Cisplatin, fluorouracil (5FU) and trastuzumab

Cisplatin, fluorouracil (5-FU) and trastuzumab is the name of a cancer drug combination. It includes the drugs we list below. Next to each drug we have how you pronounce the drug name.

• cisplatin - (sis-pla-tin)
• fluorouracil - (floor-oh-yoor-uh-sil)
• trastuzumab - (tras-too-zoo-mab)

Cisplatin and fluorouracil are chemotherapy drugs, and trastuzumab (Herceptin) is a targeted cancer drug.

It is a treatment for stomach cancer that:

• has spread to another part of the body (advanced)
• has large amounts of HER2 protein (HER2 positive)

How does cisplatin, fluorouracil and trastuzumab work?

The chemotherapy drugs cisplatin and fluorouracil destroy quickly dividing cells, such as cancer cells. Trastuzumab works by attaching to HER2 on the surface of cancer cells. HER2 is a protein that makes cells grow and divide, so trastuzumab stops the cancer cells from growing and dividing.

How do you have cisplatin, fluorouracil and trastuzumab?

You have these drugs as a drip 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

If you don't have a central line, you might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

If you have a central line, you might be able to have fluorouracil through a small pump which slowly puts the fluid into your bloodstream (infusion). You can keep the pump in a small bag or attached to a belt. When the fluorouracil infusion finishes, the nurse blocks the end of the central line with a plastic cap until the start of your next treatment. A district nurse or chemotherapy nurse may be able to do this at home.

How often do you have cisplatin, fluorouracil and trastuzumab?

You usually have cisplatin, fluorouracil and trastuzumab as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover. 

Each cycle lasts 21 days (3 weeks). You usually have 6 cycles of treatment with cisplatin and fluorouracil.

After 6 cycles of treatment with cisplatin, trastuzumab and fluorouracil, you continue trastuzumab alone.

This continues for as long as the treatment is helping you and the side effects aren't too bad.

You have each cycle of treatment in the following way:

You then start a new cycle of treatment. You also have fluids into your bloodstream for a few hours before and after each cisplatin treatment. The extra fluids help to protect your kidneys. 

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.

You may also have hearing tests and a heart scan before, during and after your treatment.

Low levels of DPD

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. 

Low levels of DPD can increase your risk of having severe side effects from fluorouracil. These side effects can rarely be life threatening. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

What are the side effects of cisplatin, fluorouracil and trastuzumab?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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

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:

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, cough, headaches, feeling cold and shivery, pain or burning feeling when weeing, or generally feeling 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 and looking pale

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

Bruising, bleeding gums or nosebleeds

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).

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

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.

Diarrhoea or constipation 

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Changes to your hearing

You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.

Kidney damage

To help prevent kidney damage, it is important to drink plenty of water. You also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Changes in levels 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.

Lung problems 

This drug can cause you to develop a cough or shortness of breath. Less commonly this could be due to infection, such as pneumonia or lung problems such as asthma or a build up of fluid around the heart (pleural effusion). More rarely it might be due to inflammation of the lungs (pneumonitis) or scarring of the lungs. 

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

Heart problems 

There might be changes to the heart muscle not allowing it to pump blood around the body properly. Less common problems are changes to your heartbeat, angina or heart attack.

During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.

Tell your doctor or nurse straight away if you have any chest pain. Your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG).

Mouth sores and ulcers 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

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 and soles (hand foot syndrome)

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.

Allergic reaction

This usually happens with the first or second treatment. Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.

Joint or muscle pain

You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

Hot flushes or sweats

We have some tips for coping with hot flushes in women and hot flushes in men. This information also includes some of the possible treatments. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe some medicines to help.

Skin and nail problems

Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Eye problems

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your healthcare team if you have this. They can give you eye drops or other medication to help. 

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Swollen hands and feet

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

Difficulty sleeping

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

A runny nose

You might have a runny nose while having treatment.

Flu like symptoms 

This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering.

If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• inflammation around the drip site

• anxiety or depression

• shingles

• liver problems that are very mild and unlikely to cause symptoms. Rarely you might have yellowing of the skin or whites of the eyes (jaundice)

• dry mouth

• drowsiness

• stinging when you pass urine or urine infection

• sore breasts (mastitis)

• piles (haemorrhoids)

Rare side effects

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

• yellowing of the skin and whites of the eyes

• shaking and trembling

• a second cancer called acute leukaemia some years after treatment has finished

• low levels of magnesium in your blood

• problems with your brain that can cause headaches, seizures (fits) and confusion

• low levels of albumin in your body that can cause swelling and weakness

• sensitivity to sunlight

• stomach ulcers and or bleeding in the stomach

• changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to vision (reversible posterior leukoencephalopathy syndrome).

Other side effects

 This treatment can cause slow wound healing. There isn't enough information to work out how often this side effect might happen. Let your healthcare team know if you notice any wounds that aren't healing.

Coping with side effects

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

What else do I need to know?

Other medicines, foods and drinks 

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 these drugs. 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 might 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 a few 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 because the drug may come through into 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.

Immunisations

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 this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.