This page tells you about the chemotherapy drug combination CTD and its possible side effects. There is information about
You usually have CTD chemotherapy as cycles of treatment. Each cycle of treatment lasts either 3 or 4 weeks. Depending on your needs you may have up to 6 cycles. So the course lasts about 6 months in total.
You take all of the drugs as tablets or capsules. Day 1 is the first day of a cycle of treatment.
3 weekly cycle
- Cyclophosphamide – you take this once a day on days 1, 8 and 15 and swallow the tablets whole, ideally on an empty stomach
- Thalidomide – you take this once a day for the whole 3 week cycle. Take the capsules with a glass of water, at night. Your doctor may tell you to increase the dose after a while if the side effects are mild
- Dexamethasone – you take the tablets once a day from days 1 to 4 and days 12 to 15. Take them after a meal, or with milk, because they can irritate your stomach lining. They can make it difficult to sleep but taking them early in the day can reduce this effect
On day 21, you have completed one cycle of your treatment. You start the next cycle on the following day.
4 weekly cycle
- Cyclophosphamide – you take this on days 1,8,15 and 22 and swallow the tablets whole, ideally on an empty stomach
- Thalidomide – you take this once a day for the 4 week cycle. Take the capsules with a glass of water, at night. Your doctor may tell you to increase the dose after a while if the side effects are mild
- Dexamethasone – you take the tablets once a day on days 1 to 4 and days 15 to 18. Take them after a meal, or with milk, because they can irritate your stomach lining. They can make it difficult to sleep but taking them early in the day can reduce this effect
On day 28 you have completed one cycle of treatment. You then start the next cycle on the following day.
It is very important to take the tablets and capsules according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
The side effects associated with CTD treatment are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have one or more of these effects.
- 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, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
- 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)
- Numbness or tingling in fingers and toes affects about 5 out of every 10 people (50%) – this starts within a few days or weeks. It can cause difficulty with fiddly things such as doing up buttons. It usually goes within a few months of finishing treatment
- Constipation happens in about 5 out of 10 people (50%) – your doctor or nurse may give you laxatives to help prevent this. Tell them if you are constipated for more than 3 days
- Tiredness and weakness (fatigue) occurs in about 2 in 10 people (20%) 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 usually be well controlled with anti sickness medicines
- Women may stop having periods (amenorrhoea) but this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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
Between 1 and 10 in every 100 people have one or more of these effects.
- Blood clots occur in around 1 out of 10 people (10%) – you may have medicines to thin the blood and prevent clots, such as low dose aspirin or heparin
- Lower levels of thyroid hormones – this can cause a number of effects. They may include feeling tired, weight gain, feeling the cold more easily, and feeling sad or depressed
- Hair thinning
- A sore mouth
- Swelling of your legs and ankles due to fluid build up (known as peripheral oedema)
- A rash and dry skin
- Indigestion, stomach pains or discomfort
- A change in blood sugar levels – tell your doctor if you get very thirsty or if you are passing more urine than usual
- A puffy face due to fluid build up
- Increased appetite with possible weight gain
- Difficulty in sleeping
- Mood swings
- Drowsiness (somnolence)
Thalidomide can cause birth defects in children. So you must not become pregnant or father a child if you are taking this drug. Your doctor or nurse will talk to you about contraception before you have the treatment.
Some people worry about taking thalidomide but it does not cause physical defects in adults.
Because thalidomide causes birth defects, you have to sign a consent form before you start treatment. This is to make sure you understand the risks of taking thalidomide and agree to use contraception for a specified period of time. Your doctor, pharmacist or nurse will help you with this.
If you are a woman of child bearing age you will need to have regular pregnancy tests during the treatment if there is any risk of pregnancy. Your doctor or nurse will tell you about this.
Pregnant women should not touch or handle thalidomide. You must store it in a place where children cannot reach it.
You may have a few of the side effects on this page. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much 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 they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. 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.
Do not breastfeed during this treatment because the drugs may come through in the breast milk.
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.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about CTD drugs look at the Electronic Medicines Compendium website at www.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.
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