VIDE

VIDE is the name of a chemotherapy combination. It includes the chemotherapy drugs we list below. Next to each drug we have written how you pronounce the drug name in brackets.

• vincristine (vin-kris-teen)
• ifosfamide (eye-foss-fa-mide)
• doxorubicin (docs-oh-roo-bi-sin)
• etoposide (ee-top-o-side)

It is a treatment for a type of:

• bone cancer called Ewing's sarcoma
• soft tissue sarcoma called desmoplatic small round cell tumour

How does VIDE work?

Vincristine, ifosfamide, doxorubicin and etoposide are all types of chemotherapy drugs. These work by destroying quickly dividing cells, such as cancer cells.

How do you have VIDE?

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

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 VIDE?

You have VIDE as cycles of treatment. This means you have the chemotherapy and then a rest to allow your body to recover.

You may have up to 6 cycles. Each cycle of treatment lasts 3 weeks (21 days). So the whole course takes up to 18 weeks.

How long each drug goes over may vary between hospitals. Here is one way of having VIDE:

You then start the next cycle of treatment. This is called cycle 2 day 1 and follows the same pattern. You repeat the cycle up to 6 times. 

Mesna and GCSF

You usually have ifosfamide with another drug called mesna. You have mesna either as a drip (infusion) into your bloodstream or as tablets.

Mesna is not a chemotherapy drug. It stops the ifosfamide from irritating your bladder and causing blood in your urine.

You usually also have a drug called granulocyte colony stimulating factor (GCSF). You have this as an injection under the skin. This makes your bone marrow produce white blood cells more quickly after the chemotherapy. It helps lower your risk of getting an infection after having this treatment. As well as helping prevent your treatment from being delayed. 

Your healthcare team will let you know what day to start your GCSF injections.

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.

What are the side effects of VIDE?

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:

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, 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 and nose bleeds

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).

Less commonly you might notice blood from other areas of your body. This can include dark or bright red blood mixed in with your poo, black or tar looking poo, or you might have blood stained sick. Symptoms of bleeding from other areas of the body include feeling tired, dizzy and you might faint. You might have tummy (abdominal) pain, look pale or be short of breath.

Tell your healthcare team if you notice blood or feel unwell.

Tiredness and weakness (fatigue) during and after treatment

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.

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.

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. 

Sore mouth, throat and inflammation of the food pipe (oesophagus)

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges and lemons, and chew gum to keep the mouth moist.

Less commonly it may be painful to swallow drinks or food. You might also feel like you have chest pain due to inflammation of your food pipe.

Tell your healthcare team if you’re in pain, struggling to eat and have any of these symptoms. They can give you advice and also help with the pain.  

Pink or red urine

You might have red or pink urine. This can be due to the colour of doxorubicin and can last for one or two days following your treatment.

Skin problems

Skin problems include a rash, reddening of the skin, areas of your skin may become darker and your skin might be sensitive to the sun.

Other less common skin problems include a raised itchy rash and dry skin. Also the skin in previous areas of radiotherapy may become sore and inflamed

Your skin usually goes back to normal when your treatment finishes. Let your healthcare team know of any skin problems. They can tell you what products you can use on your skin to help.

Nail problems

This treatment can cause your nail to separate from the nail bed (onycholysis). You might also see that your fingernails and toe nails get darker. It may appear like a dark stipe in the nail bed. This problem happens less often.

This usually goes back to normal when your treatment finishes but may take some time.

Soreness, redness and peeling on palms and 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.

Inflammation and irritation of the bladder

Ifosfamide can cause inflammation and bleeding of the bladder lining. This is called haemorrhagic cystitis. This can cause you to:

• pass urine more often than usual
• find it difficult to pass urine
• have a burning feeling or pain when you go
• not be able to wait when you need to go
• pass blood or blood clots 

It helps to drink plenty of fluids. You have a drug called Mesna to help protect your bladder.

Tell your nurse or doctor straight away if you have any problems passing urine.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Numbness and tingling in fingers and 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. 

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.

Changes to the way your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Kidney damage

To help prevent kidney damage, it is important to drink plenty of water. You might 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.

Tummy (abdominal) pain

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

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.

Blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after having this treatment.

Occasional side effects

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

• a second cancer such as acute leukaemia
• dizziness
• low blood pressure that can cause you to feel lightheaded or dizzy. Sometimes this can happen when you stand up from sitting or lying down (orthostatic hypotension)
• eye problems which can make it red, itchy, feel gritty, burn, watery and make your eyes sticky because of your eyes making pus (conjunctivitis)
• inflammation of a vein, causing pain and tenderness along the vein
• changes to how your heart works. This might be picked up from a test such as a heart trace (ECG). Or you might have symptoms such as pain in your chest, jaw, neck or back. You might have shortness of breath or feel light headed. Contact your team straight away if you feel like this
• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life-threatening alert your nurse or doctor if notice any of these symptoms
• a skin and tissue reaction at the drip site that can cause damage to the area. Tell your nurse or doctor straight away if this happens

Rare side effect

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

• inflammation of your colon. Symptoms can include tummy pain and discomfort, diarrhoea, and blood in your poo
• inflammation of your stomach. This can make you feel or be sick, you may lose your appetite, heart burn and feeling full or bloated

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

• vincristine
• ifosfamide
• doxorubicin
• etoposide

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 medicines, 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 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.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Women must not become pregnant for at least a year after the end of treatment. Men should not father a child for at least 6 months after treatment. 

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