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COVID-19: Obtenez les dernières mises à jour ou faites une autoévaluation.

Les traitements par chimiothérapie et autres traitements systémiques pourraient être modifiés en raison de la COVID-19. Vous trouverez de plus amples renseignements à la page Traitements systémiques pendant la pandémie de la COVID-19.

Certaines de ces informations ou toutes, dans certains cas, n’apparaissent qu’en Anglais. Vous pouvez demander la version française

CRBPPEME Patient Information

This page gives general information about this cancer treatment.

You Will Learn:

  • who to contact for help
  • what the treatment is
  • how it is given
  • what to expect while on treatment

This information was created by Cancer Care Ontario together with patients and their caregivers who, like you, have gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your healthcare team. Always talk to your healthcare team about your treatment.

What Is This Treatment?

CRBPPEME is the code name of your lung cancer treatment regimen.

A regimen is a combination of medications to treat cancer.

This regimen name is made up of letters from the names of the 2 medications in your treatment.

Here are the names of the medications in this regimen:

CRBP = CaRBoPlatin

PEME = PEMEtrexed

For most people, treatment lasts 12 weeks. The treatment is divided into 4 cycles. Each cycle is 3 weeks long.

Here is a picture of the schedule for CRBPPEME treatment:

CRBPPEME Treatment Schedule

After 4 cycles, your healthcare team will talk to you about how your treatment is going and plan next steps. Some people may need to have more than 4 cycles to treat their cancer.

During each 3-week cycle you will have CRBPPEME treatment on day 1 at the hospital.

Each cycle looks like this:

Day 1
Treatment Day:
Go to the hospital for CRBPPEME Treatment.
2
No
CRBPPEME Treatment
3
No
CRBPPEME Treatment
4
No
CRBPPEME Treatment
5
No
CRBPPEME Treatment
6
No
CRBPPEME Treatment
7
No
CRBPPEME Treatment
8
No
CRBPPEME Treatment
9
No
CRBPPEME Treatment
10
No
CRBPPEME Treatment
11
No
CRBPPEME Treatment
12
No
CRBPPEME Treatment
13
No
CRBPPEME Treatment
14
No
CRBPPEME Treatment
15
No
CRBPPEME Treatment
16
No
CRBPPEME Treatment
17
No
CRBPPEME Treatment
18
No
CRBPPEME Treatment
19
No
CRBPPEME Treatment
20
No
CRBPPEME Treatment
21
No
CRBPPEME Treatment

Remember To:

Important Icon

  • Tell your healthcare team about all of the other medications you are taking.
  • Keep taking other medications that have been prescribed for you, unless you have been told not to by your healthcare team.

How Is This Treatment Given?

The medications in your treatment are given through an IV (injected into a vein) at the hospital.

You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.

What Other Medications Are Given With This Treatment?

To prevent nausea and vomiting

You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.

  • These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), aprepitant (Emend®) or others.

To prevent skin rash

You will be given a medication to take starting the day before each CRBPPEME treatment cycle to prevent skin rashes.

  • The medication is a corticosteroid such as dexamethasone.

To protect healthy cells and lower your chance of side effects

You will be given a prescription for folic acid tablets to take by mouth and vitamin B12 that will be given by a needle.

You will start taking your folic acid and receive vitamin B12 at least 7 days before your first CRBPPEME treatment.

Keep taking them during treatment and for at least 21 days after your last CRBPPEME treatment.

Talk to your healthcare team about exactly how to take these medications.

DO This While on Treatment

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  • DO tell your healthcare team about any other medical conditions or procedures that you have or had such as previous radiation therapy, hearing problems, heart, liver or kidney problems, or any allergies.
  • DO check with your healthcare team before getting any vaccinations, surgery, dental work or other medical procedures.
  • DO talk to your healthcare team about your risk of getting other cancers and heart problems after this treatment.
  • DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.

DO NOT Do This While on Treatment

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  • DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products, without checking with your healthcare team.
  • DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your healthcare team.
  • DO NOT take anti-inflammatory medications (such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®) for 5 days before and 2 days after your CRBPPEME treatment. They can make your side effects worse.
  • DO NOT smoke or drink alcohol while on treatment without talking to your healthcare team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

Will This Treatment Interact with Other Medications or Natural Health Products?

Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.

Tell your healthcare team about all of your:

  • prescription and over-the-counter (non-prescription) medications
  • natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements

Check with your healthcare team before starting or stopping any of them.

