Javlor (Vinflunine)

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Your doctor has recommended a chemotherapy drug called  whose trade name is Javlor. It is supplied by the pharmaceutical company called Pierre Fabre Medicament  and licensed for the treatment of metastatic transitional cell cacarinoma  (cancer which has spread from the site of origin to another part of the body. The site of origin, in this case is usually the bladder but can also start in the tube connecting the kidney to the bladder (ureter and renal pelvis).  It is usually recommended for patients who have previously received a first line course of chemotherapy such as MVAC, cisplatin or gemcitabine. 

Javlor is given every three weeks as an infusion (drip) into a vein in your arm for approximately 1 hour at a dose of 320mg/m2 although this dose many change depending on your performance status, renal function, liver function and whether you have received previous radiotherapy. It is given along with other drugs to prevent an allergic reaction (antihistamines, steroids and anti-indigestion medication called H-2 antagonist such as ranitidine) along with drugs to prevent nausea..

Before each course of chemotherapy you will see a doctor and have a blood test. If your blood count is low then chemotherapy may be delayed a few days and the dose reduced. Your doctor, in this case, may also prescribe an addition injection to boost your blood count called a g-csf such as neupogen or neulasta.

The side-effects described below will not affect everyone.  It is important that you feel free to ask questions so that you understand what is happening. Occasionally people have rare side-effects which are not expected or mentioned on this sheet. If in doubt please ask. 

Side effects

Allergic reaction; Despite steroids, very occasionally people may have an allergic reaction to javlor in the first or second infusion. If you feel hot, shivery, breathless or develop an itchy rash then let the chemotherapy nurse know immediately and slow or stop the infusion.

Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different  tablets can be prescribed for the next cycle. Some self help tips may also be useful.

• 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.

Constipation is relatively common immediately after Javlor chemotherapy but its severity varies widely between patients. In most cases it can be easily controlled with medication. It is important to drink plenty of fluids and avoid foods which add to the constipation As well as dietary measures it may be worth considering a laxative following instruction from your medical team.

Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash. If you develop mouth ulcers you should contact your clinic and they can prescribe special mouthwashes to help.  Sometimes the lips get dry and sore - we recommend a natural lip balm.

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. 

Heart problems: Occasionally Javlor can put a strain on the heart but is unlikely to actually damage the muscle - if you already have heart disease (angina, heart failure) then report any change in symptoms to your medical team.

Weight gain or weight loss; Over the entire course of chemotherapy some men complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake. Other individuals may actually complain of Weight loss  particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.

Hair loss; As this is a new drug the true risk of hair loss is uncertain as most men in the orginal trials had already lost their hair in previous regimens. If you happen to have a full head of head, it is unlikely that this drug will cause you to loose it but can can cause some mild thinning starting 3-4 weeks after the first course and may very rarely be lost completely. You may raely also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will regrow after treatment, although it may at first be a different texture, very like a baby's hair. Some departments use a cold cap system to minimise hair loss. Your clinic nurse can arrange for you to have a wig before your treatment starts (NHS prescription charge, prices are approximately £55 for an acrylic wig, £140 for half real hair wig and  £205 for a full real hair wig).  

Altered sensation; This chemotherapy can irritate the nerve endings and some people notice altered sensation with slight numbness or pins and needles in the fingers or toes. This comes on slowly, is usually mild and will usually get better slowly after chemotherapy has finished. If the numbness is severe it may interfere with fine movement (e.g. fastening buttons). If you develop sudden numbness or weakness this should always be reported immediately.

Constipation: Some patients experience  which may be due to the anti-sickness tablets. You should drink plenty of fluids, eat a high fibre diet and take gentle exercise. If this is severe you should contact your clinic or GP. 

Steroids; This chemotherapy is given with a short course of steroids (e.g. Dexamethasone) to help prevent sickness and allergy. Steroids have some side effects, including fluid retention, weight gain, wakefulness and sometimes agitation. If you suffer from  indigestion you may be given tablets to prevent this. If you are prone to "spots" or acne this can be made worse. Likewise they can temporarily upset diabetes or high blood pressure.

Skin/nail reactions; After several treatment cycles you may experience discolouration (a change in the colour) of your nails. This is generally mild, however, loss of nails may occasionally occur. Your hands and feet may become dry and flaky, but this can be managed by using a glycerine-based hand cream, which your nurse can supply.

Increase risk of blood clots - during chemotherapy there is an increased risk of blood clots, most commonly in the legs (deep vein thrombosis) or more seriously to the lungs (pulmonary embolus). If you get unexplained swelling and discomfort in the calf report this to the oncology unit. Likewise if you start experiencing unexplained breathlessness, cough up any blood or have a pain in the chest particularly when you breath contact the clinic as soon as possible. To avoid clots its important to stay as active as possible and (exercise & chemotherapy) taking light walks two to three times a day and avoid sitting around for long periods of time. If you are required to sit (for example while receiving the chemotherapy drugs) try to move your legs and ankles regularly. Occasionally, if your doctor feels you are at high risk of developing clots you may be started on drugs to thin your blood during chemotherapy. 

Your veins Three types of damage can occur, listed in order of seriousness:

• You may experience darkening of the veins in your hands and arms. This is normal, usually doesn't hurt and should fade once your course of treatment has been completed.

• Towards the end of your chemotherapy course, some veins may feel hard and 'cord-like'. In these veins the blood has clotted (superficial thrombosis) which may take several months to resolve Your doctor may recommend a low dose of aspirin (ask before taking it yourself).
• These chemotherapy drugs can cause irritation and tissue damage if they leak out of the vein whilst injected. This is called extravasation. All nurses who administer chemotherapy have completed an intensive training programme and are fully aware of what to do if extravasation occurs. Rarely problems can start after you have left the Hospital. Look out for pain, stinging or burning sensations, redness or swelling around the area where the chemotherapy was given. If you notice any of these symptoms after you have left the Hospital, contact the emergency numbers you have been given. In the meantime, keep the arm raised and place a cool (not ice) pack on the area.

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 is usually be rarely 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. Quite commonly 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. There is some anecdotal evidence that emercing the tips of your fingers in cold water during the 1 hour infusion can reduce the damage to the nails  - see the relevant chapter in Lifestyle and Cancer

Aching muscles and joints; You may experience pain in the muscles and joints within two to three days of having your Javlor infusion, but usually resolves quite quickly. Pain-killers can be used as advised.