De Gramont

de Gramont describes one way of giving the chemotherapy drug fluorouracil (5FU) in combination with folinic acid (calcium folinate or leucovorin). These drugs are usually given after surgery for bowel cancer. The folinic acid makes the 5FU work better.

The links above takes you to more 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 they are given in a slightly different way. Some doctors believe that the modified version works just as well but it is easier to give.

The side effects of a combination of drugs are usually a mixture of the effects of each drug. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity. 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. 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. 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 cycles of treatment. Each cycle of treatment lasts 2 weeks and you may have up to 12 cycles, taking 6 months. Each cycle is given in the following way.

Day 1

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 is attached to the end of the central line and can easily be carried 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.

Day 2

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 are given 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 be able to come to your home to set up the folinic acid drip.

Day 3

Your fluorouracil finishes and that ends one treatment cycle. You will have 12 days with no treatment. You then go back to the hospital to start another cycle.

If you have the modified de Gramont regimen, 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 district 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.

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 effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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 drugs
• A sore mouth
• Diarrhoea - drink plenty of fluid and tell your doctor if diarrhoea becomes severe or continues for more than 3 days
• Constipation - your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Brown skin markings following 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
• These drugs may have a harmful effect on a developing baby - do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

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

• 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 - 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) which may cause tingling, numbness, pain and dryness

Fewer than 1 in 100 people have these.

• Complete hair loss
• Darkened skin
• Damage to heart muscle, which is usually temporary but for a small number of people may lead to angina or a heart attack - your doctor will check your heart before and after your treatment
• Confusion or unsteadiness
• Loss of fertility - you may not be able to get pregnant or father a child after treatment with this drug so it is important to talk to your doctor about your fertility before starting treatment
• Women may stop having periods (amenorrhoea) but this may only be temporary

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 drugs before
• Your general health
• The amount of the drugs 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.

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.

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 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 chemotherapy.

It is 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 not many people in the UK have oral vaccines 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.