patient education : 16256--Pembrolizumab, Carboplatin & Fluorouracil

Pembrolizumab, Carboplatin, & Fluorouracil

Treatment name

Type of Treatment

How long will it take?

Pembrolizumab

Immunotherapy

About 2 to 4 hours

Carboplatin

Chemotherapy

Fluorouracil (5-FU)

Chemotherapy

Given once every 21 days

5-FU CADD pump on for 96 hours and disconnected on day 5 of each cycle

How is pembrolizumab given?

Pembrolizumab is given through a vein by intravenous infusion (IV) over 30 minutes.

Immune related side effects

Skin rash

You may get: a red rash, bumpy rash, dry and itchy skin or skin peeling or blisters.

Moisturize your skin daily and avoid scratching.

Notify clinic if you have severe pain or itching from rash

Bowel and stomach inflammation

Diarrhea, blood in stool, bloating or stomach cramping can occur.

May use loperamide as directed on the package for mild diarrhea.

Notify clinic if you have 4 or more episodes of diarrhea in 24 hours or blood in your stool.

Lung inflammation

You may develop inflammation of your lungs from pembrolizumab.

Notify clinic if you have shortness of breath, difficulty breathing, faster heartbeat, chest pain, or new or worsening cough.

Muscle and joint problems

You may get: muscle or joint stiffness or pain, muscle weakness, joint swelling.

Notify clinic if you are unable to complete your normal daily activities due to these problems.

Thyroid changes

Thyroid changes are common with pembrolizumab, specifically underactive thyroid. You may notice: fatigue or low energy levels, depression, slow heart rate, weight gain, intolerance to cold, dry skin, hair loss, constipation.

Less common but severe side effects

Notify clinic if you have any of the bolded symptoms

• Heart damage

Chest pain, shortness of breath, abnormal heart beat)

• Liver damage

Dark urine, yellow skin or eyes, unexplained bruising or bleeding or severe stomach pain

• Hormone changes or central nervous system changes

Bad headaches, confusion, weakness, dizziness, fainting, numbness in hands or feet

• Eye problems

Any change in vision

How are carboplatin and fluorouracil given?

Carboplatin is given through a vein by intravenous infusion (IV) over 30 minutes.

Fluorouracil is given through a vein by continuous intravenous infusion (IV) through CADD pump over 96 hours. The pump is disconnected on day 5 of treatment.

Chemotherapy (onset hours to days)

Nausea and vomiting

You may feel sick on your stomach (nausea) or be sick (vomit) after treatment.

Take anti-nausea medicine as prescribed.

Drink plenty of fluids for several days after treatment.

Notify clinic if you are unable to keep down fluids or food.

Taste and smell changes

Food may lose its taste or tastes different.

These changes will go away with time.

Chemotherapy (onset days to weeks)

Infection risk (low white blood cells)

This treatment lowers the amount of white blood cells in your body. These cells help fight infection. You are more likely to get sick when your white blood cells are low from chemotherapy.

We recommend you wash your hands regularly, have a thermometer at home and limit contact with people who are sick.

Notify clinic or go to your closest Emergency Department if you have any of the following signs or symptoms of infection:

-          Temperature of 100.4⁰F or higher AND

-          Chills, shivers, sweats or shakes

-          Sore throat or cough

-          Uncontrolled diarrhea

-          Shortness of breath

-          a fast heartbeat 

Low platelets

This treatment lowers the amount of platelets in your blood. Platelets help your blood to clot. When they are low, you are at an increased risk of bleeding and bruising.

Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to.

Notify clinic if you have any bruising or bleeding, or go to your nearest hospital Emergency Department if you have any uncontrolled bleeding.

Tiredness and lack of energy

You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.

Nap for short periods (only 1 hour at a time)

Try some gentle exercise daily.(ie) simple stretches/walking

Allow your friends and family to help.

Mouth pain and soreness (mucositis)

You may have: mouth ulcers, a white coating on your tongue, pain in the mouth or throat, or difficulty eating and swallowing.

Avoid spicy, acidic or crunchy foods and very hot or cold food and drinks. Try bland and soft foods.

Brush your teeth gently with a soft toothbrush after each meal and at bedtime. If you normally floss continue to do so.

Rinse your mouth after you eat and brush your teeth, using either:

-          1/8 teaspoon of salt in 1 cup of warm water, or

-          1/4 teaspoon of bicarbonate of soda in 1 cup of warm water

Notify clinic if you get any of the symptoms listed above.

Appetite loss (anorexia)

You may not feel like eating.

Try to avoid drinking fluids at meal times.

Try to eat small meals or snacks regularly throughout the day.

Try to eat food that is high in protein and calories.

If you are worried about how much food you can eat, or if you are losing weight, ask to speak to a dietitian.

Chemotherapy (onset weeks to months)

Low red blood cells (anemia)

You may feel dizzy, light-headed, tired and appear more pale than usual.

Notify clinic or go to the nearest hospital Emergency Department if you have any chest pain, trouble breathing, or feel like your heart is racing.

Hair thinning

Your hair may become dry and may break easily.

You may lose some of your hair.

Let us know if you would like a prescription for a wig.

Date

Day of the week

Treatment day #

Day 1

Day 2

Day 3

Day 4

Days 5+

TREAMENT

DAY

Dexamethasone (Decadron)

Given in infusion center

Breakfast & Lunch

Breakfast & Lunch

Ondansetron (Zofran)

Similar medication given in infusion center

As needed every 8 hours for nausea/vomiting

Prochlorperazine

(Compazine)

As needed every 6 hours for nausea/vomiting