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Monday, October 19, 2009

VELCADE SIDE EFFECTS

Velcade is given as an injection through a needle placed into a vein.

You will receive this injection in a clinic or hospital setting. A doctor, nurse, or other healthcare provider will give you this injection.

Velcade is usually injected 2 times a week for 2 weeks, followed by 10 days without an injection. Velcade may also be given once a week for 4 weeks followed by 13 days without an injection. Follow your doctor's instructions about your individual dosing schedule.

Velcade can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. Do not miss any scheduled appointments.
What happens if I miss a dose?

Call your doctor for instructions if you will miss an appointment for your Velcade injection.
What happens if I overdose?

Seek emergency medical attention if you think you have received too much of this medicine.

Overdose may cause weakness, bruising or bleeding, pinpoint red spots on your skin, and fainting.
What should I avoid while receiving Velcade?

Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.

Avoid becoming dehydrated if you have any vomiting or diarrhea. Symptoms of dehydration include dizziness, dry mouth, fainting, or hot and dry skin. Talk with your doctor about how best to keep yourself hydrated.

Velcade can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Dizziness may be more likely to occur when rising from a sitting or lying position. Get up slowly to keep from falling.


Get emergency medical help if you have any of these signs of an allergic reaction to Velcade: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

new or worsening nerve problems such as numbness, burning, pain, weakness, or tingly feeling;

feeling like you might pass out;

dry cough and trouble breathing;

severe headache, vision problems, confusion, and/or seizure (convulsions);

black, bloody, or tarry stools, vomit that looks like blood or coffee grounds;

severe constipation;

easy bruising or bleeding, unusual weakness;

fever, chills, body aches, flu symptoms;

feeling short of breath, even with mild exertion;

fast or slow heart rate, weak pulse, lower back pain, blood in your urine;

urinating less than usual or not at all;

muscle weakness, tightness, or contraction, overactive reflexes; or

nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious Velcade side effects may include:

mild nausea, vomiting, upset stomach;

diarrhea, constipation;

headache, blurred vision, dizziness;

muscle pain, bone or joint pain;

sleep problems (insomnia);

mild rash or itching; or

skin irritation where the medicine was injected.

VELCADE SIDE EFFECTS IN NUMBERS:

Feeling sick affects just over 6 in 10 people (60%) but is usually well controlled with anti sickness drugs
Fatigue affects about 1 in 2 people taking this drug (50%)
Loss of appetite affects about 4 in 10 people (40%)
Diarrhoea affects around 6 out of 10 people (58%) – it is usually mild but tell your doctor or nurse as you can have medicines to stop it
Increased risk of getting an infection due to a drop in the number of white blood cells – you may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. Infections can sometimes be life threatening. You should urgently contact your hospital if you think you have an infection
About 1 in 10 people (10%) get shingles (herpes zoster virus) you may have to take an anti viral drug to prevent this
Bruising and bleeding due to a drop in platelets occurs in 4 out of 10 people (40%) – low platelets may also cause nosebleeds or bleeding gums after brushing teeth so if you see blood in your stool or vomit or have lots of tiny red spots or bruises on arms or legs (petechiae), contact your hospital straight away
Tiredness and breathlessness due to a drop in red blood cells (anaemia) affects about 3 out of 10 people (30%) – you may need a blood transfusion to treat anaemia
Numbness, tingling or a burning sensation in fingers and toes affects 3 out of 10 people (30%) – tell your doctor if you have a change in feeling in your hands or feet as they may need to lower your dose
A high temperature (fever) for a few hours after having the drug affects about 1 in 3 people (33%)
Headaches affect about 1 in 4 people (25%)
Skin changes – about 1 out of 4 people (25%) have a rash or very red, dry, itchy skin
Taste changes affect just over 1 in 10 people (13%)
Indigestion affects 1 in 10 people (10%)
Constipation – if you have constipation tell your hospital doctor straight away
Breathless and a cough affect about 1 in 4 people (25%)
Low blood pressure (hypotension) affects just over 1 in 10 people (12%) – this can make you feel lightheaded or dizzy
Blurred vision – about 1 in 10 people (11%) have this but it is usually mild
Pain in your muscles, bones or tummy (abdomen)
Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug.
It is important to talk to your doctor about your fertility before starting treatment
We don’t know whether bortezomib can harm a developing baby – so talk to your doctor about contraception before having treatment if there is any chance you or your partner could become pregnant

