D-PACE: Dexamethasone, Cisplatin, Doxorubicin, Cyclophosphamide, Etoposide (The James)

D-PACE: Dexamethasone, Cisplatin, Doxorubicin, Cyclophosphamide, Etoposide (The James)

 

What is D-PACE?

D-PACE is the short name for this cancer treatment. The 5 drugs you will receive during this treatment are Dexamethasone (or “D), Cisplatin (Platinol or “P”), Doxorubicin (Adriamycin or “A”), Cyclophosphamide (or “C”), Etoposide ( or “E”).

 

What is dexamethasone (deks-a-METH-a-sone) and how does it work?

Dexamethasone is a medicine (also called a steroid) that helps kill the cancer cells. This medicine helps reduce swelling in the body, but and may make it harder for your body to fight infection.

 

What is cisplatin (SIS-pla-tin) and how does it work?

Cisplatin is a chemotherapy drug known as an “alkylating agent.” It stops fast growing cancer cells from dividing and making new cells by destroying the DNA of the cell.

 

What is doxorubicin (doks-oh-ROO-bi-sin) and how does it work?

Doxorubicin is a chemotherapy drug known as an “anti-tumor antibiotic.” It is a bright red color. It is a natural medicine that comes from a type of soil fungus. This drug fights cancer by stopping the fast growing cancer cells from making new cells. It also keeps the damaged cancer cells from continuing to grow.

 

What is cyclophosphamide (sye-kloe-FOS-fa-mide) and how does it work?

Cyclophosphamide is a chemotherapy drug known as an “alkylating agent.” This drug is made in a laboratory. Cyclophosphamide works to stop fast growing cancer cells from dividing and making new cells.

 

What is etoposide (ee-TOE-poe-side) and how does it work?

Etoposide is a chemotherapy drug known as a “topoisomerase II inhibitor.” It is made from a plant and stops fast growing cancer cells from making new cells.

 

Why am I getting 5 chemotherapy drugs for my cancer?

All these drugs work to stop fast growing cancer cells from dividing and making new cells, but each medicine attacks the cancer cells differently. Giving the 5 drugs together makes your treatment more effective.

 

What should I tell my doctor before getting chemotherapy?

Talk to your doctor about the following:

  • If you have ever had chemotherapy and the names of the chemotherapy drugs you were given.
  • If you have ever had heart, liver, or kidney problems.
  • If you are pregnant or think you may be pregnant. Your doctor will talk with you about birth control while getting chemotherapy.
  • If you are breastfeeding.
  • If you have been told that you need to start a new medicine.
  • The medicines/pills you are taking, including:
    • Medicines prescribed by any of your doctors
    • Herbs
    • Vitamins
    • Over-the-counter medicines

 

How does my doctor decide my chemotherapy dose?

To determine your treatment dose, your doctor will review the following: your height, your weight, your medicines, how well your liver and kidneys are working, and any other health problems you have. You will receive a treatment every 4 weeks. You will see the doctor or nurse practitioner before each of your treatments.

 

Should I eat or drink before my treatment?

It is best to eat a small meal before getting your chemotherapy. Drinking plenty of non-caffeinated fluids may also be helpful. However, if you have been told to limit fluids, check with your doctor about how much you can drink.

 

How will my treatment be given?

You will be given dexamethasone along with ondansetron, 30 minutes before your treatment. Dexamethasone works to treat your cancer and prevents nausea and vomiting. Ondansetron also helps to prevent nausea and vomiting.

Dexamethasone is given directly into your blood stream through a tube (IV) placed in your arm or chest. Dexamethasone comes in a bag with tubing attached. The nurse will connect the tubing to a pump. This treatment takes 30 minutes. You will receive this medicine through your IV one time each day for 4 days. On day 5, you will take a lower dose of dexamethasone by mouth for 3 more days.

Cisplatin, doxorubicin, cyclophosphamide and etoposide (PACE) are mixed together in a large bag with tubing attached. It is given directly into your blood stream through a tube (IV) placed in your arm or chest. Each dose (bag) will take 24 hours. You will be given a total of 4 bags for your PACE treatment.

Chemotherapy can cause your white blood cell count to drop below normal, which may make it harder for your body to fight infection. Neulasta is a medicine that helps your body make more white blood cells to decrease your risk for infection. On day 6 of your treatment, Neulasta will be given as a shot under the skin on your belly. You may be able to self-inject this medicine at home or you may need to come to the clinic for your injection. Your doctor will talk with you about what plan is best for you.

What are the side effects of this treatment?

Every person responds differently to treatment. Some of the more common side effects of this chemotherapy are:

  • Red urine for 1 to 2 days after getting Doxorubicin
  • Nausea and/or vomiting
  • Low white blood cell count (may increase your risk for infection)
  • Low hemoglobin (may cause you to have less energy and tire more easily)
  • Low platelet count (may cause you to bleed more easily or longer than normal and have more bruising)
  • Numbness, tingling or burning in your hands or feet
  • Fatigue
  • Hair loss, including the hair on your head and body (this normally starts 10 to 14 days after chemotherapy)
  • Mouth pain or open sores in the mouth
  • “Jittery” feeling, insomnia
  • High blood sugar
  • Bladder pain
  • Kidney damage
  • High frequency hearing loss

 

When should I call my doctor?

You should call your doctor right away if you have any of the following signs or symptoms:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher

A fever can be life-threatening if not treated. Your doctor may ask you to go to the hospital.

  • Chills, sore throat, cough or a wound that does not get better
  • Open sores in your mouth
  • Nausea that prevents you from eating or drinking
  • Vomiting even after you have taken your anti-nausea medicine
  • Skin redness or blisters where the chemotherapy was given through the IV
  • Bleeding or bruising, including bloody or black stools or blood in your urine
  • Diarrhea (4 or more loose stools in 24 hours)
  • Changes in your heartbeat
  • Shortness of breath or difficulty breathing
  • Swelling in feet or ankles
  • Fast weight gain

 

Is there anything else I should know about this treatment?

  • Cisplatin may cause numbness or tingling in your hands, feet, arms and legs. Higher doses of this medicine may cause high frequency hearing loss. It can also hurt your kidneys, so you will be given fluids during your chemotherapy.
  • Doxorubicin may cause problems with the pumping of your heart. Your doctor will order a test to check your heart before you start taking this chemotherapy drug.
  • Cyclophosphamide can irritate the lining of your bladder at higher doses. You will be given fluids and should urinate often during your chemotherapy and for a few days after your treatment.
  • Chemotherapy may make it harder for your body to fight infections. Wash your hands often and stay away from people who are sick.
  • This treatment requires special precautions to prevent the chemotherapy drugs from coming into contact (through blood, urine, bowel movements, vomit and vaginal or seminal fluids) with others. Your chemotherapy nurse will give you guidelines to follow for 48 hours after receiving chemotherapy.
  • Chemotherapy can change how your body reacts to vaccines. Talk to your doctor before getting any vaccines.
  • You should drink 8 to 10 eight-ounce glasses of non-caffeinated fluid each day throughout your treatment. It is important for you stay hydrated while you are getting this treatment.

For more information about cancer, chemotherapy, side effects or how to care for yourself during treatment, refer to your Chemotherapy and You book, or ask your doctor, nurse or pharmacist.

You may also find it helpful to watch The James Patient Education videos at http://cancer.osu.edu/patientedvideos to help you learn tips for managing treatment side effects.

 

© March 21, 2024. The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.