Whether or not you take part in the FOxTROT study, the recommended treatment for your condition would involve surgery and a course of adjuvant chemotherapy. There are small risks from any form of major surgery and chemotherapy can also produce unwanted effects. Your doctor will explain in detail what these treatments involve. Some patients get no side-effects, but it is helpful to be forewarned of some of the things that could possibly happen with OxMdG or OxCap chemotherapy:
- For a few hours or days after starting treatment, you may feel tingling ('pins and needles') in the hands and feet if you touch cold things or go out in the cold. You may also feel tingling in the throat. This is harmless and will settle without treatment.
- Just occasionally, people can become allergic to one of the drugs, though this is rare. If, while the drip is running, you develop a racing heart beat, an itchy rash, wheezing or a swollen tongue, please tell the nurses immediately.
- Chemotherapy can cause diarrhoea. You will be given anti-diarrhoea tablets to use if this is mild, but if you have severe diarrhoea (more than 4 watery stools in a day) please telephone the hospital for advice.
- Some patients find they feel a little sick for a few days after starting treatment, but vomiting is unusual. You will be provided with some anti-sickness tablets to take if you start feeling sick. If you vomit more than once in a 24-hour period, please telephone the hospital for advice.
- Some people notice soreness in the mouth or a change in taste for some foods. You will be provided with a mouthwash which may help. If you develop ulcers or pain in the mouth, please telephone the hospital for advice.
- Some people feel more tired than usual during chemotherapy treatment. There is no easy answer to this, but if you are affected you may find it helps to set aside a rest period in the middle of each day.
- Any chemotherapy treatment may temporarily reduce your resistance to infections, so if you develop a high temperature or other symptoms of infection between treatments, you may need to come to the hospital for an urgent check-up.
- Occasionally, we meet someone who is particularly sensitive to the effects of chemotherapy and has more severe side-effects than expected. If that happens, treatment is stopped until the problems have settled; it is usually then possible to continue treatment at a lower dose.
- Women of childbearing potential must: have a negative pregnancy test prior to trial entry and avoid pregnancy during and for 6 months after study treatment. Men with a partner of childbearing potential must use adequate, medically approved, contraceptive precautions during and for 90 days after the last dose of study treatment.
In FOxTROT, some patients will receive the antibody treatment, panitumumab, in addition to chemotherapy, which can causeadditional side-effects. Nearly all patients receiving antibody will develop a rash, which is usually mild. It can take the form of red blotches or spots, or may resemble acne. Occasionally it can become more severe with itching, blisters or flaking. In some cases, it may cause infected sores requiring medical and/or surgical treatment, or cause severe skin infection. You should call your doctor IMMEDIATELY if the skin in the affected area becomes red, tender, swollen, hot to the touch, blistered, starts peeling, becomes scaly, or is discoloured. This could be a sign of an infection on or below the skin called cellulitis, or a severe skin reaction known as Stevens-Johnson Syndrome or toxic epidermal necrolysis that may require urgent medical and/or surgical treatment. This condition is rare (less than 1 in a 1000 patients) but can spread rapidly in that area and to other parts of your body and may lead to shock and death.
Other skin side-effects from panitumumab may include swelling and soreness around your nails and at the tips of your fingers and toes. Some patients receiving antibody have reported loss of appetite, or feeling tired, dizzy, anxious or short of breath. It may cause your muscles and joints to ache or cause slight swelling in your hands and feet. Having antibody alongside chemotherapy also increases the risk that you will experience diarrhoea after the chemotherapy. About 3% of people who have been treated with panitumumab have had allergic reactions, most of which were mild to moderate in intensity. Most severe reactions occur in less than 1 in 100 patients treated and can, very rarely (less than about 1 in 20,000 patients treated), be fatal. The three fatal infusion-related reactions that have been reported with panitumumab (as of January 2012), were all in patients who had advanced (incurable) cancer though, and all had previously experienced hypersensitivity reactions. Panitumumab is no longer used in patients who have had any previous severe hypersensitivity reactions. We believe, therefore, that the chance of such severe reactions in FOxTROT is extremely low and all patients will be carefully monitored during treatment to minimise the risk.. There is also a very small chance that antibody treatment might cause a heart attack: this does not seem to be a problem with panitumumab, the antibody used in FOxTROT, but some patients treated with a similar drug have experienced heart damage. If you experience a racing heart beat, chest pain or any other symptom that you believe may be related to your heart, please contact the hospital immediately. Panitumumab has been tried and tested in several thousands of patients but, as with any new drug, there is a potential that you may experience other side-effects not previously observed.