Occasional side effects
Some people may have one or more of the following side effects
Flu like symptoms
Swelling of ankles and legs due to a build up of fluid (oedema) affects 1 in 20 people (5%) but is usually mild
Hiccups
Changes in mood – you may feel anxious or low
Dehydration – drink plenty of fluids (around 2 litres a day) to prevent dehydration

Rare side effects
Few people may have some of the following effects:
Heart problems, including chest pain, affect fewer than 1 in 100 people (1%) - contact your doctor as soon as possible if you have chest pain
Mild changes in how your liver works - this is unlikely to cause symptoms, and your liver will almost certainly go back to normal after the treatment ends
Kidney problems may cause difficulty or pain passing urine, needing to pass urine often or blood in your urine - tell your doctor if you have any of these problems.

Important points to rememberNot everyone will get these side effects. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. The side effects depend on
How many times you've had the drug before

Your general health

The amount of the drug you have (the dose)
Other drugs you are having
Some side effects are inconvenient or upsetting but not damaging to your health.
Some side effects are serious medical conditions and need treating. Where we tell you to contact your doctor, it is because
Your side effect may need treating
Your drug dose may need reducing to try to prevent the side effect.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, alternative therapies and over the counter remedies – some drugs can react together. A study in mice published in 2009 found that green tea may stop bortezomib (velcade) from working properly, so the authors of the study strongly recommend that people taking bortezomib do not drink green tea or take any green tea preparations.
Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them.

Immunisations:

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

EFFETS SECONDAIRES DU VELCADE

Le bortézomib : Velcade

Médicament récent d’une nouvelle classe thérapeutique, inhibiteur du protéasome. Le concept d'inhibition du protéasome (ou ubiquitine-protéasome) a apporté une réelle avancée dans le domaine des thérapies ciblées anticancéreuses. Le bortezomib est le premier inhibiteur sélectif de ce protéasome à avoir démontré une activité anti-tumorale en agissant sur les mécanismes de régulation de la croissance des cellules.
Ce traitement est utilisé en injection intraveineuse 2 fois par semaine, 2 semaines sur trois, pendant 8 cycles.
Le bortézomib a une toxicité que l’on commence à bien connaître du fait de son utilisation régulière en rechute. Les injections peuvent provoquer une fatigue générale et des troubles digestifs à type de diarrhées ou à l’inverse de constipation. Ce traitement ne provoque pas d’alopécie, ni d’aplasie profonde, mais parfois on observe une thrombopénie (baisse des plaquettes dans le sang) modérée et contrôlable sans complications hémorragiques majeures. Le problème principal du bortézomib est une toxicité neurologique périphérique, qui s’exerce par un mécanisme différent du thalidomide. Les neuropathies surviennent plus tôt, en moyenne au cours du 3ème mois de traitement, elles sont douloureuses et elles ont la particularité d’être très souvent réversibles, en 3 à 4 mois. Elles sont traitées efficacement par certains médicaments de type Neurontin, Rivotril ou Laroxyl.

http://sante-az.aufeminin.com/w/sante/m5649573/medicaments/velcade/detail.html

VELCADE SIDE EFFECTS

Taking Care of Yourself While Taking Velcade

If you take Velcade, your health care provider will give it to you as an injection. Velcade may be a particularly good first choice of myeloma therapy if you have kidney problems, which are a common complication in patients with multiple myeloma, Redei says. Your body doesn't get rid of the drug through the kidneys, nor does the drug affect the functioning of your kidneys.

However, a common side effect of Velcade is peripheral neuropathy, which is damage to your nerves. This may cause pain, tingling, numbness, and possibly weakness in your hands and feet, Redei says. Your doctor may need to reduce your dosage if this side effect becomes too severe.

In addition, if you lose sensation in your feet or hands from this myeloma therapy, it's wise to take the following precautions:
Check your feet regularly for blisters, cuts, and other small injuries that you might not be able to feel.
Get the right shoes. Help protect your feet by wearing properly fitting shoes instead of going barefoot.
Enlist help. For example, have someone else feel your bath or shower water before you get in to ensure that it's not too hot.
Injury-proof your home. Ensure that your home is free from clutter and other obstacles that could cause you to trip; have secure handrails at stairs, and keep your home well-lit. People with peripheral neuropathy may be prone to falling, and people with multiple myeloma are at higher risk of broken bones.

