The drugs you may have

It is most common to have two or more chemotherapy drugs together to treat cancer. You may hear this called combination chemotherapy. Using two or more drugs together is often more effective than using one drug. The main drugs used in the treatment of nasopharyngeal cancers are Cisplatin Fluorouracil (5-FU) Other chemotherapy drugs that have been used more recently for nasopharyngeal cancers include Docetaxel (Taxotere) Paclitaxel (Taxol) Gemcitabine These links will take you to information about the specific side effects of each drug.
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Chemoradiation drugs
If you have stage 3 or 4 nasopharyngeal cancer you are likely to have chemotherapy and radiotherapy at the same time (known as chemoradiation or synchronous treatment). Some people with stage 2 nasopharyngeal cancer may also have this treatment. You may have one of the following chemotherapy drugs Cisplatin Cisplatin and 5FU Carboplatin Paclitaxel (Taxol) Docetaxel (Taxotere) Some of this treatment is experimental and you may have it as part of a clinical trial. Doctors use the results from clinical trials to improve treatment for head and neck cancers in the future. There is information about the side effects of chemoradiation on the next page in this section.
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How you have chemotherapy

You usually have chemotherapy as cycles of treatment. You have these drugs through a drip (intravenous infusion) into your arm, usually once every 3 or 4 weeks. Or you may have the drugs through a tube going into your chest called a central line or portacath. Each 3 or 4 week period is known as one cycle of treatment. You will probably have between 3 and 4 cycles. Your own doctor will decide the exact amount and number of treatments you have. So the complete chemotherapy course can take several months or more. If you have chemoradiation, you usually have chemotherapy once a week or every 3 weeks during the radiotherapy course.
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What cisplatin is
Cisplatin is a chemotherapy drug that is used to treat different types of cancer, including testicular cancer, germ cell cancer, head and neck cancer, bladder cancer, cervical cancer, and non small cell lung cancer. At the centre of this drug is an atom of the metal platinum.
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How you have cisplatin

You have cisplatin into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through acentral line, a PICC line or a portacath. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. You usually have chemotherapy as a course of several cycles of treatment. We have detailed information about how chemotherapy treatment is planned on the planning chemotherapy page. You usually have cisplatin every 3 or 4 weeks. Or you may have it each week. We've listed the side effects that cisplatin can cause below. You can use the links (underlined) to find out more about each side effect. Where is no link please use the search box at the top of the screen. You can also look in the section about the side effects of cancer drugs.
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Common side effects

More than 10 in every 100 people have one or more of the side effects listed below. A temporary drop in the number of blood cells made by the bone marrow, causing
Increased risk of getting an infection from a drop in white blood cells it is harder to fight

infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery Tiredness and breathlessness due to a drop in red blood cells (anaemia) you may need a blood transfusion Bruising more easily due to a drop in platelets you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia) Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working. Other common side effects include

 Tiredness (fatigue) during and after treatment most people find their energy levels are back

to normal within 6 months to a year Feeling or being sick can be severe it may begin a few hours after treatment and last for a few days. It is usually possible to control this side effect with anti sickness injections and tablets but if you are still being sick, tell your doctor or nurse Cisplatin can cause kidney damage you will have blood tests before your treatment, to make sure your kidneys are able to cope with the drug. To help prevent damage it is important to drink plenty of water and you will have fluids into your vein before and after your treatment You may have some hearing loss, especially with high pitched sounds This drug may have a harmful effect on a developing baby you should not become pregnant or father a child while taking this drug. Discuss contraception with your doctor or nurse before having the treatment, if there is any possibility that you or your partner could become pregnant.
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Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.
Women may stop having periods (amenorrhoea) but this may only be temporary Loss of fertility you may not be able to get pregnant or father a child after treatment with

this drug. It is important to talk to your doctor about your fertility before starting treatment
Loss of appetite may occur a few days after your treatment Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing

up buttons this starts within a few days or weeks and usually goes within a few months of finishing treatment. Some people may have permanent numbness Ringing in the ears (tinnitus) happens in about 3 in 10 people (30%), but nearly always gets better on its own Loss of taste or a metallic taste may occur
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Rare side effects

