Cisplatin and fluorouracil (5FU)

Cisplatin and fluorouracil are chemotherapy drugs. Fluorouracil is also called 5FU.

You pronounce cisplatin as sis-plat-in.

You pronounce fluorouracil as floor-oh-yoor-uh-sil.

They are a combination treatment for a few different types of cancer.

How does cisplatin and 5FU work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have cisplatin and 5FU?

You have cisplatin and fluorouracil into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

How often do you have cisplatin and 5FU?

You have cisplatin and 5FU as cycles of treatment .

You may have up to 6 cycles of treatment. Each cycle lasts 3 weeks (21 days).  Your doctor will tell you how often and when you have it.

On the first day of the cycle you have

• cisplatin through a pump or as a drip for between 1 and 8 hours
• extra fluids through a drip before and after the cisplatin to protect your kidneys
• 5FU as a drip through a pump for either 4 days or continuously for 21 days

The pump may be a small portable one if you have a long line. This means that you can go home with it. You go back to the hospital for the nurses to refill it or disconnect it.

Your doctor or nurse will tell you when you need to go back.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before starting treatment with fluorouracil (5FU) you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from this chemotherapy, so you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, nurse or pharmacist will talk to you about this.

What are the side effects of cisplatin and 5FU?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Changes to the level of minerals in your blood

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

Much less common this could include low levels of magnesium in the blood. 

Heart problems

You might have some changes to the way your heart works. These usually go back to normal when the drug is stopped.

The most common is changes to your heartbeat. Less common are problems such as angina, heart failure or a heart attack.

You will have regular heart checks during and after the treatment. Tell your doctor or nurse straight away if you have any chest pain.

Inflammation of the lining of the digestive tract

Your digestive tract includes the:

• mouth
• throat
• oesophagus (food pipe)
• stomach
• intestines (gut)
• bowel

The lining of one or more these parts could become sore and swollen. Contact your advice line or talk to a member of your healthcare team if this happens. 

Less common this can be sores (ulcers) and bleeding. If this becomes quite bad your doctor might stop treatment. 

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Loss of appetite

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

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Soreness, redness and peeling of palms or soles of feet

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

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Lack of energy and strength (malaise)

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

Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.

Slow healing of wounds

Fluorouracil can cause wounds to heal more slowly. Contact your advice line or talk to a member of your healthcare team if you notice this happening or if you might need to have other treatment such as an operation or tooth extraction.

Occasional side effect

Blood clots are a side effect that can happen in between 1 and 10 out of every 100 people (between 1 and 10%).

They can be life threatening. Signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms.

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• an allergic like reaction. Symptoms include flushing, wheezing, shortness of breath, fast heart rate and low blood pressure. Contact your healthcare team if you have any of these symptoms.

• mood changes such as feeling of happiness and feeling good for no apparent reason (euphoria)

• eye changes including rapid eye movement, blurred sight, watery, sore red eyes (conjunctivitis), double vision, discomfort or pain when exposed to light

• headaches

• sleepiness

• changes to handwriting, hands and or fingers shaking, slow movement, stiff legs and or arms, voice changes, stooping, rigid facial expression (symptoms similar to Parkinson's disease)

• low blood pressure (hypotension)

• not enough fluid in the body (dehydration)

• changes to the liver

• dry, itchy, red skin, a rash or a combination of these

• increased sensitivity of the skin to sunlight

• nail changes including being brittle, colour changes and or the nail coming away from the nail bed

• changes to your hearing this can include ringing in the ears (tinnitus) or loss of hearing

• dizziness

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other treatments, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about these drugs

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.