TPF is the name of a chemotherapy combination that includes:
- docetaxel (also known by its brand name Taxotere)
- cisplatin (a type of platinum drug)
- fluorouracil (5FU)
It is a TPF treatment for head and neck cancers.
How it works
These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.
How you have TPF
You have all 3 drugs as a drip into your bloodstream (intravenously).
Drugs into your bloodstream
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of TPF treatment. This can be a:
- central line
- PICC line
- portacath
If you don’t have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have TPF treatment.
When you have TPF
You usually have TPF chemotherapy as cycles of treatment. Each cycle lasts about 3 weeks. You usually have 3 or 4 cycles, taking 9 to 12 weeks in total.
This treatment is often followed by a course of radiotherapy and chemotherapy (chemoradiotherapy). You usually have each treatment cycle in the following way:
Day 1
- You have docetaxel as a drip into your bloodstream over 1 hour
- Have cisplatin as a drip into your bloodstream over 2 to 3 hours
- You have fluorouracil as a continuous drip (infusion)
Day 2 to day 4
- You have fluorouracil as a continuous drip (infusion)
Day 5 day 21
- You have no treatment
Then your next cycle of treatment starts. You may stay in hospital to have TPF for 4 or 5 nights.
Tests
You have blood tests before and during your TPF treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Side effects
We haven’t listed all the side effects. It’s very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you’re having. For example, your side effects could be worse if you’re also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:
Risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Breathlessness
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Hair loss
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.
Sore mouth and throat
It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy.
Fatigue
Tiredness and weakness (fatigue) can happen during and after treatment – doing gentle exercises each day can keep your energy up. Don’t push yourself, rest when you start to feel tired and ask others for help.
Diarrhoea or constipation
Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help.
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Kidney damage
To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.
Skin changes
Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.
Taste changes
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.
Headaches
Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.
Difficulty sleeping
It can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
Hearing changes
You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.
Fluid build up
You may have swelling of your hands and legs due to a build up of fluid (oedema).
Lung problems
You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.
Numbness or tingling in fingers or toes
Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you’re finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:
- an allergic reaction during the first or second treatment
- brittle, chipped and ridged nails
- a brown marking on the skin following the line of the vein where the treatment was given
- soreness, redness and peeling on palms and soles of feet
- numbness or tingling in fingers and toes
- changes to the heart muscle that are usually temporary and changes to the heart rate
Rare side effects
Fewer than 1 in 100 people (1%) have muscle weakness (myasthenia) in different parts of the body.
Coping with side effects
We have more information about side effects and tips on how to cope with them.
Important information
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you’re having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Fertility
You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Breastfeeding
Don’t breastfeed during this treatment because the drugs may come through in your breast milk.
Low levels of DPD
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency.
Some people have severe side effects from capecitabine or fluorouracil even if they don’t have low DPD levels. Contact your doctor or nurse if your side effects are severe.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment
if you need treatment for anything else, including teeth problems.
Immunizations
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
You can:
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations – You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn’t possible, wash your hands well after changing their nappy.
