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This information is about a chemotherapy treatment for small cell lung cancer using carboplatin and etoposide. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
The treatment involves two chemotherapy drugs:
Carboplatin and etoposide chemotherapy treatment can usually be given to you as a day patient. Before you start treatment, you will need to have a blood test, either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare the chemotherapy drugs for you. All of this may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube which is inserted under the skin and into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will then be given some anti-sickness (anti-emetic) medicines. These are usually given by injection (through the cannula, central line or PICC line) which is connected to a drip (infusion). Some anti-sickness medicines may also be given as tablets.
The chemotherapy drugs are then given separately:
If you are having your treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness medicines to take with you. It is important to take these as directed even if you are not feeling sick. This is because some anti-sickness medicines are better at preventing sickness than stopping it once it has started.
Your doctor may use the word 'regimen' (eg the carboplatin etoposide regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.
On the first day of treatment (day 1) you will be given the carboplatin and etoposide as infusions, as described above. On the next day (day 2) you will be given another infusion of etoposide, or you will be given etoposide capsules to take. Day 3 is a repeat of day 2. After this, you will have a rest with no chemotherapy for 18 days. This completes what is called a cycle of treatment. Each cycle takes 21 days (three weeks).
You will start the next cycle of your treatment after the rest period, which will be three weeks after your first injection. Usually 2–6 cycles are given, depending on how well your cancer is responding to the treatment and how well you are able to tolerate the side effects. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having carboplatin and etoposide chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.
Lowered resistance to infection Carboplatin and etoposide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising or bleeding Carboplatin and etoposide can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with these drugs you may become anaemic. This can make you feel tired and breathless. Let your doctor or nurse know if this is a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can now prescribe very effective anti-sickness (anti-emetic) medicines to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness medicines which may be more effective. Some anti-sickness medicines may cause constipation. Let your doctor or nurse know if this is a problem.
Your kidney function may be affected Usually this does not cause any symptoms and the effect on the kidneys is generally mild. Some people may develop kidney damage but this is rarely permanent. Often the chemotherapy treatment would be discontinued, the dose reduced, or an alternative chemotherapy found before any damage occurs.
Before each treatment you will have a blood test to check how well your kidneys are working. You may be asked to drink more than normal on the day after treatment. It is important to tell your doctor or chemotherapy nurse if you are not able to drink enough. Also let them know if you are not passing as much urine as normal.
Tiredness and a general feeling of weakness You may feel very tired. It is important to allow yourself plenty of time to rest.
Hair loss This usually begins about 3-4 weeks after starting treatment, although it may occur earlier. Hair may fall out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair should start to grow again once treatment has finished.
Numbness or tingling in hands or feet This is due to the effect of the carboplatin on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. The problem usually improves slowly a few months after treatment is over.
Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Let your nurse or doctor know if you have any of these problems as they can give you special mouthwashes and medicines to prevent or clear any mouth infection.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Loss of appetite A dietitian or specialist nurse at your hospital can give advice on boosting your appetite, coping with eating difficulties and maintaining weight.
Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness or darkening of the face, dizziness, a headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these.
Diarrhoea This can usually be controlled easily with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea. Tell your doctor if you have any change in bowel habit.
Very rarely, etoposide may cause a second cancer, usually a type of acute leukaemia, to develop years later. Your nurse or doctor can discuss this with you.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg; or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some medicines can be harmful to take when you are having chemotherapy. Always tell your doctor about any medicine you are taking. This includes any that you may have bought from a pharmacy or supermarket and any herbal or complementary therapies.
Leakage into the tissue around the vein If etoposide leaks into the tissue around the vein it can damage the cells in that area. If you notice any stinging or burning around the vein while either drug is being given, tell the doctor or nurse immediately.
Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking this treatment as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for up to a year afterwards. Again, discuss this with your doctor.
This section is based upon our carboplatin and etoposide chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see general bibliography.
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