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De Gramont

Find out what de Gramont is, how you have it and other important information about having de Gramont. 

De Gramont describes a way of giving the chemotherapy drug fluorouracil (5FU) in combination with folinic acid (calcium folinate or leucovorin).

It is a treatment given after surgery for bowel cancer. 

There is also a modified de Gramont combination. This includes the same drugs but you have them in a slightly different way. 

How it works

Fluorouracil is a chemotherapy drug that works by destroying quickly dividing cells, such as cancer cells. Folinic acid makes the fluorouracil work better.

How you have it

You have fluorouracil and folinic acid into your bloodstream (intravenously).

Drugs into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

You usually have chemotherapy as cycles of treatment. Each cycle lasts 2 weeks and you may have up to 12 cycles, taking 6 months. Each cycle is given in the following way.

Day 1
  • You have folinic acid as a drip (infusion) into your bloodstream over 2 hours.
  • You have fluorouracil as a drip or as a small portable pump into your bloodstream over 22 hours.

You might need to stay in hospital overnight to have this treatment if you don't have a central line.

If you have a central line you can have the fluorouracil through a small portable pump. The pump attaches to the end of the central line and you can easily carry it in a small bag or on a belt. You can go home with the pump. It gives a small amount of fluorouracil continuously over 22 house. 

Day 2
  • You have folinic acid as a drip (infusion) into your bloodstream over 2 hours.
  • You have fluorouracil as a drip or as a small portable pump into your bloodstream over 22 hours.

If you have a central line you go back to the hospital in the morning and have your fluorouracil pump disconnected. You stay in hospital for the 2 hour drip of folinic acid and then begin another 22 hour pump of fluorouracil. 

Some people have enough fluorouracil in a pump to last for 44 hours. If this happens you will need to go back to the hospital to stop the pump after 22 hours and have your second dose of folinic acid. Or a nurse may come to your home to set up the folinic acid drip. 

Day 3 to 14
  • You have no treatment.

This is one treatment cycle. You then start another cycle.

Modified de Gramont

If you have the modified de Gramont treatment, you have a 2 hour drip of folinic acid on the first day. This is followed by an injection of fluorouracil which takes a few minutes. You then go home with a portable pump. The pump gives the correct dose of fluorouracil over 46 hours.

On the third day you go back to the hospital to have the pump disconnected. Or a nurse can come to your home to do this. You then have 12 days with no treatment before starting another cycle.

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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