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This information is about a chemotherapy treatment for bowel cancer. It describes the drugs used, how they are given and some of the possible side effects. 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 de Gramont regimen is named after the doctor who first used it and involves the drugs:
The de Gramont regimen is one of several different ways of combining these two drugs and each has a different name. Some doctors in the UK use a version of the de Gramont regime known as modified de Gramont, because they feel it is easier to give and just as effective.
Treatment with de Gramont or modified de Gramont chemotherapy can be given to you during a short stay in hospital or as a day patient. You will need to have a blood test before you start treatment – 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 your chemotherapy drugs. All of this may take a couple of hours.
The nurse will then 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 into a vein near the collarbone (central line) or passed through a line in your arm (PICC line). A central or PICC line will almost certainly be needed if you are going to have your treatment as an outpatient. Your doctor or nurse will explain more about this to you.
Before your chemotherapy, you may be given tablets of an anti-sickness drug, which can also be given by injection through the cannula. You may also be given a supply of anti-sickness drugs to take home with you.
After the anti-sickness drugs you will be given folinic acid, which is given as a drip (infusion) over two hours. This is followed by an injection of 5FU (a colourless fluid) into your cannula or line.
After this you will be given 5FU by drip, which will take 22 hours. This means you will need to stay in hospital unless you have a central or PICC line. If you have a line, this part of the treatment (5FU for 22 hours) can be given to you through a small portable pump. The pump is used to give a controlled amount of the drug into your bloodstream over a set period of time. It is small enough to be carried in a belt or holster. This means that once the pump is connected to your central line and the treatment is started, you can go home.
When the infusion is finished there may be some fluid left in the pump. This may be normal as some types of pump need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.
The next day (day 2), when the 22-hour infusion has finished, exactly the same treatment is given again. If you are having treatment at home you will come back to the hospital for more chemotherapy and to have your pump changed.
Sometimes the pump will be filled with enough 5FU to last for 44 hours. After the first 22 hours, the pump will be stopped to give more folinic acid (as described above).
Your pump will be disconnected when your treatment is finished (on the third day). After this you will have a rest period with no chemotherapy for the next 11 days. This completes what is called a cycle of the chemotherapy treatment. Each cycle takes two weeks.
After the anti-sickness drugs you will be given folinic acid followed by an injection of 5FU as described above. You will then be given an infusion of 5FU that takes 46 hours using a small portable pump. You can then go home. When the infusion is finished (on the third day) you will return to the hospital and your pump will be disconnected. It may be possible to arrange for a district, or community, nurse to visit your home and disconnect the pump.
After this you will have a rest period with no chemotherapy for the next 11 days. This completes a cycle of the chemotherapy treatment. Each cycle takes two weeks.
Your doctor may use the word 'regimen' (eg the de Gramont regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.
You will start the next cycle of your treatment after the rest period, which will be a fortnight after your first injection. The treatment is usually given for 12 cycles over a period of six months. 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 de Gramont 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 do notice any effects that you think may be due to the drug, but which are not listed in this information, please let your nurse or doctor know.
Lowered resistance to infection De Gramont and modified de Gramont can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin a few days after treatment has been given. 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 De Gramont and modified de Gramont 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, and bleeding gums.
Anaemia (low number of red blood cells) While having treatment with de Gramont or modified de Gramont you may become anaemic. This may make you feel tired and breathless. Let your nurse or doctor know if these effects are a problem.
Feeling sick (nausea) and being sick (vomiting) This is usually very mild and your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor who can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss This is rare with this treatment, but you may notice that your hair becomes thinner. If any of your hair falls out, it will start to grow again once the treatment has finished.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Tell your nurse or doctor if you do have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection. Using a soft toothbrush may be helpful.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Diarrhoea If you have diarrhoea it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid you are losing.
Skin changes Your skin may become itchy and dry. Your doctor can prescribe treatment to help to reduce this.
Your skin may darken but this will slowly return to normal a few months after the treatment has finished. During treatment, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes and a hat.
Gritty eyes and blurred vision If this happens let your doctor know. They can prescribe soothing eye drops.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
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 other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
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 the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In some women this may be temporary but for some it may be permanent. If your periods stop permanently this will result in menopausal symptoms such as hot flushes and sweats.
This section is based upon our de Gramont and modified de Gramont chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography
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