Cancer drugs A to Z list
Tucatinib, trastuzumab and capecitabine are cancer drugs. You can see below how to pronounce the drug names:
tucatinib (too-ka-tinib)
trastuzumab (tras-too-zoo-mab)
capecitabine (ka-peh-site-a-been)
These drugs are a treatment for or breast cancer. You might have this drug combination:
if your cancer is
after treatment with 2 or more anti HER2 treatments
Read more about treatment for breast cancer
Tucatinib is a type of called a . Tyrosine kinases are proteins that cells use to signal to each other to grow. They act as chemical messengers. Blocking these signals helps to slow or stop the cancer from growing.
There are several different tyrosine kinases. You have tests on your cancer cells before you have this treatment. The tests look for changes in these proteins or . With tucatinib they look for and gene changes.
Trastuzumab is a type of targeted cancer drug called a . It works by attaching to HER2 so it stops the cancer cells from growing and dividing.
Capecitabine is a type of chemotherapy called an anti metabolite. The body changes capecitabine into a common chemotherapy drug called fluorouracil. It stops cells from making and repairing . Cancer cells need to make and repair DNA so they can grow and multiply.
Read more about targeted cancer drugs
You take tucatinib and capecitabine as tablets that you swallow. You swallow the tablets whole with a glass of water. You take tucatinib with or without a meal. You take capecitabine within 30 minutes after the end of a meal.
You have trastuzumab as an injection under the skin (subcutaneously).
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.
You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.
You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.
You have tucatinib, trastuzumab and capecitabine as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover.
Each cycle of treatment lasts 21 days (3 weeks). You usually keep taking tucatinib, trastuzumab and capecitabine for as long as they work or until the side effects get too bad.
You have each cycle of treatment in the following way:
Day 1
You take tucatinib as tablets that you swallow twice a day 12 hours apart (morning and evening).
You take capecitabine as tablets that you swallow twice a day 12 hours apart (morning and evening).
You have trastuzumab as an injection under you skin over 2 to 5 minutes.
Day 2 to 14
You take tucatinib as tablets that you swallow twice a day 12 hours apart (morning and evening).
You take capecitabine as tablets that you swallow twice a day 12 hours apart (morning and evening).
Day 15 to 21
You take tucatinib as tablets that you swallow twice a day 12 hours apart (morning and evening).
You then start the next cycle of treatment.
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.
You will also have tests to check how well your heart works.
Before starting treatment with capecitabine 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 these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.
Find out more about having a DPD deficiency
Side effects can vary from person to person. They also depend on what other treatment you are having.
Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely 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
the side effects are affecting your daily life
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
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.
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 is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling 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.
Less commonly, you might get sepsis. This is a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, being sick, having a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
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. This is known as petechiae.
Less commonly, you might have bleeding from your small bowel, stomach, food pipe (oesophagus) or bottom (rectum). Symptoms might include tummy pain, vomiting blood, having dark stools or blood in your stool. Contact 999 or your healthcare team immediately if you have this.
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 , 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.
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.
You might get a sore mouth and mouth ulcers. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.
You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
Less commonly, you might have a painful burning or tingling sensation in your mouth, or you might have no sensation.
You might notice skin changes, such as dryness, itching and a rash similar to acne. Other skin changes include flat or raised areas, red bumps with pus inside, red raised areas all over your body or a reaction that causes redness on the palms of your hands or soles of your feet.
Less commonly, your skin might look bruised, you might sweat a lot, have night sweats or have hives.
Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.
If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sunblock if you’re going out in the sun.
You might feel some pain in your muscles and joints. Your muscles might also feel tight. Pain might also include chest pain.
Contact your doctor or nurse as soon as possible if you have any chest pain.
Less commonly, you might have pain in your back, bones, jaw, neck or arms and legs. Or you might have muscle spasms or a locked jaw.
Speak to your doctor or nurse about what painkillers you can take to help with this.
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes.
You have regular blood tests to check for any changes in the way your liver is working.
Less commonly, you might have inflammation of the liver (hepatitis) or tenderness of the liver.
Rarely, your skin or the white of your eyes may turn yellow (jaundiced).
You might lose weight while having this treatment. Let your doctor or nurse know and they can recommend ways of maintaining your weight. Or they can refer you to a dietitian.
You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
Less commonly, you might feel drowsy and sleepy.
You may develop shaky hands (tremor) with this treatment.
This drug might make you feel dizzy. You might also feel dizzy when standing or moving around. Or it might feel like the world is spinning.
Don’t drive or operate machinery if you have this.
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
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.
Other nerve changes may include an unpleasant feeling when being touched, weakness in your hands, arms or feet or nerve pain.
Less commonly, nerve changes might cause stiff muscles.
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.