http://www.everydayhealth.com/multiple-myeloma/velcade-treatment.aspx

Sunday, October 18, 2009

NOUVEAU TRAITEMENT POUR LE LYMPHOME DU MENTEAU

APRES LE PREMIER TRAITEMENT AU MABTERA ET QUI A DURE PENDANT 6 MOIS,POUR 8 SEANCES DE QUATRE JOUR,CHAQUE 20 JOUR ,
JE RECOIT UN NOUVEAU TRAITEMENT AVEC UN NOUVEAU MEDICAMENT:
VELCADE,
POUR UNE DUREE DE TROIS MOIS,A RAISON DE 2 JOURS PAR SEMAINE EXAMPLE: LUNDI -JEUDI,2 SEMAINES A LA SUITE = 4 FOIS PUIS UN REPOS DE 10 JOURS PUIS ON RECOMENCE.
CE QUI VEUT DIRE QU'A LA FIN J'AURAIS FAIT 16 SEANCES DE VELCADE.

Sunday, March 15, 2009

CHEMOTHERAPY TIMELINE PROTOCOL PROBLEMS AND MANAGEMENT

 
                 CHOP-R PROTOCOL
Other names: LYCHOP-R
C 
Cyclophosphamide
H
Doxorubicin (also known as ADRIAMYCIN®)
O
Vincristine (also known as ONCOVIN®)
P
Prednisone (taken by mouth)
R

Rituximab (also known as RITUXAN®

Uses:
• CHOP-R is a drug treatment given for Non-Hodgkin’s Lymphoma with the
expectation of destroying cancer cells.
• CHOP-R is currently offered to patients with Non-Hodgkin’s Lymphoma
(diffuse large B-cell).
Treatment Plan:
• Your treatment plan consists of several (up to 8) chemotherapy cycles. Each
cycle lasts 3 weeks (21 days). For each cycle you will have four
chemotherapy drugs, plus a drug called prednisone taken as a pill by mouth.
• Your very first treatment cycle will be over 2 days. The first day (Day 1) will be
about 2 hours; the next day (Day 2) plan to spend about 5 hours in the
treatment room. Each cycle thereafter will be approximately 3 hours. You
may receive all the drugs on Day 1 or you may receive the drugs on two
separate days (Day 1 and 2). You will take the oral medication, prednisone,
daily for the first five days of each cycle.
• The day before each scheduled chemotherapy treatment you will have a
blood test and an appointment with your nurse and doctor to assess how you
are tolerating your treatment.
Drugs:
• Five chemotherapy drugs (cyclophosphamide, doxorubicin, vincristine,
prednisone and rituximab) will be given at each cycle. All drugs, except the
prednisone, are given by injection into a vein. Rituximab may be given on
separate days throughout the treatment or may be given the same day (Day
1) after the first cycle.
• You will be given an oral medication (prednisone) to start on Day 1 and you
will need to take this daily for a total of 5 days (Days 1-5).
• You will be given a prescription for anti-nausea pills to help prevent nausea
and vomiting. Fill this prescription at your drugstore. Please also buy
acetaminophen 325 mg and diphenhydramine 25 mg, you will need these
prior to rituximab.
 

2
• During the rituximab infusion, the nurse will monitor your heart rate, breathing
and blood pressure at frequent intervals.
• During the course of your treatment, your oncologist (cancer doctor) may
decide that you need a drug called filgrastim (also known as G-CSF,
granulocyte colony stimulating factor, NEUPOGEN®) to improve your white
blood cell count. If it is needed, the drug is given as an injection under the
skin (subcutaneous, SC) daily for 3 to 5 days, starting a few days after the
chemotherapy (your doctor will specify when to start this). Your nurse will
teach you or a family member how to give a SC injection. The filgrastim
prescription is filled at your community pharmacy and, since it is not
commonly available the drugstore may require 1-2 days to obtain the drug.
• A blood test will be taken prior to each cycle of treatment. Your doctor will
determine whether you need filgrastim based on your blood counts; the dose
of chemotherapy may be changed based on your blood tests and/or other
side effects.
• If needed, radiation therapy will start approximately 3-4 weeks after your last

cycle of chemotherapy.

