Microsoft word - focus 3 pis stage 4 v2.0 october 2009.doc

FOCUS 3 – A study to determine the feasibility of molecular selection of therapy using KRAS, BRAF and topo-1 in patients with metastatic or Information for patients receiving IrFU chemotherapy This sheet gives some information about the chemotherapy you will be receiving. ‘IrFU’ is short for ‘Irinotecan + Fluorouracil’. IrFU chemotherapy is given each fortnight. The treatment starts with an anti-sickness injection then a 2-3 hour ‘drip’, into a vein, of a chemotherapy drug (irinotecan) and a vitamin called folinic acid (FA). This is followed by an injection of the chemotherapy drug, ‘FU’ (fluorouracil). The injection, also into the vein, takes about five minutes. After that, you receive more FU, this time given very slowly into the vein, over the next 46 hours. There are several different methods of doing this and your oncology doctor or nurse will discuss with you the way that suits you best. Generally this is given at home, using a portable pump, however there may be times when you need to stay in hospital. Depending upon which method is used, you may need to have a thin flexible tube fitted in either your arm or your chest. This leads into one of your veins, and chemotherapy is given through it. Once fitted, it can stay in for the duration of your treatment. You may also be asked to take warfarin, a tablet which reduces the risk of blood clots. For most patients the side effects of IrFU are only mild. However, you may find it helpful to be forewarned about some of the things which could occur. During the first couple of hours of the chemotherapy you may notice sweating or watering eyes, and feel stomach cramps or have a bout of diarrhoea. If you are affected, tell the nurse on the chemotherapy unit: these symptoms are easily stopped by an injection. If this happens to you, you may receive the injection in advance for future treatments. If the symptoms occur after you have got home from the hospital, during the 24 hours after your irinotecan infusion, rest quietly and telephone the ward Occasionally, more severe diarrhoea can occur as a side effect of IrFU chemotherapy. If left untreated this could be dangerous, but it usually responds well to prompt treatment, therefore you will be given tablets (loperamide) to take if necessary. If you have diarrhoea (except within the first 24 hours after the irinotecan infusion) Take 2 of the loperamide tablets provided, immediately after the first liquid stool, then another tablet every two hours until 12 hours after the diarrhoea has stopped. Drink plenty of water, fizzy drinks or soups for as long as the diarrhoea lasts. If the diarrhoea hasn’t settled within 24 hours, you should contact the hospital. You will be asked to start a course of an antibiotic called ciprofloxacin. However, if the diarrhoea is severe, or if you can’t drink plenty of liquid or if you also have a temperature, you may need to be admitted for a period of observation. Some people feel more tired than usual for a few days. You may notice a change in taste for certain foods, or soreness in the mouth. Some patients find they feel sick, although actual vomiting is unusual. In the longer term, usually after several months of treatment, your hands and feet may become rather dry or sore, and you may have some have hayfever-like symptoms such as a runny nose or sore eyes. All these side-effects can be helped by medication, so if you are affected please talk to your oncology team. If medication has been tried but the side effects persist, it is usually possible to get rid of them by slightly reducing the dose of chemotherapy. This does not compromise the effectiveness of treatment. It is possible, though not inevitable, that your hair will thin during this treatment. If you find that you are losing hair, talk it through with your oncology nurses who will be able to help you cope. Hair loss, if it occurs, is temporary – it will grow back when IrFU Just occasionally, we meet someone who is unusually sensitive to the effects of FU chemotherapy, and the side effects described above occur more quickly and severely than for others. The reason for this is an unusual metabolism which means that the FU stays in the bloodstream for longer after it has been given. If this happens, treatment is stopped until the problems have resolved, and it is then usually possible to restart at a lower dose. This does not compromise the effectiveness of treatment. Very rarely, chemotherapy can cause heart palpitations, chest pain, or poor co- ordination. It is most unlikely that you will be affected, but if you suspect you have one of these problems, please discuss it with your oncology doctor. If you have had a tube fitted for receiving chemotherapy at home, there is a possibility of a problem related to the tube. If you notice any problems such as redness, pain or discharge around the tube, or swelling of one arm, please speak to the oncology doctor Most other medications (though not all) can be taken safely alongside IrFU treatment. If you are on regular medications (including non-prescribed drugs such as complementary therapies and herbal drugs), please make sure your oncology doctor knows about them before you start your treatment so that they can be checked. After