PAD

PAD is the name of a combination of chemotherapy drugs used to treat myeloma. It is made up of the drugs

• Bortezomib (Velcade) – this was originally called PS341, which is where the P comes from
• Doxorubicin (Adriamycin)
• Dexamethasone (a steroid)

The links above take you to more information about the individual side effects of each drug.

You have PAD chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have up to 4 cycles, taking 12 weeks (3 months) in total.

You have PAD drugs 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 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. Sometimes you can have bortezomib as an injection under the skin.

You have each 3 week cycle of treatment in the following way. Day 1 is the first day you have treatment for each cycle.

You have

• Bortezomib as an injection into your bloodstream or as an injection just under the skin on days 1, 4, 8 and 11
• Adriamycin as a continuous drip (infusion) from days 1 to 4
• Dexamethsone – for the first cycle of treatment you take this as a tablet on days 1 to 4, then days 8 to 11, and days 15 to 18. With the cycles of treatment after the first one you take it on days 1 to 4. You need to swallow the tablets whole after food

It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. 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 of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with PAD 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.

A temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• 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

• Temporary numbness or tingling in fingers and toes (peripheral neuropathy) and pain affect more than half of people having treatment and 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
• Tiredness affects  a quarter of people (25%) 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 well controlled with anti sickness medicines
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Constipation – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• A sore mouth
• Sensitivity to sunlight – don’t sit out in the sun, and do cover up or use sun block on exposed skin
• Brown skin markings following the line of the vein where the chemotherapy was injected
• Watery eyes
• Difficulty sleeping
• Hair loss – most people have complete hair loss but the hair will grow back once the treatment ends
• Your urine may become a pink or red colour for 1 or 2 days after treatment – this is not harmful
• Changes in mood and behaviour – you may feel more anxious and emotional than usual and may be a bit tired and sad for a while
• Loss of appetite
• Low blood pressure (hypotension) affects just over 1 in 10 people – it can make you feel lightheaded or dizzy
• About 1 in 10 people get shingles – you may have to take an anti viral drug to prevent this
• This drug may have a harmful effect on a developing baby so talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant   
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you

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

• Some people have an allergic reaction while having treatment, usually at the first or second treatment – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
• Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
• Damage to heart muscle from doxorubicin, which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment
• Liver changes that are very mild and unlikely to cause symptoms may occur – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment finishes, but you will have regular blood tests to check how well your kidneys are working

Fewer than 1 in 100 people have high uric acid levels in the blood due to cancer cells being broken down by the body. You will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol.

Not everyone will get these side effects. You may have 1 or 2 or several. 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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

Tell your doctor, nurse or pharmacist about any other medicines you are taking, including vitamins, herbal supplements and 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.