This page tells you about the chemotherapy drug combination called de Gramont. There is information about
De Gramont describes one 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. The folinic acid makes the 5FU work better.
The links above take you to information about the individual side effects of 5FU and a description of folinic acid.
There is also a modified de Gramont combination. This includes the same drugs but you have them in a slightly different way.
The side effects associated with de Gramont chemotherapy are listed below. You can use the links (underlined) to find out more about each side effect. Or see our cancer drug side effects section for more information.
You have fluorouracil and folinic acid into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large blood vessel in your chest. The tube can stay in place throughout the course of treatment.
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.
On the first day you have folinic acid by drip (infusion) over 2 hours. You then have a drip of fluorouracil for 22 hours. If you don’t have a central line you will need to stay in hospital overnight to have this treatment. 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 and it gives a small amount of fluorouracil continuously over 22 hours.
On the second day you have the same treatment as on day one. For people who stay in hospital this means that once your 22 hour infusion of 5FU ends, you start a 2 hour drip of folinic acid. You then begin another 22 hour drip of fluorouracil.
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 your 2 hour drip of folinic acid and then go home again with 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.
Your fluorouracil finishes and that ends one treatment cycle. You then have 12 days with no treatment. After that you start another cycle.
If you have the modified de Gramont treatment, you have your 2 hour drip of folinic acid on the first day. This is followed by an injection into your central line or PICC line 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.
More than 10 in every 100 people have one or more of the side effects listed below.
- 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 or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
- Tiredness and weakness (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 is usually mild and well controlled with anti sickness medicines
- A sore mouth
- Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
- Constipation – your nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
- Brown skin markings can occur along the line of the vein where the chemotherapy was injected
- Hair thinning – this is temporary and your hair will grow back after the treatment ends
- Loss of taste or a metallic taste in your mouth, which usually gets better once the treatment ends
Between 1 and 10 in every 100 people have one or more of these effects.
- Brittle, chipped and ridged nails
- Gritty eyes, blurred vision or watery eyes from over production of tears
- Sensitivity to sunlight, so don’t sit out in the sun. Do cover up or use sun block on any exposed skin
- Skin rashes, which may be itchy
- Loss of appetite
- Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar - plantar syndrome). This may cause tingling, numbness, pain and dryness
Fewer than 1 in 100 people have these effects.
- Complete hair loss
- Darkened skin
- Damage to heart muscle, which is usually temporary. For a small number of people the damage may lead to angina (chest pain) or a heart attack. Your doctor will check your heart before and after your treatment
- Confusion or unsteadiness
- Women may stop having periods (amenorrhoea) but this may only 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
You may have a few of the side effects mentioned on this page. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may have more more side effects as the course goes on. This depends on
- How many times you've had the drugs before
- Your general health
- The amount of the drugs 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.
Pregnancy and contraception
These drugs may 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.
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 these 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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