  • If you take anti-inflammatory medications such as ibuprofen (Advil® or Motrin®) or naproxen (Aleve®) or Aspirin®), your healthcare team will ask you to stop taking them for at least 5 days before and 2 days after your CRBPPEME treatment day.
  • If you take seizure medications (such as phenytoin), your healthcare team will monitor your blood levels closely and may change your dose.
  • If you take a blood thinner (such as warfarin), your healthcare team may need extra blood tests and may change your dose.
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Talk to your healthcare team BEFORE taking or using these:

  • Over-the-counter products such as dimenhydrinate (Gravol®)
  • Natural health products such as St. John’s Wort
  • Supplements such as vitamin C
  • Grapefruit juice
  • Alcoholic drinks
  • Tobacco
  • All other drugs, such as marijuana (medical or recreational)

What Should I Do If I Feel Unwell, Have Pain, a Headache or a Fever?

  • Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen [Tylenol]).
    • Fever can be a sign of infection that may need treatment right away.
    • If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

  • You have a fever if your temperature taken in your mouth (oral temperature) is:
    • 38.3°C (100.9°F) or higher at any time

    OR

    • 38.0°C (100.4°F) or higher for at least 1 hour.

medication icon

If you do have a fever

  • Try to contact your healthcare team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
  • Download theFever pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your healthcare team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.

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DO NOT take Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding and can make side effects worse.
Important Icon
Talk to your healthcare team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

How Will This Treatment Affect Sex, Pregnancy and Breast Feeding?

Talk to your healthcare team about:

  • How this treatment may affect your sexual health.
  • How this treatment may affect your ability to have a baby, if this applies to you. CRBPPEME treatment may damage sperm.

This treatment may harm an unborn baby. Tell your healthcare team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

  • If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until 6 months after your last treatment dose. Talk to your healthcare team about which birth control options are best for you.
  • Do not breastfeed while on this treatment.

What Are the Side Effects of This Treatment?

The following table lists side effects that you may have when getting CRBPPEME treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Keep the link to this page during your treatment so that you can refer to it if you need to.

Very Common Side Effects (50 or more out of 100 people)

Side effect and what to do

When to contact healthcare team

Low neutrophils (white blood cells) in the blood (neutropenia)

(May be severe)

When neutrophils are low, you are at risk of getting an infection more easily. Download theNeutropenia (Low white blood cell count) pamphlet for more information.

What to look for:

  • If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever.
  • Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
  • Do not eat or drink anything hot or cold right before taking your temperature.

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time

OR

  • 38.0°C (100.4°F) or higher for at least 1 hour.

What to do:

If your healthcare team has told you that you have low neutrophils:

  • Wash your hands often to prevent infection.
  • Check with your healthcare team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
  • Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your healthcare team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

If you have a fever, try to contact your healthcare team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.

Low platelets in the blood

(May be severe)

When your platelets are low you are at risk for bleeding and bruising. Download theLow Platelet Count pamphlet for more information.

What to look for:

  • Watch for signs of bleeding:
    • Bleeding from your gums
    • Unusual or heavy nosebleeds
    • Bruising easily or more than normal
    • Black coloured stools (poo) or blood in your stools (poo)
    • Coughing up red or brown coloured mucus
    • Dizziness, constant headache or changes in your vision
    • Heavy vaginal bleeding
    • Red or pink coloured urine (pee)

What to do:

If your healthcare team has told you that you have low platelets:

  • Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
  • Check with your healthcare team before you go to the dentist.
  • Take care of your mouth and use a soft toothbrush.
  • Try to prevent cuts and bruises.
  • Ask your healthcare team what activities are safe for you.
  • Your treatment may have to be delayed if you have low platelets. Your healthcare team may recommend a blood transfusion.

If you have signs of bleeding:

  • If you have a small bleed, clean the area with soap and water or a saline (salt water) rinse. Apply pressure for at least 10 minutes.

If you have bleeding that doesn’t stop or is severe (very heavy), you must get emergency medical help right away.

Talk to your healthcare team if you have any signs of bleeding. If you have bleeding that doesn’t stop, or is severe (very heavy), you MUST get emergency medical help right away.

Nausea and vomiting

What to look for:

  • Nausea is feeling like you need to throw up, you may also feel light-headed.
  • You may feel nausea within hours to days after your treatment.

What to do:

To help prevent nausea:

  • It is easier to prevent nausea than to treat it once it happens.
  • Take your anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (like coffee, tea) and avoid alcohol.

If you have nausea or vomiting:

  • Take your rescue (as-needed) anti-nausea medication(s) as prescribed.
  • Download theNausea & Vomiting pamphlet for more information.
  • Talk to your healthcare team if:
    • nausea lasts more than 48 hours
    • vomiting lasts more than 24 hours or if it is severe

Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe.

Common Side Effects (25 to 49 out of 100 people)

Side effect and what to do

When to contact healthcare team

Too much or too little salt in your body

What to look for:

  • Muscle spasms, cramping, weakness, twitching, or convulsions.
  • Irregular heartbeat, confusion or blood pressure changes.