starting your IrFU treatment, if any new medication is required it is important that any doctor prescribing it knows you are on IrFU. Finally, if you become suddenly unwell between hospital visits, and especially if you develop a high temperature, shivering fits or severe diarrhoea, please seek advice immediately, either from your hospital team or from your GP. FOCUS 3 – A study to determine the feasibility of molecular selection of therapy using KRAS, BRAF and topo-1 in patients with metastatic or Information for patients receiving FU chemotherapy This sheet gives some information about the chemotherapy you will be receiving now that you have been allocated to this treatment plan. FU chemotherapy is given each fortnight. The treatment starts with a two hour drip, into a vein, of a vitamin called folinic acid (FA). This is followed by an injection of the chemotherapy drug, fluorouracil. The injection, also into the vein, takes about five After that, you receive more fluorouracil, this time given very slowly into the vein, over the next 46 hours. There are several different methods of doing this and your oncology doctor or nurse will discuss with you the way that suits you best. Generally this is given at home, using a portable pump, however there may be times when you need to stay in Depending upon which method is used, you may need to have a thin flexible tube fitted in either your arm or your chest. This leads into one of your veins, and chemotherapy is given through it. Once fitted, it can stay in for the duration of your treatment. You may also be asked to take a tablet called warfarin, to reduce the risk of a blood clot forming Any chemotherapy can cause side effects. For most patients the side effects of FU are mild, and some have no side effects at all. However, you may find it helpful to be forewarned about some of the side effects that could occur. FU 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 the FU 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. Occasionally, more severe diarrhoea can occur as a side effect of IrFU chemotherapy. If left untreated this could be dangerous, but it usually responds well to prompt treatment, therefore you will be given tablets (loperamide) to take if necessary. If you have diarrhoea (except within the first 24 hours after the irinotecan infusion) Take 2 of the loperamide tablets provided, immediately after the first liquid stool, then another tablet every two hours until 12 hours after the diarrhoea has stopped. Drink plenty of water, fizzy drinks or soups for as long as the diarrhoea lasts. If the diarrhoea hasn’t settled within 24 hours, you should contact the hospital. You will be asked to start a course of an antibiotic called ciprofloxacin. However, if the diarrhoea is severe, or if you can’t drink plenty of liquid or if you also have a temperature, you may need to be admitted for a period of observation. Some people feel more tired than usual for a few days. You may notice a change in taste for certain foods, or soreness in the mouth. You will be provided with a mouthwash which may help. If you develop ulcers or pain in the mouth, please telephone the Some patients find they feel sick, although actual vomiting is unusual. In the longer term, usually after several months of treatment, your hands and feet may become rather dry or sore, with redness or dryness of the skin and you may have some have hayfever-like symptoms such as a runny nose or sore eyes. All these side-effects can be helped by medication, so if you are affected please talk to your oncology team. If medication has been tried but the side effects persist, it is usually possible to get rid of them by slightly reducing the dose of chemotherapy. This does not compromise the effectiveness of treatment. Very rarely, FU chemotherapy can cause heart palpitations, chest pain (angina), or poor co-ordination. It is most unlikely that you will be affected, but if you suspect you have one of these problems, please discuss it with your oncology doctor or nurse. If you have had a tube fitted for receiving chemotherapy at home, there is a possibility of a problem related to the tube. If you notice any problems such as redness, pain or discharge around the tube, or swelling of one arm, please speak to the oncology doctor Most other medications (though not all) can be taken safely alongside FU treatment. If you are on regular medications (including non-prescribed drugs such as complementary therapies and herbal drugs), please make sure your oncology doctor knows about them before you start your treatment so that they can be checked. After starting your FU treatment, if any new medication is required it is important that any doctor prescribing it knows you are on FU. Finally, if you become suddenly unwell between hospital visits, and especially if you develop a high temperature, shivering fits or severe diarrhoea, please seek advice immediately, either from your hospital team or from your GP. FOCUS 3 – A study to determine the feasibility of molecular selection of therapy using KRAS, BRAF and topo-1 in patients with metastatic or Information for patients receiving Ox Ir FU This sheet gives some information about the chemotherapy you will be receiving. ‘OxIrFU’ is short for ‘Oxaliplatin + Irinotecan + Fluorouracil’. OxIrFU chemotherapy is given each fortnight. The treatment starts with an anti- sickness injection then a 30 minute ‘drip’ into a vein with the first chemotherapy drug (irinotecan), followed by another 2-3 hour ‘drip’, into a vein, of a chemotherapy drug (oxaliplatin) and a vitamin (FA). This is followed by an injection of the chemotherapy drug, ‘FU’ (fluorouracil). The injection, also into the vein, takes about five minutes. After that, you receive more FU, this time given very slowly into the vein, over the next 46 hours. There are several different methods of doing this and your oncology doctor or nurse will discuss with you the way that suits you best. Generally this is given at home, using a portable pump, however there may be times when you need to stay in hospital. Depending upon which method is used, you may need to have a thin flexible tube fitted in either your arm or your chest. This leads into one of your veins, and chemotherapy is given through it. Once fitted, it can stay in for the duration of your treatment. You may also be asked to take warfarin, a tablet which reduces the risk of blood clots. You may find it helpful to be forewarned about some of the side effects which could During the first couple of hours of the chemotherapy you may notice sweating or watering eyes, and feel stomach cramps or have a bout of diarrhoea. If you are affected, tell the nurse on the chemotherapy unit: these symptoms are easily stopped by an injection. If this happens to you, you may receive the injection in advance for future treatments. If the symptoms occur after you have got home from the hospital, during the 24 hours after your irinotecan infusion, rest quietly and telephone the ward Occasionally, more severe diarrhoea can occur as a side effect of OxIrFU chemotherapy. If left untreated this could be dangerous, but it usually responds well to prompt treatment, therefore you will be given tablets (loperamide) to take if necessary. If you have diarrhoea (except within the first 24 hours after the irinotecan infusion) Take 2 of the loperamide tablets provided, immediately after the first liquid stool, then another tablet every two hours until 12 hours after the diarrhoea has stopped. Drink plenty of water, fizzy drinks or soups for as long as the diarrhoea lasts. If the diarrhoea hasn’t settled within 24 hours, you should contact the hospital. You will be asked to start a course of an antibiotic called ciprofloxacin. However, if the diarrhoea is severe, or if you can’t drink plenty of liquid or if you also have a temperature, you may need to be admitted for a period of observation. For a few hours or days after starting treatment, you may feel 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 quite normal and not harmful. If affected, you may wish to wear gloves and avoid cold places for the periods when you are affected. After several months of treatment, some patients find that the temporary tingling sensations, instead of lasting just a few hours or days, persist for longer. As a general rule, if this symptom persists right through the 2 weeks until your next treatment is due, and especially you have numbness as well as tingling, it is time to drop one of the drugs – oxaliplatin – from the chemotherapy. Please ensure you discuss this with your doctors Some people feel discomfort or pain up their arm during the 2 hours that the oxaliplatin drip is running. If you are affected please tell the nurse on the chemotherapy unit straight away: this symptom can usually be relieved by placing a warm pad over the Just occasionally, people can become allergic to oxaliplatin, though usually only after several treatments. If, while the oxaliplatin drip is running, you develop palpitations, an itchy rash, wheezing or a swollen tongue, please tell the nurses immediately. Some people feel more tired than usual for a few days. You may notice a change in taste for certain foods, or soreness in the mouth. Some patients find they feel sick, although actual vomiting is unusual. In the longer term, usually after several months of treatment, your hands and feet may become rather dry or sore, and you may have some have hayfever-like symptoms such as a runny nose or sore eyes. All these side-effects can be helped by medication, so if you are affected please talk to your oncology team. If medication has been tried but the side effects persist, it is usually possible to get rid of them by slightly reducing the dose of chemotherapy. This does not compromise the effectiveness of treatment. It is possible, though not inevitable, that your hair will thin during this treatment. If you find that you are losing hair, talk it through with your oncology nurses who will be able to help you cope. Hair loss, if it occurs, is temporary – it will grow back when IrFU Just occasionally, we meet someone who is unusually sensitive to the effects of FU chemotherapy, and the side effects described above occur more quickly and severely than for others. The reason for this is an unusual metabolism which means that the FU stays in the bloodstream for longer after it has been given. If this happens, treatment is stopped until the problems have resolved, and it is then usually possible to restart at a lower dose. This does not compromise the effectiveness