Instructions:
• Bring your anti-nausea drugs, and the acetaminophen and diphenhydramine
with you to take before each IV treatment. The nurse will instruct you when to
take your pills. You may also need to take anti-nausea drugs at home after
the chemotherapy. It is easier to prevent nausea than treat it once it has
occurred, so follow directions closely.
• Call your cancer doctor immediately (day or night) at the first sign of any
infection but especially if you have a fever over 38°C or 100°F.
• Check with your doctor or pharmacist before you start taking any new drugs.
Other drugs such as barbiturates, digoxin (LANOXIN®), ciprofloxacin
(CIPRO®) and similar antibiotics, phenytoin (DILANTIN®), carbamazepine
(TEGRETOL®), ketoconazole (NIZORAL®) and similar antibiotics, nifedipine
(ADALAT®), blood pressure medications and warfarin (COUMADIN®), may
interact with CHOP-R.
• We may ask you to skip your dose of blood pressure medication 12
hours before and during rituximab treatment.
• Drink 8-12 cups of liquid a day on the day of your treatment and the day after
your treatment. Empty your bladder (pass urine) every 2 hours while you are
awake and at bedtime for at least 24 hours after your treatment. Your doctor
may also tell you to get up in the night to empty your bladder. This helps
prevent bladder and kidney problems.
• You may drink small amounts of alcohol, as it will not affect the safety or
effectiveness of your treatment. Drinking alcohol may increase the risk of
some side effects of prednisone; discuss this with your doctor or pharmacist.
 

3
• Tell other doctors or dentists that you are being treated with CHOP-R
chemotherapy before you receive any treatment from them.
• Use effective contraception (birth control) if you could become pregnant or if
your partner could become pregnant. Becoming pregnant while on
chemotherapy will likely harm the baby. Do not breast feed.
Serious Side Effects:
Unexpected and unlikely side effects can occur with any drug treatment.
The ones listed below are particularly important as they are directly related
to the common actions of the drugs in your treatment plan.
• Infection: The number of white blood cells that help fight infections will be
lowered by the treatment. Your blood count is expected to return to normal by
Day 1 of the next cycle. If your white blood cell count becomes very low you
could get a serious infection. If you have a fever over 38ºC or 100ºF, call
your cancer doctor immediately (24 hours a day) or go immediately to
your nearest Hospital Emergency and tell the doctor that you are on
chemotherapy. It is recommended you have a working thermometer at
home.
• Allergic Reaction: Rituximab can cause allergic type reactions during or
hours after your treatment. Report any light-headedness or dizziness,
difficulty breathing, shortness of breath, cough, rash, skin flushing, itchy skin,
tickle in throat, or chest tightness to your chemotherapy nurse immediately.
• Bleeding Problems: If you develop black tarry stools, blood in your urine,
pinpoint red spots on the skin, or prolonged nose bleeds report them
immediately to your doctor or nurse.
• Tissue Injury: Doxorubicin and vincristine can cause tissue injury if they leak
out of the vein while they are being given. Report any sensation of burning,
stinging or pain to your chemotherapy nurse immediately.
• Early menopause: If you are a woman still having menstrual periods, CHOP-
R may cause your ovaries to stop working, resulting in menopausal
symptoms (such as hot flashes) and infertility. Your periods may stop. This
may be permanent especially if you are 40 years of age or older.
• Heart failure: Rarely, doxorubicin can have an effect on the heart in some
patients causing failure of the heart’s pumping action which results in
shortness of breath, fatigue and leg swelling. Report shortness of breath,
chest pain, or a fast or uneven heart beat to your doctor immediately.
• Bladder problems: Rarely, cyclophosphamide may cause damage to the
lining of the bladder. Report any signs of blood in urine, frequent need to
pass urine, or pain on passing urine to your doctor immediately.
 

4
Common Side Effects and Management:
SIDE EFFECTS:
 
Nausea and vomiting can occur with this
treatment and you will need to take anti-
nausea medications before and after your
chemotherapy.
You will be given a prescription for anti-
nausea drugs to take before your IV
treatment and later at home.
• It is easier to prevent nausea than
treat it once it has occurred, so follow
directions closely.
• Refer to the following pamphlets: For
the Patient: Managing Nausea;
Chemotherapy & You; Food choices to
help control nausea*
Fevers and chills may occur especially
during the first Rituximab treatment.

