Docetaxel, cisplatin and fluorouracil (TPF)

TPF is the name of a combination of chemotherapy drugs. It includes the drugs below. How to pronounce the drug names are in brackets. 

• docetaxel - (doe-see-tax-el) also known as Taxotere
• cisplatin - (sis-pla-tin)
• fluorouracil - (floor-oh-yoor-uh-sil) also known as 5FU

It is a treatment for head and neck cancer. 

How does TPF work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do 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 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. You have a new cannula each time you have treatment.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

How often do you have TPF?

You usually have TPF chemotherapy as cycles of treatment. A cycle is the time between one round of treatment until the start of the next.

Each cycle is 21 days (3 weeks). You have up to 4 cycles, taking up 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: 

Then you start the cycle again.

You may stay in hospital (inpatient) to have TPF for 4 or 5 nights. In some hospitals you might have it as an outpatient. 

Tests

You have blood tests before and during your 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.

Before starting treatment with fluorouracil (5FU) you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from this chemotherapy, so you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, nurse or pharmacist will talk to you about this.

What are the side effects of TPF?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an 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.

Breathing problems

You might have a sudden feeling of tightness in your chest, difficulty catching your breath, wheezing and a cough. This is caused by spasms in the muscles of your airways.

Rarely docetaxel can cause scarring on the lungs (called fibrosis). If you develop breathing problems with a cough or chest pain contact your healthcare team or doctor. 

Bruising, bleeding gums or nosebleeds

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. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. Some people may have permanent hair loss although this is rare.

Soreness or inflammation of the digestive tract

Soreness or inflammation can happen in any part of your gastrointestinal tract. It includes the mouth, stomach, large and small intestines, and the back passage (rectum).

This might cause difficulty and pain with swallowing because of inflammation of the food pipe (oesophagus) or if you have a very sore mouth and throat.

Your might have tummy (abdominal) pain, sore back passage or pass blood if the lower part of your digestive tract is affected.

Let your nurse and doctor know if you are experiencing any of these symptoms, so they can give you medicines to help.

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.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Skin changes

Skin problems includes itching, and less commonly a rash or dry skin.

Rarely, you might have patches of discolouration on the skin, irritation such as cracked or broken skin, and sensitivity to sunlight. You might also have peeling or shedding.

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 returns to normal a few weeks after your treatment finishes.

Soreness, redness or peeling on palms or soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

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, feet and legs due to a build up of fluid (oedema). 

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 healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Heart problems

This might be a change in heart rate or rhythm (arrythmia) or less commonly chest pain.

Rarely you might have an enlargement of the heart (called cardiomyopathy), changes to the heart muscle or a heart attack.

Feeling generally unwell

You might feel weak and generally unwell. This is called malaise.

Low sodium levels in the blood

You will have regular blood tests to check for this.

Rarely, you might have low levels of magnesium in the blood.

Weight loss

You might lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your weight loss.

Changes to your sense of smell

Talk to your team about this.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• sepsis - a serious reaction to an infection - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• an allergic reaction can happen during the first or second treatment – let your nurse know if you have flushing, itching, dizziness or breathing difficulties

• dizziness - don’t drive or operate machinery if you are dizzy

• eye problems such as excessive tears, or inflammation of the part of the eye called the conjunctiva (called conjunctivitis). Rarely you might have rapid involuntary eye movements or sensitivity to light

• indigestion, symptoms include heartburn, bloating and burping

• dark poo – this might be caused by bleeding in the gastrointestinal tract

• pain in different parts of the body such as in your muscles, tummy (abdomen) and at the site of your cancer

• weight gain

• pain or difficulty swallowing

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• a second cancer (such as leukaemia) some time after finishing treatment

• headaches

• being very drowsy

• low blood pressure

• ulcers along the digestive tract

• intense feeling of happiness or excitement (euphoria)

• weakness in your legs or an increase in the muscle tone of your legs and feet causing them to be stiff

• symptoms of Parkinson’s disease such as tremor, slower movements, or memory problems

• nail problems such as change in colour, pain and thickening of the nail bed, or a skin infection around the nails

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of 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 and for 4 weeks after your last dose, because the drug may come through into your breast milk.

Other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

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 one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.