of treatment. Very rarely, chemotherapy can cause heart palpitations, chest pain, or poor co- ordination. It is most unlikely that you will be affected, but if you suspect you have one of these problems, please discuss it with your oncology doctor. If you have had a tube fitted for receiving chemotherapy at home, there is a possibility of a problem related to the tube. If you notice any problems such as redness, pain or discharge around the tube, or swelling of one arm, please speak to the oncology doctor Most other medications (though not all) can be taken safely alongside OxIrFU treatment. If you are on regular medications (including non-prescribed drugs such as complementary therapies and herbal drugs), please make sure your oncology doctor knows about them before you start your treatment so that they can be checked. After starting your OxIrFU treatment, if any new medication is required it is important that any doctor prescribing it knows you are on OxIrFU. Finally, if you become suddenly unwell between hospital visits, and especially if you develop a high temperature, shivering fits or severe diarrhoea, please seek advice immediately, either from your hospital team or from your GP. FOCUS 3 – A study to determine the feasibility of molecular selection of therapy using KRAS, BRAF and topo-1 in patients with metastatic or Information for patients receiving IrFU chemotherapy and cetuximab This sheet gives some information about the chemotherapy you will be receiving. ‘IrFU’ is short for ‘Irinotecan + Fluorouracil’. IrFU & cetuximab chemotherapy is given each fortnight. The treatment starts with the first dose of cetuximab. A drip will be placed in your arm. Because cetuximab is an antibody, it can occasionally cause an allergic reaction. To begin with, an injection is given through the drip to reduce the risk of an allergic reaction. You will then receive the first dose of cetuximab as a drip over 2 hours. The nurse will monitor your pulse and blood pressure regularly before, during and after this treatment. Following this you will have a 2-3 hour ‘drip’ of a vitamin called folinic acid (FA), into a vein, followed by a ‘drip’ of another chemotherapy drug (irinotecan) for another half an hour. This is followed by an injection of the chemotherapy drug, ‘FU’. The injection, also into the vein, takes about five minutes. After that, you receive more FU, this time given very slowly into the vein, over the next 46 hours. There are several different methods of doing this and your oncology doctor or nurse will discuss with you the way that suits you best. Generally this is given at home, using a portable pump, however there may be times when you need to stay in hospital. Depending upon which method is used, you may need to have a thin flexible tube fitted in either your arm or your chest. This leads into one of your veins, and chemotherapy is given through it. Once fitted, it can stay in for the duration of your treatment. You may also be asked to take warfarin, a tablet which reduces the risk of blood clots. For most patients the side effects of IrFU and cetuximab are only mild. However, you may find it helpful to be forewarned about some of the things which could occur. During the first couple of hours of the chemotherapy you may notice sweating or watering eyes, and feel stomach cramps or have a bout of diarrhoea. If you are affected, tell the nurse on the chemotherapy unit: these symptoms are easily stopped by an injection. If this happens to you, you may receive the injection in advance for future treatments. If the symptoms occur after you have got home from the hospital, during the 24 hours after your irinotecan infusion, rest quietly and telephone the ward Occasionally, more severe diarrhoea can occur as a side effect of IrFU chemotherapy. If left untreated this could be dangerous, but it usually responds well to prompt treatment, therefore you will be given tablets (loperamide) to take if necessary. If you have diarrhoea (except within the first 24 hours after the irinotecan infusion) Take 2 of the loperamide tablets provided, immediately after the first liquid stool, then another tablet every two hours until 12 hours after the diarrhoea has stopped. Drink plenty of water, fizzy drinks or soups for as long as the diarrhoea lasts. If the diarrhoea hasn’t settled within 24 hours, you should contact the hospital. You will be asked to start a course of an antibiotic called ciprofloxacin. However, if the diarrhoea is severe, or if you can’t drink plenty of liquid or if you also have a temperature, you may need to be admitted for a period of observation. Cetuximab causes a rash in most people that is like acne. This happens because it is blocking the action of the growth factor on the skin cells. It comes on gradually over the first three weeks and tends to affect the chest, front and back, and can affect the face. The treatments that are given for acne can help this rash including local and oral antibiotics. It can get quite bad in which case your oncology doctor may recommend interrupting the cetuximab treatment for 1 – 2 weeks to allow it to settle. In most patients it has settled down by 12 weeks of treatment. Patients who have a longer course of treatment with cetuximab can find their skin gets dry and their