VIDE

VIDE is the name of a combination of chemotherapy drugs used to treat a type of bone cancer called Ewings sarcoma. It is made up of the drugs

• V = Vincristine
• I = Ifosfamide
• D = Doxorubicin
• E = Etoposide

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

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 VIDE are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

Doxorubicin is a red fluid. All the other drugs are clear colourless fluids. You have VIDE drugs into your bloodstream (intravenously).

You can have the drugs 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.

You usually have chemotherapy as cycles of treatment. You may have up to 6 cycles. Each cycle of treatment lasts 3 weeks. So the whole course takes 18 weeks.

On the first day you have an injection of vincristine and doxorubicin into your cannula or central line alongside a drip of salt water (saline). You also have a 1 hour drip (infusion) of etoposide and a 3 hour drip of ifosfamide. You usually have ifosfamide with another drug called mesna, either as a drip or as tablets. If you have the tablets you must take them exactly as your doctor prescribes. Mesna stops the ifosfamide from irritating your bladder and making it bleed.

On the second day you have the same drugs again but without vincristine. On the third day, you have the same drugs as day 2. Then you have no treatment for almost 3 weeks. You then start the next treatment cycle.

You usually have surgery after the course of VIDE and then more chemotherapy, with either VAI or VAC combination chemotherapy.

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 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
• Hair loss
• 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
• A drop in blood pressure can happen if etoposide is given too quickly – if you feel dizzy or faint, call your nurse straight away to slow your drip down
• A sore mouth and throat can happen about 5 days after each treatment, which usually clears up over a couple of weeks
• Your urine may become a light pink or red colour for one or two days after treatment with doxorubicin – this is nothing to worry about
• Sensitivity to sunlight – don’t sit out in the sun, and cover up or use sun block on exposed skin
• Black or brown discoloration may occur in the creases of your skin after doxorubicin
• Irritation of the bladder and kidneys with ifosfamide – drink as much water as possible to flush out the ifosfamide and you may have fluids into your drip before and after your treatment. Tell your doctor or nurse straight away if you have pain or bleeding when passing urine
• Changes to your nails
• Severe constipation with abdominal pain occurs in 1 in 3 people who have vincristine (30%) – 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
• Vincristine can temporarily stop the normal waves of contraction that go through the gut, leading to sickness, a swollen abdomen, and cramps
• These drugs may have harmful effects 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
• Women may stop having periods (amenorrhoea) – this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations occur in about one person in 8 (12%) having ifosfamide – if you have any of these, it is important to tell your doctor or nurse straight away
• Numbness or tingling in fingers and toes caused by vincristine affects between 1 and 2 out of every 10 people (10 to 20%) 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

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

• Temporary taste changes
• Diarrhoea
• Loss of appetite
• Jaw pain, caused by vincristine affecting your nerves
• Fevers and chills
• Liver changes that are very mild and unlikely to cause symptoms – 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
• A skin rash, which may be itchy
• Your skin may temporarily become darker with ifosfamide
• An allergic reaction occurs in 3 people in 100 (3%) who have doxorubicin – you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins, which 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
• 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, during and after your treatment
• An allergic reaction to etoposide happens in 1 or 2 out of every 100 people (1 to 2%), causing chills, fever, wheezing, a racing heart, drop in blood pressure and swelling of the face

There is a small risk that you may get a second cancer some years after treatment.

Not everyone will get these side effects. 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. Your nurse will give you a contact number. You can ring them 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.