What to do:

Get emergency medical help right away for severe symptoms.

Get emergency medical help right away for severe symptoms.

Fatigue

What to look for:

  • Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.

What to do:

  • Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
  • Check with your healthcare team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Ask family or friends to help you with things like housework, shopping, and child or pet care.
  • Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your healthcare team has told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired.

Download theFatigue pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Less Common Side Effects (10 to 24 out of 100 people)

Side effect and what to do

When to contact healthcare team

Low Appetite

What to look for:

  • Loss of interest in food or not feeling hungry.
  • Weight loss.

What to do:

  • Try to eat your favourite foods.
  • Eat small meals throughout the day.
  • You may need to take meal supplements to help keep your weight up.
  • Talk to your healthcare team if you have no appetite.

Download theLow Appetite pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Change in your hearing

What to look for:

  • Not being able to hear as well as before.
  • New noise or ringing sounds in your ears.
  • Changes in hearing usually go away over time. In some rare cases they may be permanent.

What to do:

  • Tell your healthcare team if you have any of these symptoms. Your healthcare team may need to change your medication.

Talk to your healthcare team as soon as possible.

Mouth sores

What to look for:

  • Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
  • Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
  • They may last for 3 days or longer.

What to do:

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often with a homemade mouthwash.
  • To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
  • Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth.

If you have mouth sores:

  • Avoid hot, spicy, acidic, hard or crunchy foods.
  • Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection.
  • Talk to your healthcare team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Download theMouth Care pamphlet for more information.

Talk to your healthcare team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Rash; dry, itchy skin

What to look for:

  • You may have cracked, rough, flaking or peeling areas of the skin.
  • Your skin may look red and feel warm, like a sunburn.
  • Your skin may itch, burn, sting or feel very tender when touched.
  • The rash may be seen in areas where you have had radiation before.

What to do:

To prevent and treat dry skin:

  • Use fragrance-free skin moisturizer.
  • Protect your skin from the sun and the cold.
  • Use sunscreen with UVA and UVB protection and a SPF of at least 30.
  • Avoid perfumed products and lotions that contain alcohol.
  • Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your healthcare team has told you to drink more or less.

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Talk to your healthcare team if it does not improve or if it is severe.

Diarrhea

What to look for:

  • Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.

What to do:

If you have diarrhea:

  • Take anti-diarrhea medication if your healthcare team prescribed it or told you to take it.
  • Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day, unless your healthcare team has told you to drink more or less.
  • Talk to your healthcare team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
  • Talk to your healthcare team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in 1 day.

Download theDiarrhea Pamphlet for more information.

Talk to your healthcare team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in 1 day).

Kidney problems

(May be severe)

Your healthcare team may check for proteins in your urine (pee) and your kidney function regularly with a blood test. You may have blood in your urine.

What to look for:

  • Swelling in your hands, ankles, feet or other areas of your body.
  • Weight gain that is not normal for you.
  • Pain in your lower back.
  • Muscle twitches and cramps or itchiness that won’t go away.
  • Nausea (feeling like you need to throw up) and vomiting.
  • Changes in urination (peeing) such as less urine than usual.

What to do:

  • If you have any of these signs, talk to your healthcare team or go to your closest emergency department.

To prevent kidney infections:

  • Drink at least 6 to 8 cups (2 Litres) of water or other liquids per day unless your healthcare team has told you to drink more or less.
  • When you feel the need to pee, go as soon as possible. Do not wait or hold in the pee.

Get emergency medical help right away

Liver problems

Your healthcare team may check your liver function with a blood test. The liver changes do not usually cause any symptoms.

What to look for:

  • Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe.

What to do:

If you have any symptoms of liver problems, get emergency medical help right away.

Get emergency medical help right away.

Other Rare but Serious Side Effects Are Possible with This Treatment.

If you have any of the following, talk to your cancer healthcare team or get emergency medical help right away:

  • Chest pain, fainting (passing out)
  • Signs of allergic reaction: fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness. It may happen during or shortly after your treatment is given to you.
  • Pain and swelling or hardening of a vein in your arm or leg
  • New coughing, coughing up blood
  • New shortness of breath or other breathing problems
  • Seizures, trouble speaking, difficulty moving your arms or legs or weakness on 1 side of your body
  • Sudden, severe belly pain or bloating
  • Unusual weight gain
  • Painful cramping in 1 or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs
  • Leg numbness or weakness or feeling cold on in your lower leg or foot, especially when compared with the other side
  • Any changes to your vision

For more information on how to manage your symptoms, ask your healthcare provider or go to Managing Symptoms, Side Effects & Well-Being.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.