eyelashes grow longer and curly. In addition some people develop a sore area alongside the nails (especially of the big toes and thumbs). Treatment can help all Cetuximab may cause an allergic reaction that may be life threatening. This occurs in 1 in 50 people receiving this treatment. You will be given medicines at each cycle to reduce this risk and emergency treatment will be available to treat the reaction if it Cetuximab may cause a reduction in the level of magnesium salt in your blood. This may cause tiredness and unsteadiness and very rarely confusion and irregularity of heart rhythm. The level of magnesium in the blood will therefore be monitored regularly and supplements provided if the level falls below normal. Some people feel more tired than usual for a few days. You may notice a change in taste for certain foods, or soreness in the mouth. Some patients find they feel sick, although actual vomiting is unusual. In the longer term, usually after several months of treatment, your hands and feet may become rather dry or sore, and you may have some have hayfever-like symptoms such as a runny nose or sore eyes. All these side-effects can be helped by medication, so if you are affected please talk to your oncology team. If medication has been tried but the side effects persist, it is usually possible to get rid of them by slightly reducing the dose of chemotherapy. This does not compromise the effectiveness of treatment. It is possible, though not inevitable, that your hair will thin during this treatment. If you find that you are losing hair, talk it through with your oncology nurses who will be able to help you cope. Hair loss, if it occurs, is temporary – it will grow back when IrFU Just occasionally, we meet someone who is unusually sensitive to the effects of FU chemotherapy, and the side effects described above occur more quickly and severely than for others. The reason for this is an unusual metabolism which means that the FU stays in the bloodstream for longer after it has been given. If this happens, treatment is stopped until the problems have resolved, and it is then usually possible to restart at a lower dose. This does not compromise the effectiveness of treatment. Very rarely, chemotherapy can cause heart palpitations, chest pain, or poor co- ordination. It is most unlikely that you will be affected, but if you suspect you have one of these problems, please discuss it with your oncology doctor. If you have had a tube fitted for receiving chemotherapy at home, there is a possibility of a problem related to the tube. If you notice any problems such as redness, pain or discharge around the tube, or swelling of one arm, please speak to the oncology doctor Most other medications (though not all) can be taken safely alongside IrFU + cetuximab treatment. If you are on regular medications (including non-prescribed drugs such as complementary therapies and herbal drugs), please make sure your oncology doctor knows about them before you start your treatment so that they can be checked. After starting your IrFU + cetuximab treatment, if any new medication is required it is important that any doctor prescribing it knows you are on IrFU + cetuximab. Finally, if you become suddenly unwell between hospital visits, and especially if you develop a high temperature, shivering fits or severe diarrhoea, please seek advice immediately, either from your hospital team or from your GP. FOCUS 3 – A study to determine the feasibility of molecular selection of therapy using KRAS, BRAF and topo-1 in patients with metastatic or Ir FU & bevacizumab Information Sheet Information for patients receiving IrFU and bevacizumab chemotherapy. This sheet gives some information about the chemotherapy you will be receiving. ‘IrFU’ is short for ‘Irinotecan + Fluorouracil’. IrFU + bevacizumab treatment is given each fortnight. The treatment starts with an anti-sickness injection then a 90 minute ‘drip’, into a vein, of a the drug bevacizumab, followed by a 30 minute ‘drip’ of another drug called irinotecan. A vitamin called folinic acid (FA) is then given as a ‘drip’ over a further 2 hours. This is followed by an injection of the chemotherapy drug, ‘FU’ (fluorouracil). The injection, also into the vein, takes After that, you receive more FU, this time given very slowly into the vein, over the next 46 hours. There are several different methods of doing this and your oncology doctor or nurse will discuss with you the way that suits you best. Generally this is given at home, using a portable pump, however there may be times when you need to stay in hospital. Depending upon which method is used, you may need to have a thin flexible tube fitted in either your arm or your chest. This leads into one of your veins, and chemotherapy is given through it. Once fitted, it can stay in for the duration of your treatment. You may also be asked to take warfarin, a tablet which reduces the risk of blood clots. You may find it helpful to be forewarned about some of the side effects that could occur During the first couple of hours of the chemotherapy you may notice sweating or watering eyes, and feel stomach cramps or have a bout of diarrhoea. If you are affected, tell the nurse on the chemotherapy unit: these symptoms are easily stopped by an injection. If