UW MEDICINE PATIENT EDUCATION PCV Treatment for brain tumors This handout explains PCV treatment for brain tumors. It includes how to take each of the drugs and how to handle common side effects. What is PCV? PCV is a type of chemotherapy (chemo) treatment for brain tumors. The name PCV comes from the names of the 3 drugs that are used in the treatment. The letters stand for: P = procarbazine (brand name Matulane) C = CCNU, also called lomustine (brand name Gleostine) V = vincristine (brand name Ocovin) When do I take my chemo drugs? We will give you a schedule to follow for your PCV treatment. Do not start taking your chemo drugs until your doctor or nurse tells you to start. This will be after we have reviewed your lab tests. Lomustine Your doctor or nurse will tell you when to take your lomustine. Lomustine is taken as a single dose on 1 day only. To take your dose: Take your anti-nausea medicine ondansetron (Zofran) 60 minutes (1 hour) before you take your dose of lomustine. When you take your dose of lomustine: Always take your chemotherapy drugs exactly as prescribed. Take it at night, on an empty stomach. This is either 2 hours after a meal or 1 hour before eating. Swallow the capsule whole. Do not chew, open, or crush the capsule. Drink a full glass (8 ounces) of water when you take your dose. Page 1 of 8 PCV Treatment
If you miss your dose or vomit after taking a dose, call your Alvord Brain Tumor Center (ABTC) nurse at 206.598.9467 and ask what to do. What side effects can I expect? The table below shows side effects that can occur with lomustine treatments, and what to do about them. Other side effects may also occur. Please report any symptoms to your doctor, pharmacist, or nurse. Side Effects Allergic reaction Call your ABTC nurse right away if you have itching, hives, rash, or swelling. Go to the Emergency Department right away if you have any tingling in your mouth or throat, chest tightness, or trouble breathing. Nausea Constipation Lomustine and ondansetron may cause constipation (hard stool). Decreased white blood cells an infection due to low white blood cell counts. Decreased platelets a low platelet count or bleeding. Take ondansetron 1 hour before your dose of lomustine and as needed for nausea. Read your prescription for dose and timing. Call your ABTC nurse if ondansetron does not ease nausea or vomiting. Help prevent nausea by eating small meals often during the day. To prevent constipation, stay active, drink lots of liquids, and eat a diet high in fiber. Take bowel medicines as prescribed unless loose stools or diarrhea occur. If you have constipation for 2 days, call your ABTC nurse and ask what to do. A fever higher than 100.4 F (38 C) Burning when you urinate (pee) A sore that becomes red, has drainage, or does not start to heal A cough with mucus A sore that oozes even when you apply pressure A lot of bleeding from your gums when you brush or floss your teeth A bloody nose that lasts longer than 5 minutes A lot of bruising Page 2 of 8 PCV Treatment
Side Effects Fertility may affect your ability to have a child. Hair Loss Vision changes Fatigue Please talk with your doctor or nurse if you have questions about fertility. Your hair will grow back after treatment is over. Some people choose to wear scarves, caps, or wigs during this time. Call your ABTC nurse if you have any vision changes or discomfort in your eyes. You may feel tired, but it is important to be active. Try to walk about 3o minutes a day. Lomustine Safety Warnings Birth Control (Contraception) Women will have a pregnancy test done and a blood draw before starting chemotherapy. While taking lomustine: If you are a woman, do not become pregnant or breastfeed. If you are a man, do not get a partner pregnant. If you are of childbearing age, use birth control during therapy and for at least 1 month after your last dose. For 48 hours after taking your dose, use a barrier form of protection during sex. The drug stays in body fluids for 48 hours after each dose. Handling Only the patient should touch the lomustine capsules. If your caregiver must handle the capsules, they must: Wear disposable rubber gloves. Wash their hands after handling. Your caregiver should wear gloves when helping clean up any body fluids. Linens or clothing that are soiled should be washed apart from other laundry items. Vaccines While taking lomustine: Do not receive live vaccines. Page 3 of 8 PCV Treatment
Avoid contact with anyone who has received a live vaccine within the last 6 weeks. Talk with your provider before getting vaccinated. Procarbazine Your doctor or nurse will tell you when to start taking your procarbazine. You will take it by mouth for 14 days, starting on day 8 to 21. To take your dose: Take your anti-nausea medicine ondansetron (Zofran) 60 minutes (1 hour) before you take your dose of procarbazine. When you take your dose of procarbazine: Take it with or without food. Take it at the same time every day. Drink a full glass (8 ounces) of water when you take it. Swallow the capsule whole. Do not chew, open, or crush the capsule. While you are taking procarbazine: Avoid alcohol. Follow the Low Tyramine Diet while you are taking procarbazine. We will give you instructions about this diet. If you miss a dose or vomit after taking a dose: Do not take another dose. Take your next dose at the next scheduled time. Call the Alvord Brain Tumor Center (ABTC) nurse at 206.598.9467 and ask what to do. What side effects can I expect? The table below shows side effects that can occur with procarbazine treatments, and what to do about them. Other side effects may also occur. Please report any symptoms to your doctor or nurse. Side Effects Allergic reaction Call your ABTC nurse right away if you have itching, hives, rash or swelling. Go to the Emergency Department right away if you have any tingling in your mouth or throat, chest tightness, or trouble breathing. Page 4 of 8 PCV Treatment