A very small number of people have an allergic reaction while having cisplatin, usually at the first or second treatment. Let your treatment team know immediately if you have any skin rashes, itching, feeling hot, shivering, redness of the face, feeling dizzy, headache, shortness of breath, anxiety, or a sudden need to pass urine.
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High dose side effects

Blurred vision can be a side effect of high doses of cisplatin. This will go back to normal once the treatment has finished. Or you may notice that you find it difficult to tell the difference between certain colours. This may carry on for a while after treatment has finished, but will usually get better on its own eventually.
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Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
How many times you've had the drug before Your general health The amount of the drug you have (the dose) Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them. Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies some drugs can react together.
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Immunisations and chemotherapy

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

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website atwww.medicines.org.uk. If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

What fluorouracil is
Fluorouracil is also known as FU or 5FU and is one of the most commonly used drugs to treat cancer. It is used to treat many types of cancer including, breast cancer, head and neck cancers, anal cancer, stomach cancer, colon cancer and some skin cancers.
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How fluorouracil works

Fluorouracil is part of a group of chemotherapy drugs known as anti metabolites. Anti metabolites are similar to normal body molecules but they have a slightly different structure. These differences mean that anti metabolites stop cells working properly. They stop cells making and repairing DNA. Cancer cells need to make and repair DNA so that they can grow and multiply. Anti metabolites also stop normal cells working properly. This is why you get side effects.
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How you have fluorouracil

You can have fluorouracil as an injection or drip (infusion) into a vein (intravenously). It can also be used as an ointment called Efudix for skin cancer. You can have fluorouracil intravenously through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. You usually have intravenous fluorouracil as part of a course of several cycles of treatment. The exact treatment plan depends on which type of cancer you have. To find out more about the way chemotherapy treatment is planned look at our planning chemotherapy page. You may have the fluorouracil over several days through a drip or using a small pump that you carry around. Some other medicines can stop fluorouracil working so well. Or the fluorouracil can change how some other medicines work. You should tell your doctor if you are taking the anti epileptic drug phenytoin or the blood thinning drug warfarin. The fluorouracil can interfere with how your body absorbs these drugs.

The side effects associated with intravenous fluorouracil are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, please see our cancer drugs side effects section or use the search box at the top of the page.
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Common side effects

More than 10 in every 100 people have one or more of the side effects listed below. Temporary drop in the number of blood cells made by the bone marrow, causing
Increased risk of getting an infection from a drop in white blood cells it is harder to fight

infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery Tiredness and breathlessness due to a drop in red blood cells (anaemia) you may need a blood transfusion Bruising more easily due to a drop in platelets you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia) Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working. Other common side effects include
Tiredness (fatigue) during and after treatment most people find their energy levels are back

to normal from 6 months to a year after their treatment finishes Feeling or being sick, which is usually mild Mouth sores and ulcers Diarrhoea you need to drink plenty of fluids. If the diarrhoea becomes severe or continues you could get dehydrated so tell your doctor or nurse Heart problems, such as angina, heart failure or a heart attack let your doctor or nurse know if you have any chest pain This drug may have a harmful effect on a baby developing in the womb. It is not advisable to become pregnant or father a child while having chemotherapy. It is important to talk to your doctor or nurse about contraception before having the treatment
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Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.
Hair thinning

 Brittle, chipped and ridged nails Sensitivity of the skin to sunlight you should not use sunbeds or sit in the sun if having

fluorouracil. Cover up or use a sun block Rashes, which may be itchy Watery eyes from increased production of tears Gritty eyes and blurred vision Loss of appetite Brown marking on the skin following the line of the vein where fluorouracil has been injected Continuous infusion of fluorouracil can occasionally cause soreness, redness and peeling on the palms of the hands and soles of the feet (palmar plantar syndrome) which may cause tingling, numbness, pain and dryness
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Rare side effects

Fewer than 1 in 100 people have these.
Total hair loss Darkened skin Confusion or unsteadiness Women may stop having periods (amenorrhoea) but this may only be temporary Loss of fertility you may not be able to get pregnant or father a child after treatment with

this drug. It is important to talk to your doctor about your fertility before starting treatment
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Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
How many times you've had the drug before Your general health The amount of the drug you have (the dose) Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them. Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies some drugs can react together.
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Immunisations and chemotherapy

