UFTORAL chemotherapy

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Your doctor has explained that you have colorectal cancer and has recommended treatment with chemotherapy called Uftoral. This is a new chemotherapy agent that contains the chemical compounds tegafur and uracil.  It is taken with another drug folinic acid (sometimes called Leucovorin).   The main advantage of this drug is that it is given as oral tablets (therefore does not require an injection) and it doesn't cause sore hand & feet which is common to other oral drugs of a similar category

How should Uftoral capsules and the fplinic acid (Leucovorin) tablets be taken?
Ideally, the treatment should be taken three times a day (every 8 hours).  They should be swallowed with some water, on an empty stomach.  This means you should take them at least an hour before a meal or at least an hour after a meal.  The capsules and tablets should be taken at the same time. It is not necessary to stay up very late or get up very early to take the treatment.  Instead, try to plan your day so that you take the treatment 

• First thing in the morning, at least an hour before your breakfast

• Mid- to late-afternoon, at least an hour after your lunch

• Last thing at night, at least an hour after your evening meal

How many tablets do you take? The doses of Uftoral and folinic acid (Leucovorin) will depend on your height and weight and your doctor will calculate the correct dose.  Because people are different shapes and sizes there are capsules containing different amounts of the drug.  These are differently coloured.  (Other people in the clinic may have different coloured capsules because of this). Your doctor will discuss with you the number of capsules you need to take each day. You will also have a blood test before starting chemotherapy, usually every three weeks during treatment and at other times if you feel unwell.  If your blood count is low the is a change in your liver and kidney function the chemotherapy may be delayed or the dose reduced.  

The Uftoral will be provided in cartons which each containing 7 days supply of capsules. Your chemotherapy nurse may give you a diary in which s/he will write what you need to take, at what times of the day.  You will need to take one or two capsules of Uftoral each time and one or two tablets of folinic acid (Leucovorin).  The diary is for you to keep a record of when you take the doses. You should take the treatment every day for 28 days, then have a break for 7 days. The number of courses you have will depend on how well you respond to the Uftoral.  Every person is different and your doctor will discuss this with you.

Side effects

We have outlined the side-effects you may experience during treatment.  It is important that you feel free to ask questions so that you understand what to expect and what to do.  Most side effects of Uftoral stop when you finish taking the drug.  Occasionally people have rare side-effects which are not expected or mentioned on this sheet.  If in doubt ask:-

• White Blood Cells (WBC) Shivering or shaking attacks of fever (flu like symptoms). If you feel hot or unwell check your temperature. A raised temperature indicates you have an infection which could be life threatening. A normal temperature is between 36^oC and 37.2^oC. If it is 38°C (100F) telephone the Hospital or cancer unit immediately and they will advise you. Do not take Paracetamol or Aspirin as this will bring your temperature down and mask the signs of infection.  This is most likely to happen in the middle week (7-14 days) between cycles.

• Haemoglobin (Hb) Tiredness, lethargy, breathlessness, dizziness (particularly on standing) and pale facial colour. Occasionally patients require a blood transfusion at some point during the whole course.

• Platelets If you notice any bleeding, i.e. nose bleeds, unexplained bleeding, bruising or persistent headaches contact the Hospital immediately.

Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but are otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.

Diarrhoea; This chemotherapy can cause diarrhoea, which can usually be easily controlled with diet. If diarrhoea starts try to avoid spicy foods, fibre and excess vegetables, it is important to drink plenty of fluids. If you have any alteration in bowel pattern tell your doctor it may be necessary to take an anti-diarrhoeal drug such as loperamide (Immodium). 

Sore mouth; Rarely it is possible to develop a sore mouth so it is important that you maintain good oral hygiene.  A soft, baby toothbrush and a salt water mouthwash may help.  If you develop red gums, a painful tongue or mouth ulcers that persist, then please contact your Hospital.  Special mouthwashes can be prescribed to help you. 

Nausea & sickness; This treatment does not normally cause any sickness, but you will be given anti-sickness tablets to take home if required. Some self help tips may also be useful.

Hair loss; This treatment does not usually cause  significant hair loss, but there may be some thinning noticed by some people.   

Fatigue; All chemotherapy can cause fatigue. As your treatment progresses you will experience this. You may find that gentle exercise such as a short walk each day (if you are not working) may help.  Fatigue and malaise may last up to 2-3 months (or longer) after the end of chemotherapy. 

You may find that your eyes become itchy and more sensitive to light and that they start ‘watering’. If this occurs your doctor may prescribe you some eye drops. 

Fertility may be affected by chemotherapy, in both men and women.  It is important to discuss fertility with your doctor before starting treatment.  For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent, causing menopausal symptoms. You should not become pregnant during chemotherapy, as it will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant.  Men must also use a barrier contraceptive whilst receiving chemotherapy as sperm  is damaged by chemotherapy. 

Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team. 

Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally. 

Other issues and frequently asked questions

What if I miss a dose?
If you miss a dose, the next scheduled dose should be taken at the usual time.  Do not make up the missed dose by taking extra the next time.  You should let your specialist doctor know at the next visit.

What if I take too many capsules? 
You should speak to your specialist doctor or nurse as soon as you realise what you have done.  If this is not possible, there is no need to panic but you should go to the nearest hospital accident and emergency department taking the containers and remaining doses with you.

How should the Uftoral and folinic acid (Leucovorin) be stored? 
You should store your capsules and tablets in a dry place at room temperature, away from direct heat and light and out of the reach of children and animals.

Are there any particular things I should let my doctor know?
Your doctor will have reviewed your medical history before prescribing Uftoral, but you should let him know if any of the following apply to you:

• You are pregnant or breast feeding

• You and your partner are trying for a baby, or intending to try within the next year

• You have recently undergone chemotherapy

• You are taking any other medicine

• You have problems with you kidney, liver or heart

• You have a problem with bowel obstruction or diarrhoea

Can I drink alcohol while I am taking Uftoral? 
You can take the occasional small alcoholic drink with your meal, but you should limit your alcohol consumption and avoid excessive drinking.

Can I take other drugs at the same time as Uftoral?
You  should let your specialist doctor know if you are taking any other tablets.  Ask your doctor or pharmacist about whether you can continue with any ‘over the counter’ medicines.

Can I still drive my car?  
Yes. Uftoral does not affect your ability to drive.  However, it may be sensible to avoid driving if you feel dizzy or light headed or very nauseous.

Can I take exercise? 
You may take exercise while you are taking Uftoral and folinic acid (Leucovorin) but you should not overtire yourself.  However, exercise is good for you, so do take some gentle exercise if you feel up to it. You can find some useful tips on exercise issues in our section dedicated to exercise.

How do they kill cancer cells?
The 5-fluorouracil, uracil and folinic acid (Leucovorin) are transported in the bloodstream.  Inside the cancer cells, they act together to inhibit the processes that allow the cells to multiply; they also activate the body’s natural anti-cancer mechanisms, causing the cancer cells to die.

If you want to talk to someone independent about your disease or its treatment, then click here for a list of organisations which may help.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.