Biological Therapies

Aldesleukin (Proleukin®)

What is aldesleukin?

Aldesleukin is a protein produced naturally in the body in very small amounts. It is produced by a type of white blood cell called a T-lymphocyte. It works as part of the body’s defence mechanism (immune system) in fighting illness. Aldesleukin can be made commercially as a drug and is used as a treatment for cancer.

How aldesleukin works:

Aldesleukin is given to stimulate the body’s own defence mechanism to fight some types of cancer. The exact way in which it works is still not fully understood. However, it can stimulate white cells to recognise and destroy some cancer cells.

Possible side effects:

The side effects of aldesleukin usually disappear once the treatment has finished and may include any of those listed below:

Flu-like symptoms These can occur quite soon after the drug has been given and it makes some people feel quite unwell. You may have aching joints or muscles, a high temperature, a feeling of no energy (lethargy) and chills. If these symptoms do happen, it is important to drink plenty of fluids and get plenty of rest. Paracetamol is often prescribed to help reduce these effects.

Feeling sick (nausea) and occasionally being sick (vomiting) Your doctor can now prescribe very effective anti-sickness (antiemetic) drugs to reduce or prevent these effects. If the sickness is not controlled, or if it continues, tell your doctor or nurse. There are other anti- sickness drugs that can be prescribed.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice.

Skin changes Aldesleukin may cause red or darker, dry, itching skin, which may peel or blister. Your doctor can prescribe medicine and creams to help. If you already have a skin complaint such as psoriasis, aldesleukin may make it worse.

Changes in behaviour Let your doctor know if you feel anxious, agitated or confused.

Tiredness and a general feeling of weakness It is important to allow yourself plenty of time to rest if this happens.

Your kidneys may not work as well as usual Your doctors will check how well your kidneys are working with a blood test before and during your course of treatment.In some hospitals you will be asked to measure and record everything you drink and the amount of urine that you pass. You may be given medicine to help you pass urine if you do not pass enough.

Fluid retention You may notice that you put on weight, and/or that your face, ankles and legs swell. This improves slowly once your treatment has finished. Sometimes drugs can be given to help to reduce the swelling.

Anaemia Anaemia is a low number of red blood cells. Symptoms of anaemia include a feeling of having no energy (lethargy) and tiredness. If you feel very tired, tell your doctor or nurse.

Changes in the way your heart works and lowering of blood pressure In some people, aldesleukin can affect how the heart works. The effect on the heart depends on the dose given. The hospital team will check your blood pressure regularly during treatment. It is important to tell your doctor if you feel dizzy, faint or have any chest pain.

Lenalidomide (Revlimid®)

What is Lenalidomide?

Lenalidomide belongs to a new class of drugs called immunomodulatory drugs (IMiDs™). The exact way lenalidomide works is not completely understood at the moment. It affects the way the immune system works.

Lenalidomide also has the ability to block the development of new blood vessels. Making blood vessels is called angiogenesis. Cancer cells need to make new blood vessels so they can grow and spread.

Possible side effects:

Each person's reaction to a cancer drug is different. Some people have very few side effects, while others may experience more. We have outlined the most common side effects. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug but which are not listed here, please discuss them with your doctor or nurse.

Lowered resistance to infection Lenalidomide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. Your blood counts will be monitored while you are taking lenalidomide.

Contact your doctor or the hospital straightaway if:

your temperature goes above 38ºC (100.5ºF)

you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more treatment to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Lenalidomide can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding.

Risk of blood clots Lenalidomide may increase your risk of developing blood clots. These can be either a deep vein thrombosis (DVT) which is a clot in the leg, or a pulmonary embolism (PE), which is a clot in the lung. While taking lenalidomide you may also be given medication to thin your blood and help to prevent any clots forming. Let your hospital doctor know if you develop any pain, swelling or redness in one of your calves (a possible DVT), or if you notice any breathlessness or chest pain (a possible PE).

Important information:

Contraception Because lenalidomide can potentially cause serious birth defects it is very important not to become pregnant or father a child while taking this drug. Women will be asked to have a pregnancy test, to check that they are not pregnant. They will also be advised to use a highly effective form of contraception (such as implanted or injected contraception) as well as a barrier method (such as a condom or cap).

Thalidomide

What is Thalidomide?

This information is about a drug called thalidomide. It is used to treat myeloma (a cancer of the plasma cell of the blood). Research is now looking to see whether it might be effective as a treatment for some other cancers. Thalidomide was originally developed to prevent morning sickness in pregnant women.

Possible side effects:

Each person's reaction to a cancer drug is different. Some people have very few side effects, while others may experience more. We have outlined the most common side effects. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug but which are not listed here, please discuss them with your doctor or nurse.

Birth defects You must not become pregnant or father a child while taking thalidomide, as it causes severe abnormalities in developing babies. Women will be asked to have a pregnancy test, to check that they are not pregnant. They will also be advised to use a highly effective form of contraception (such as implanted, or injected contraception) as well as a barrier method (such as a condom or cap).

Feeling sick (nausea) and being sick (vomiting) Most people have little or no nausea. You will probably be given anti-sickness (anti-emetic) medicines to take, but tell your doctor if the nausea becomes a problem.

Risk of blood clots Thalidomide may increase your risk of developing blood clots. These can be either a deep vein thrombosis (DVT), or a pulmonary embolism (PE), which is a clot in the lung. While taking thalidomide you may also be given warfarin (an anticoagulant) that will thin your blood and help to prevent any clots forming. Let your hospital doctor know if you develop any pain, swelling or redness in one of your calves (a possible DVT), or if you develop any breathlessness or chest pain (a possible PE).