids and get plenty of rest. Paracetamol is often prescribed to help reduce these effects.

Nausea and occasional vomiting  There are now very effective anti-sickness drugs to reduce or prevent this. If the sickness is not controlled, or continues, tell your doctor or nurse.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice.

Skin changes  IL2 may cause red, or darker, dry, itching skin, which may peel or blister. Your doctor can prescribe medicine and creams to help. If you already have a skin complaint such as psoriasis, IL2 may worsen it.

Tiredness and a general feeling of weakness  If this happens, it is important to allow yourself plenty of time to rest. CancerBACUP has further information on coping with tiredness.

Your kidneys may not work as well as usual  Your kidney function will be checked by a blood test before and during your course of treatment.

In some hospitals you will be asked to measure and record everything you drink and the amount of urine that you pass. You may be given medicine to help you pass urine if you do not pass enough.

Fluid retention  You may notice that you put on weight, and/or that your face, ankles and legs swell. This improves slowly once your treatment has finished. Sometimes drugs can be given to help to reduce the swelling.

Anaemia is a low number of red blood cells. Symptoms of anaemia include lethargy (a feeling of having no energy) and tiredness. If you feel very tired, tell your doctor or nurse.

Changes in the way your heart works and lowering of blood pressure  In some people, IL2 can affect how the heart works. The effect on the heart depends on the dose given. The hospital team will check your blood pressure regularly during treatment. It is important to tell your doctor if you feel dizzy, faint or have any chest pain.

Additional information

Some patients having IL2 treatment have to stay in hospital for close monitoring. This may be needed if treatment is given at higher doses than normal, when side effects may be more severe.

Some patients give their own injections at home. If this is the case you must keep your IL2 in the refrigerator.

For more information contact CancerBACUP’s Cancer Support Service.

References

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

  • Martindale: The Complete Drug Reference (33rd edition). Eds. Sweetman et al, Pharmaceutical Press, 2002.
  • British National Formulary (46th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2003.
  • The Chemotherapy Source Book (3rd edition). MC Perry. Lippincott Williams and Wilkins, 2001.

For further references, please see the general bibliography.

Biological therapies

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