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

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website atwww.medicines.org.uk. If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk

What docetaxel is
Docetaxel is one of the taxane type drugs that were originally developed from the yew tree. Docetaxel is a man made drug that was first made from yew tree needles. It is also known by its brand name, Taxotere. It works by stopping the cancer cells from separating into 2 new cells, so it blocks the growth of cancer. It is a treatment for
Breast cancer Lung cancer Head and neck cancer Prostate cancer Stomach cancer

You may also have it as part of trials for other types of cancer such as ovarian cancer and bladder cancers.
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How you have docetaxel treatment

Docetaxel is a liquid that you have through a drip (infusion) into a vein (intravenously). Each infusion takes about an hour and you have one every 1 to 3 weeks, depending on the type of cancer you have. You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. You usually have chemotherapy as a course of several cycles of treatment. There is detailed information about planning chemotherapy in the main chemotherapy section. Docetaxel can cause an allergic reaction. To try to prevent this, your doctor or nurse will give you steroid tablets to take, usually for 3 days, starting the day before each treatment. For prostate cancer your steroid treatment usually starts 12 hours before your chemotherapy. You will then have 2 further doses at 3 hours before treatment, and 1 hour before treatment. The side effects associated with docetaxel are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, see the cancer drug side effects section or click on 'search' at the top of the page.
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Common side effects

More than 10 in every 100 people have one or more of the side effects listed below. A temporary drop in the number of blood cells made by the bone marrow, causing
An increased risk of getting an infection from a drop in white blood cells it is harder to fight

infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery Tiredness and breathlessness due to a drop in red blood cells (anaemia) you may need a blood transfusion Bruising more easily due to a drop in platelets you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia) Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

Fatigue (tiredness) during and after treatment most people find their energy levels are back

to normal from 6 months to a year after their treatment finishes Hair loss your hair normally falls out completely and this affects 8 out of 10 people treated. A cold cap may help to stop your hair falling out, but you need to talk to your doctor about whether this is advisable with your type of cancer Fluid retention occurs in about 5 out of 10 people you may have swelling of the hands and feet, breathlessness, and weight gain. The steroids you have with the drug can help to prevent this side effect A rash, which may be itchy, in about 5 out of 10 people
Discoloured fingernails but they will go back to normal a few months after the treatment ends Soreness, redness and peeling on the palms of the hands and soles of the feet (palmar

plantar syndrome), which may cause tingling, numbness, pain and dryness A sore mouth in about 4 out of every 10 people Diarrhoea in about 4 out of every 10 people Numbness and tingling in hands and feet you may have a change in how things feel when you touch them, which can make doing fiddly things difficult (for example doing up buttons) An allergic reaction during the infusion more than 2 out of 10 people have an allergic reaction to docetaxel. This nearly always happens in the first 10 minutes. If you are going to have a reaction, it is most likely the first or second time you have the drug. Your chemotherapy nurse will monitor you closely Watery eyes let your doctor or nurse know if you have watery eyes as they may be able to prescribe medicines to help
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Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.
Feeling or being sick is usually mild and lasts for only a short time after each treatment Women may stop having periods (amenorrhoea) but this may only be temporary Loss of fertility this drug can stop men being able to father children and may cause an early

menopause in some women. It is important to talk to your doctor before starting treatment if having a baby is important to you Aching muscles and joints A high temperature (fever) Inflammation around the drip site if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately
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Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
How many times you've had the drug before Your general health The amount of the drug you have (the dose) Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems.

Other medicines
Docetaxel can interact with some other medicines and herbal products. Tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

Docetaxel may have a harmful effect on a baby developing in the womb. You should not become pregnant or father a child whilst taking this drug. Discuss contraception with your doctor before you start your treatment if there is any possibility that you or your partner could become pregnant. Men need to continue using contraception for 6 months after treatment ends.

Breastfeeding
Breastfeeding is not advisable during docetaxel treatment because the drug may come through in the breast milk.
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Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine). You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine. It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have

these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
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More information about docetaxel

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you.