MANAGEMENT:

You will take acetaminophen (eg,
TYLENOL®) and diphenhydramine (eg,
BENADRYL®) before and every 4 hours
during your rituximab treatment. Tell
your nurse immediately if you have a
reaction during treatment.
Hives, a type of allergic reaction, may
occur. Hives are red or pale raised
patches on your skin and are usually itchy.
These reactions usually occur during or up
to 24 hours after the infusion.
• Take diphenydramine (eg,
BENADRYL®) 25 or 50 mg up to 4 times
a day. (Note: diphenhydramine causes
drowsiness)
Hair Loss. Your hair will fall out 2-4
weeks after treatment begins. Your scalp
may feel tender. You may lose hair on
your face and body. Your hair will grow
back once your treatments are over and
sometimes between treatments. The
colour and texture of the new hair growth
may be different.
• Cutting your hair short or shaving your
head may be more comfortable.
• Avoid hair spray, bleaches, dyes and
perms.
• Apply mineral oil to your scalp to
reduce itching.
• If you lose your eyelashes and
eyebrows, protect your eyes from dust
and grit with a broad-rimmed hat and
glasses.
• Ask your nurse about information on
wigs and head coverings.
 


SIDE EFFECTS:
 
Mouth Sores may occur a few days after
treatment. Mouth sores can occur on the
tongue, gums and sides of the mouth or in
your throat. Mouth sores or bleeding

gums can lead to an infection.

FATIGUE AND BODY ENERGY SLOW DOWN

PLATLETS DOWN

MANAGEMENT:

Brush your teeth gently after eating

and at bedtime with a soft toothbrush.
If your gums bleed use gauze instead
of a brush. Use baking soda instead of
toothpaste.
• Try baking soda mouth rinses (using ¼
tsp baking soda in 1 cup warm water)
and rinse several times a day. Try
ideas in Easy to chew, easy to swallow
food ideas*.
• Tell your doctor about a sore mouth, as
your chemotherapy doses may need to
be decreased if mouth sores are
severe.
Fatigue is common especially in the first
1-2 weeks after your treatment. As the
number of cycles increases fatigue may
get worse.
• Your energy level should slowly
improve (weeks – months) after your
final treatment is completed.
• Refer to the pamphlet ‘Your Bank to
Energy Savings-How people with
cancer can handle fatigue’

Your platelets may decrease

AVOID FOOD THAT CAN DRAW PLATLETS DOWN:

ONION,GARLIC,GRAPEFRUIT

6-13 days after your treatment. They will
return to normal with time. Platelets help
your blood clot if you cut yourself. You
may bruise or bleed more easily than
usual.
To help prevent bleeding problems:
• Try not to bruise, cut or burn yourself.
• Clean your nose by blowing gently; do
not pick your nose.

• Avoid constipation:

EAT DRYIED FRUITS SUCH AS PRUNES

• Avoid ASA (eg, ASPIRIN®) unless
recommended by your doctor.
• For minor pain use acetaminophen
(TYLENOL®). Take your temperature
prior to taking acetaminophen-
containing products.
• Do not take common painkillers such
as ibuprofen (eg, ADVIL®, MOTRIN®)
 

6
SIDE EFFECTS:
 
Severe constipation could occur due to

vincristine.

MANAGEMENT:

• See your doctor as soon as possible if
you get severe constipation.
• Drink plenty of fluids
• Add prunes or prune juice to diet
• Eat foods high in fibre such as bran,
whole grain breads and cereals, nuts,

raw fruits and vegetables.


SIDE EFFECTS :

Numbness or tingling of fingers or toes

could occur due to vincristine.

MANAGEMENT:

• Numbness and tingling of the toes and
fingers will slowly return to normal after
your last chemo.
• Tell your doctor at your next visit if you
develop numbness or have trouble
picking up small objects, doing up
buttons or writing.
• Be careful handling sharp, hot or cold

objects.

SIDE EFFECTS:

Your urine may be pink or reddish for 1-
2 days after your treatment.
This is expected as doxorubicin is red and
is passed in your urine.
Sugar control may be affected in people

with diabetes.

MANAGEMENT:

Check your blood sugar regularly if you
are diabetic. See your doctor if your have
signs of blood sugar problems such as

thirst and frequent need to pass urine.

SIDE EFFECTS:

Increased energy and difficulty
sleeping may be due to prednisone.
• The days you take your prednisone
you may feel as though you have extra
energy.
• You may also have difficulty sleeping

at night.

MANAGEMENT:

• Take the prednisone first thing in the
morning to prevent insomnia at night.
 

7
If you experience symptoms or changes in your body that have not
been described above but worry you, tell your doctor about them at the
time of your next visit.
If you have symptoms that are severe or need emergency services, go
to your local hospital’s Emergency Department.
 

BEIRUT CANCER

THIS IS MY CANCER BLOG FROM BEIRUT