this happens to you, you may receive the injection in advance for future treatments. If the symptoms occur after you have got home from the hospital, during the 24 hours after your irinotecan infusion, rest quietly and telephone the ward Occasionally, more severe diarrhoea can occur as a side effect of IrFU chemotherapy. If left untreated this could be dangerous, but it usually responds well to prompt treatment, therefore you will be given tablets (loperamide) to take if necessary. If you have diarrhoea (except within the first 24 hours after the irinotecan infusion) Take 2 of the loperamide tablets provided, immediately after the first liquid stool, then another tablet every two hours until 12 hours after the diarrhoea has stopped. Drink plenty of water, fizzy drinks or soups for as long as the diarrhoea lasts. If the diarrhoea hasn’t settled within 24 hours, you should contact the hospital. You will be asked to start a course of an antibiotic called ciprofloxacin. However, if the diarrhoea is severe, or if you can’t drink plenty of liquid or if you also have a temperature, you may need to be admitted for a period of observation. Some people feel more tired than usual for a few days. You may notice a change in taste for certain foods, or soreness in the mouth. Some patients find they feel sick, although actual vomiting is unusual. In the longer term, usually after several months of treatment, your hands and feet may become rather dry or sore, and you may have some have hayfever-like symptoms such as a runny nose or sore eyes. All these side-effects can be helped by medication, so if you are affected please talk to your oncology team. If medication has been tried but the side effects persist, it is usually possible to get rid of them by slightly reducing the dose of chemotherapy. This does not compromise the effectiveness of treatment. It is possible, though not inevitable, that your hair will thin during this treatment. If you find that you are losing hair, talk it through with your oncology nurses who will be able to help you cope. Hair loss, if it occurs, is temporary – it will grow back when IrFU About one third of people receiving bevacizumab develop mild or moderate raised blood pressure (hypertension). We will monitor your blood pressure each time you attend before treatment and if your blood pressure goes up significantly (more than 20mmHg) then a blood pressure tablet will be prescribed for you. It is rare to have an allergic reaction to bevacizumab. Signs of a reaction include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness. You will be monitored closely during your treatment, but it is very important to tell your nurse or oncology doctor if you have Wounds may also take longer to heal while you are having treatment with bevacizumab. Bevacizumab can also reduce the production of platelets (which help the blood to clot). Let your oncology doctor or GP know if you have any unexplained bruising or bleeding. Just occasionally, we meet someone who is unusually sensitive to the effects of FU chemotherapy, and the side effects described above occur more quickly and severely than for others. The reason for this is an unusual metabolism which means that the FU stays in the bloodstream for longer after it has been given. If this happens, treatment is stopped until the problems have resolved, and it is then usually possible to restart at a lower dose. This does not compromise the effectiveness of treatment. Very rarely, chemotherapy can cause heart palpitations, chest pain, or poor co- ordination. It is most unlikely that you will be affected, but if you suspect you have one of these problems, please discuss it with your oncology doctor. Your blood pressure will be checked regularly as bevacizumab can sometimes cause high blood pressure. If you have any headaches, nosebleeds or feelings of dizziness let your oncology doctor or GP There have been some reports of an increased risk of blood clots (DVT), stroke and angina (heart pain) in people taking bevacizumab. There are also rare reports of gastro- intestinal perforation in people taking bevacizumab. It is important that you contact your doctor immediately if you suffer from severe stomach pain. If you have had a tube fitted for receiving chemotherapy at home, there is a possibility of a problem related to the tube. If you notice any problems such as redness, pain or discharge around the tube, or swelling of one arm, please speak to the oncology doctor Most other medications (though not all) can be taken safely alongside IrFU + bevacizumab treatment. If you are on regular medications (including non-prescribed drugs such as complementary therapies and herbal drugs), please make sure your oncology doctor knows about them before you start your treatment so that they can be After starting your IrFU + bevacizumab treatment, if any new medication is required it is important that any doctor prescribing it knows you are on IrFU + bevacizumab. Finally, if you become suddenly unwell between hospital visits, and especially if you develop a high temperature, shivering fits or severe diarrhoea, please seek advice immediately, either from your hospital team or from your GP.

Source: http://www.focus3trial.org/PDF/FOCUS%203%20PIS%20Stage%204%20v2.0%20October%202009.pdf