VAD

VAD is the name of a chemotherapy drug combination usually used to treat multiple myeloma. VAD is made up of the drugs

• V = Vincristine
• A = (Adriamycin) – now called doxorubicin
• D = Dexamethasone which is a steroid drug

You can click on the links above to find out about the side effects of each individual drug.

There are a number of combinations of drugs for people with myeloma. VAD is just one type of treatment. Your doctor will decide which drugs are best to treat your type of myeloma and the stage of your myeloma.

There is more information about chemotherapy for myeloma in our treating myeloma section.

You usually have chemotherapy as cycles of treatment. You have VAD in 4 week cycles, every 28 days. On the first day of your cycle you start a 4 day treatment with all 3 drugs. You have the vincristine and doxorubicin slowly over the 4 days through an infusion pump. The pump is connected to a drip line, but you will be able to go home with the infusion pump on.

Then you have a break with no treatment for 24 days. This competes one cycle. You then start the next cycle. On occasions during each cycle of treatment, you will have dexamethasone tablets to take. Usually you take these for 4 days at a time. You may take up to 3 lots of dexamethasone tablets during each cycle of chemotherapy.

You will probably have between 4 and 6 cycles of treatment over 4 to 6 months. The number of cycles you have depends on

• How well your cancer responds to the drugs
• Whether your cancer has spread

You have the drug injections into a vein through a plastic tube called a central line. There are different ways of doing this. You may have a central line put into your chest. Or another type of central line, called a PICC line, which runs up a vein in your arm. Another type of central line is a portacath which has a port under the skin. Central lines give the drugs directly into a large vein in your chest. They stay in throughout your whole course of treatment. Your nurse will teach you how to look after the line. 

The side effects of a combination of drugs are usually a mixture of the side effects of each drug. We have listed the side effects associated with VAD below. You may get one or two or several of the effects. Use the links to find out more about each side effect. For general information about side effects please see our cancer drug side effects section or use the search box at the top of the page.

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 hospital 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 (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Nerve problems causing abdominal cramps, constipation, jaw pain, double vision or temporary incontinence of urine – tell your doctor or nurse if you have any of these effects
• Temporary numbness and tingling in fingers and toes (peripheral neuropathy), may be caused by vincristine. You may have a feeling of general weakness and find that it is difficult to do fiddly things, such as buttoning clothes
• Feeling or being sick – doxorubicin can cause sickness. It may begin a few hours after treatment and last for a few days. It is usually possible to control this side effect with anti sickness injections and tablets, but if you are still being sick, tell your doctor or nurse
• Hair loss
• A sore mouth
• Your urine may become a pink or red colour for one or two days after taking doxorubicin
• Sensitivity to the sun – cover up and stay in the shade while you are having treatment with doxorubicin. If you have to go out in the sun, use a high factor sun cream
• Gritty eyes, blurred vision or watery eyes from increased production of tears
• Loss of fertility – we don’t know exactly how VAD drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Vincristine and doxorubicin may have a harmful effect on a developing baby – do talk to your doctor or nurse 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.

• An allergic reaction to doxorubicin affects 3 people in 100 (3%). This causes a sudden rash of pink, itchy bumps on your skin and reddening of the skin along the veins. It should clear up within a few days
• 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
• Taking dexamethasone may affect your blood sugar levels and your blood will be tested regularly. If you are diabetic, talk to your diabetes doctor or nurse about the best way to control your diabetes
• Doxorubicin can cause temporary damage to the muscles of the heart, which may change the rhythm of the heartbeat. In most cases this goes back to normal after the treatment is completed. There is a small, more serious risk of heart failure after a lot of treatment with doxorubicin. Your doctor will check your heart before you start treatment, and at times through your treatment course
• Taste changes
• Nails may become darker and white lines may appear on them
• You may develop black or brown discoloration in the creases of your skin
• 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
• Dexamethasone may cause bruising of the skin, an increased appetite, skin spots, and shoulder or hip muscle weakness. Let your doctor or nurse know if you get any of these effects

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 drug before
• Your general health
• The amount 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 that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call 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 this treatment 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.

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.