Pegylated Liposomal Irinotecan

Symptoms of drug allergy including one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Infusion-related reaction

• This usually happens during the first few doses.
• This is usually mild or moderate, but rarely can be more severe.

• Inform the nurse immediately if you experience any of the following during the infusion:
  • Flu-like symptoms such as fever, chills or dizziness, headache, feeling warm or flushed
  • Red, warm, and itchy bumps on the skin
  • Swelling of the lips, tongue or throat
  • Breathlessness, wheezing, cough or sudden difficulty breathing
  • Back pain or chest pain
• You may be given medications before the infusion to reduce the chance of this happening.
• If you do have a reaction, this is usually treated by slowing or stopping the drip until the reaction is over. You may also be given medications to help with the symptoms. Future infusions may also be given at a slower rate.

Decrease in white blood cell count. This may increase your chances of getting an infection.

• To reduce risk of infection:
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
  • Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection such as fever of 38ºC and above, chills, bad sore throat, pain when you pass urine or have mouth sores or wounds that do not heal.
  • Avoid taking Paracetamol to relieve fever as this may mask your fever and delay treatment of the infection.

Decrease in platelet count. Low platelet levels can increase your chance of bleeding. 

• To reduce risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have:
  • Bruising without a cause or bruises that get larger in size
  • Black, sticky stools
  • Blood in the urine
  • Coughing out blood or vomit that looks like coffee grounds
  • Bleeding which does not stop

• A medication called atropine will be given as an injection under the skin before Pegylated Liposomal Irinotecan to prevent early diarrhoea.
• Inform nurses or doctor immediately if it happens while chemotherapy is being given.
• Proceed to A&E department if it happens when you get home.

Late diarrhoea may occur a few days after treatment. 

You may notice that stools become more loose or frequent than usual.

• Late diarrhoea must be treated immediately. If you have the anti-diarrhoeal medication Loperamide at home, follow the instructions given by your doctor or pharmacist.
• Proceed to the A&E Department immediately if you have very bad diarrhoea (for example increase in bowel movement of more than 4 times per day) that does not improve even after taking anti-diarrhoeal medications.
• Drink plenty of clear fluids (at least 2 litres every day) unless instructed otherwise by your doctor.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.

• Take small and frequent meals.
• Avoid foods / smells that may make you feel nauseous, such as oily, fried or strong-smelling food.
• Avoid tight-fitting clothes around the waist.
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.

• Do not drive or operate machinery if you are feeling tired.
• Eat well and get enough sleep. Prioritize tasks to ensure you make the best use of your energy.
• Simple exercise such as walking can help to boost your energy.
• Avoid alcohol as this may cause you to feel more tired and drowsy.

Hair Loss

• This is a temporary side effect and may be more obvious by the second week of treatment.
• You may lose all the hair on your head and may even lose your eyebrows, eyelashes or body hair.

• Consider cutting your hair short before chemotherapy, using wigs or using head coverings like hats or scarves.
• Use a mild shampoo (such as baby shampoo) to wash your hair and scalp.
• Your hair will grow back a few weeks after chemotherapy is completed.

Mouth ulcers or sores

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce chances of infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot lesser because of mouth pain.

• Proceed to the A&E department immediately if you have any new or worsening symptoms of lung problems such as shortness of breath, cough or chest pain.

Liver problems 

• Rarely, this medication can injure or damage the liver. A liver injury may recover on its own. However, in some cases, it can cause serious liver damage. 

• Stop this medication and proceed to the A&E department immediately if you experience any:
  • Dark coloured urine
  • Light-coloured stools
  • Yellowing of your skin or eyes
  • Nausea, vomiting that does not go away
  • Severe abdominal pain

If you need to go to the hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment.

Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.

It is normal to feel fearful or worried about your condition.

Do not be afraid to talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.