Side Effects Nausea Constipation Procarbazine and ondansetron may cause constipation (hard stool). Take ondansetron 1 hour before your dose of procarbazine and as needed for nausea. Read your prescription for dose and timing. Call your ABTC nurse if ondansetron does not ease nausea or vomiting. Help prevent nausea by eating small meals often during the day. To prevent constipation, stay active, drink lots of liquids, and eat a diet high in fiber. Take bowel medicines as prescribed unless loose stools or diarrhea occur. If you have constipation for 2 days, call your ABTC Decreased white blood cells an infection due to low white blood cell counts. Decreased platelets a low platelet count or bleeding. Allergic reaction Fertility may affect your ability to have a child. Fatigue nurse and ask what to do. A fever higher than 100.4 F (38 C) Burning when you urinate (pee) A sore that becomes red, has drainage, or does not start to heal A cough with mucus A sore that oozes even when you apply pressure A lot of bleeding from your gums when you brush or floss your teeth A bloody nose that lasts longer than 5 minutes A lot of bruising Call your ABTC nurse right away if you have itching, hives, rash or swelling. Go to the Emergency Department right away if you have any tingling in your mouth or throat, chest tightness, or trouble breathing. Please talk with your doctor or nurse if you have questions about fertility. You may feel tired, but it is important to be active. Try to walk about 3o minutes a day. Page 5 of 8 PCV Treatment
Procarbazine Safety Warnings Birth Control (Contraception) Women will have a pregnancy test done and a blood draw before starting chemotherapy. While taking procarbazine: If you are a woman, do not become pregnant or breastfeed. If you are a man, do not get a partner pregnant. If you are of childbearing age, use birth control during therapy and for at least 1 month after your last dose. For 48 hours after taking your dose, use a barrier form of protection during sex. The drug stays in body fluids for 48 hours after each dose. Handling Only the patient should touch the procarbazine capsules. If your caregiver must handle the capsules, they must: Wear disposable rubber gloves. Wash their hands after handling. Your caregiver should wear gloves when helping clean up any body fluids. Linens or clothing that are soiled should be washed apart from other laundry items. Vaccines While you are taking procarbazine: Do not receive live vaccines. Avoid contact with anyone who has received a live vaccine within the last 6 weeks. Talk with your provider before getting vaccinated. Vincristine Your doctor or nurse will tell you when it is time to receive your vincristine injection. Vincristine is given by injection into a vein at the 8-Southeast Infusion Center. You will be in the center for about 1½ hours (90 minutes). Take your anti-nausea medicine ondansetron (Zofran) 60 minutes (1 hour) before you receive your injection of vincristine. Do not drink grapefruit juice on the morning of your injection and for 1 week after. Page 6 of 8 PCV Treatment
What side effects can I expect? The table below shows side effects that can occur with vincristine treatments, and what to do about them. Other side effects may also occur. Please report any symptoms to your doctor, pharmacist, or nurse. Side Effects Nausea Take ondansetron 1 hour before your dose of vincristine and as needed for nausea. Read your prescription for dose and timing. Call your ABTC nurse if ondansetron does not ease nausea or vomiting. Help prevent nausea by eating small meals often during the day. Constipation Vincristine and ondansetron may cause constipation (hard stool). Vision changes Peripheral neuropathy Decreased white blood cells an infection due to low white blood cell counts. Decreased platelets a low platelet count or bleeding. Fatigue To prevent constipation, stay active, drink lots of liquids, and eat a diet high in fiber. Take bowel medicines as prescribed unless loose stools or diarrhea occur. If you have constipation for 2 days, call your ABTC nurse and ask what to do. Call your ABTC nurse if you have any vision changes or discomfort in your eyes. Call your ABTC nurse if you have numbness or tingling in your fingers or toes, weakness, or changes in your sense of touch such as a burning feeling or skin pain. A fever higher than 100.4 F (38 C) Burning when you urinate (pee) A sore that becomes red, has drainage, or does not start to heal A cough with mucus A sore that oozes even when you apply pressure A lot of bleeding from your gums when you brush or floss your teeth A bloody nose that lasts longer than 5 minutes A lot of bruising You may feel tired, but it is important to be active. Try to walk about 3o minutes a day. Page 7 of 8 PCV Treatment
Side Effects Fertility may affect your ability to have a child. Please talk with your doctor or nurse if you have questions about fertility. Vincristine Safety Warnings Birth Control (Contraception) Women will have a pregnancy test done and a blood draw before starting chemotherapy. While taking vincristine: If you are a woman, do not become pregnant or breastfeed while taking vincristine and for 2 months after your injection. If you are a man, do not get a partner pregnant while taking vincristine and for 2 months after your injection. If you are of childbearing age, use birth control during therapy and for at least 1 month after your injection. For 1 week after your injection, use a barrier form of protection during sex. The drug stays in body fluids for 1 week after the injection. Questions? Your questions are important. Call your doctor or healthcare provider if you have questions or concerns. To talk with a nurse weekdays from 8 a.m. to 5 p.m.,, call the Alvord Brain Tumor Center Nurse Line at 206.598.9467. After hours and on weekends and holidays, you will be given the option to talk directly with a nurse at the Community Care Line. Handling Only the patient should touch the vincristine capsules. If your caregiver must handle the capsules, they must: Wear disposable rubber gloves. Wash their hands after handling. Your caregiver should wear gloves when helping clean up any body fluids. Linens or clothing that are soiled should be washed apart from other laundry items. Vaccines While you are taking vincristine: Do not receive live vaccines. Avoid contact with anyone who has received a live vaccine within the last 6 weeks. Talk with your provider before getting vaccinated. University of Washington Medical Center Published PFES: 06/2018 Clinician Review: 06/2018 Reprints on Health Online: https://healthonline.washington.edu Page 8 of 8 PCV Treatment