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Side effects of cisplatin, fluorouracil (5-FU) and trastuzumab (Herceptin)

Find out about the side effects of the chemotherapy combination treatment cisplatin, fluorouracil (5-FU) and trastuzumab (Herceptin).

 

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 37.5C.

The side effects of this combination of drugs might be different if you have it with other cancer treatments. 

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38C. Severe infections can be life threatening.

Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You'll have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

A very small number of people have an allergic reaction while having cisplatin, usually at the first or second treatment.

Tell your doctor or nurse immediately if you have any of these symptoms:
  • a rash
  • shortness of breath
  • redness or swelling of the face
  • feeling hot
  • dizziness
  • a sudden need to pass urine

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

Skin changes include darker skin and rashes, which may be itchy.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, smoothing in unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Feeling or being sick can be severe. It can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You may need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid fried foods, fatty foods or foods with a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they are feeling sick.

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

Talk to your doctor or nurse if you’re having problems sleeping. It can help to change a few things about when and where you sleep.

Tips

  • Go to bed and get up at the same time each day.
  • Make sure the temperature is right.
  • Spend time relaxing before you go to bed - have a bath, read or listen to music.
  • Do some light exercise each day to help tire yourself out.
  • Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon.
  • Have a light snack before you go to bed to stop hunger waking you up.

Both men and women can have hot flushes.

You can get hot flushes with other symptoms including:

  • reddening of the skin
  • sweating
  • racing heart (palpitations)
  • feeling anxious, irritable or panicky

Tips

  • Cut out coffee, tea and nicotine.
  • Cut down on alcohol.
  • Sip cold or iced drinks.
  • Wear layers of light clothing so you can take clothes off if you overheat.
  • Have layers of bedclothes to remove as you need to.
  • Wear natural fibres such as silk or cotton instead of man made fabrics.

Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe medicine.

Indigestion is pain or discomfort in your chest or stomach. It often happens shortly after eating or drinking.

Symptoms can also include:

  • heartburn, a burning sensation in the lower chest
  • feeling sick
  • feeling bloated
  • belching

This is caused by stomach acid irritating the foodpipe, the stomach or the top part of the bowel. Ask your doctor or nurse for anti heartburn medicines if you need them.

Tips

  • Stop smoking.
  • Limit your caffeine intake found in coffee and tea, canned drinks and chocolate.
  • Avoid foods and drinks that can cause heartburn, such as citrus fruits and alcohol.
  • Raise the head of your bed when sleeping or lying down.
  • Don't eat for 2 or 3 hours before going to bed.
  • Reduce fatty foods in your diet, such as deep fried foods.

The skin on your hands and feet can become sore, red, and peel. You might also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Tell your doctor or nurse straight away if you have pain, swelling, redness or tingling of your hands or feet.

Tips

  • Take medicines that your doctor or nurse can prescribe.
  • Keep your hands and feet cool.
  • Avoid very hot water.
  • Don’t wear tight fitting gloves or socks.
  • Moisturise your skin with non perfumed creams.

You may get ringing in your ears (tinnitus). This normally gets better on its own.

You may have some hearing loss, especially with high pitched sounds. 

You have hearing tests before and during treatment. Tell your doctor or nurse if you notice any changes.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

You may get heart problems, such as angina, heart failure or a heart attack.

Tell your doctor or nurse straight away if you have any chest pain.

You will have regular heart checks during and after the treatment.

Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.

Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently every morning and evening and after each meal.
  • Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

Changes in taste may make you go off certain foods. Many people go off tea and coffee, for example. You may also find that some foods taste different from usual. Some people find that they prefer to eat spicier foods.

Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

You might have eye problems, including watery eyes and redness (conjunctivitis).

Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.

You may have some pain in your joints, arms and legs, or back. Tell your doctor or nurse if you have any pain. They can give medicine to help.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

You might feel depressed or sleep more whilst having this treatment. You can also feel more worried or panicky than usual. This is common so don’t be embarrassed to talk to your doctor or nurse. They can find the best person to help you.

You might develop lung problems that cause breathlessness, for example, fluid build up around the lungs.

Let your doctor know if you need oxygen at home before or during your treatment.

Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

This is due to inflammation of the pancreas (pancreatitis). Tell your doctor or nurse immediately if you have this.

Your nails can have a blue tinge or become darker. Or they might flake, be painful and thicken where the nail starts growing (the nail bed).

Tips

  • Use nail oils or moisturising creams if your nails are flaking.
  • Don't worry about marks on your nails as they will grow out in time.
  • You can cover marked nails with nail varnish but avoid quick drying varnishes as they can make your nails even drier.

You have blood tests before your treatments, to check how well your kidneys are working.

To help prevent damage, it is important to drink plenty of water. You also have fluids into your vein before and after your treatment for several hours.

Your nurse might ask you to keep a record of how much you drink. And you may need to measure the amount of urine that you pass and keep a record of that.

Tell your nurse or doctor if you're not able to drink as much as you should – for example, if you feel sick. And tell them if the amount of urine you pass goes down.

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

The changes are usually very mild and unlikely to cause symptoms. They will almost certainly go back to normal when treatment is finished. 

You have regular blood tests throughout your treatment so your doctor can check this.

About cisplatin, fluorouracil (5-FU) and trastuzumab

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
06 Jul 2016
  • Electronic medicines compendium, SPC and PILs
    Accessed May 2016

  • Cisplatin/ 5-Fluorouracil (+ Trastuzumab) in Gastric Cancer
    South East London Cancer Network, 2011

  • Neutropenic sepsis: prevention and management in people with cancer
    National Institute for Health and Care Excellence, 2012

  • Trastuzumab in gastric cancer
    South East London Cancer Network, 2011

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