You might have eye problems such as redness and inflammation of the thin layer of tissue that covers the front of the eye (conjunctivitis). Or you might have increased production of tears.
Less commonly, you might have dry eyes, eye pain, blurred vision or loss of vision.
Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.
During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.
Less commonly, a sudden severe increase in blood pressure might happen.
You may have changes to how your heart works, such as your heart rhythm. Tests such as a heart trace (ECG) might pick this up. Or your heart muscle might not pump blood as well as it should (heart failure). Symptoms might include breathlessness or tiredness.
Less commonly, a heart attack might happen. Symptoms of a heart attack include an overwhelming pain in the chest that might feel heavy, tight or as though it's squeezing the chest. Other heart attack symptoms include feeling lightheaded, dizzy, pain in different parts of the body, sweating or anxiety.
We have some tips for coping with hot flushes in women and hot flushes in men. This information also includes some of the possible treatments. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe some medicines to help.
This treatment can cause lung problems.
Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.
Less commonly, you might have lung changes such as inflammation caused by an infection, asthma or fluid collecting between the layers covering the lung.
Rarely, you might have lung inflammation not caused by an infection or wheezing when breathing.
You might have a runny nose while having treatment.
You may develop swollen lips with this treatment.
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.
Less commonly, you might feel bloated or have tummy discomfort.
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.
The hair on your head could become thinner or you may gradually lose your hair.
Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before.
Read about coping with hair loss
You might have nail problems that include broken nails. Tell your doctor or nurse if this happens.
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.
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
You might have flu-like symptoms such as fever, chills and muscle aches.
Contact your advice line if you have flu-like symptoms and check if you can take paracetamol.
A reaction may happen during the injection. Symptoms can include pain at the injection site, a skin rash, itching, red skin, breathing difficulties or a cough. You might also have a drop in blood pressure causing dizziness or a fast heart rate. Your nurse will give you medicines beforehand to try to prevent a reaction.
Rarely, an allergic reaction can be severe and life threatening.
Tell your doctor or nurse immediately if at any time you feel unwell. They will give you medicine to help relieve your symptoms.
This usually goes away on its own, but tell your doctor or nurse if you have it.
Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.
Symptoms of a blood clot include:
• pain, redness and swelling around the area where the clot is and may feel warm to touch • breathlessness • pain in your chest or upper back – dial 999 if you have chest pain • coughing up blood
Your throat might get sore. Or you might have an unpleasant sensation when swallowing. It may be painful to swallow drinks or food. You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
Tell your doctor or nurse if your throat is sore.
Your body might have difficulty balancing your temperature between cold and hot.
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:
feeling overly worried (anxious) or low in mood (depression)
feeling generally unwell
enlarged blood vessels inside or around the bottom (piles). Your doctor can prescribe creams to help relieve discomfort
a dry mouth
changes to how your kidneys work. You might have blood or protein in your urine. You will have regular tests to check this
breast inflammation or infection
bruises
low levels of substances in the blood such as potassium, sodium, magnesium and calcium. You will have regular blood tests to check your levels
high blood sugar levels. Symptoms include headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you are diabetic
a ringing sound in your ears (tinnitus) or hearing loss. Rarely, you might have complete hearing loss
sudden reddening and warmth of the neck, upper chest and face (flushing)
inflammation of a vein
hiccups
hoarseness
difficulty swallowing
discomfort or pain when passing urine
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
fluid collecting between the layers covering the heart (pericardial effusion). Symptoms include shortness of breath or chest pain
kidneys stopping working
There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:
a cancerous or non cancerous (benign) tumour growing
high uric acid levels in the blood due to the breakdown of tumour cells (tumour lysis syndrome) – you will have regular blood tests to check this
high levels of substances in the blood, such as potassium. Symptoms include heart palpitations, shortness of breath, chest pain, nausea, or vomiting. You have regular blood tests to check this
swelling of a part of the eye called the optic disc due to increased pressure in the skull (papilloedema). Symptoms include headaches, feeling and being sick and vision changes such as blurred or double vision. Contact your healthcare team immediately if you have these symptoms
the heart not pumping enough blood and oxygen to the brain and other organs (cardiogenic shock). Symptoms include confusion, sweating, and rapid breathing
lung changes such as scarring of the lung tissue, too much fluid in the lung, tightening of the muscles of the airway or swelling of the voice box. This can cause breathing problems which can be life threatening due to a lack of oxygen to important organs
pregnancy changes such as too little amniotic fluid around the baby or the baby’s kidneys and lungs not developing properly
We have more information about side effects and tips on how to cope with them.
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.
This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 7 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment. Let them know immediately if you or your partner falls pregnant while undergoing treatment.
It is not known whether this treatment affects in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Don’t breastfeed during this treatment and for 7 months afterwards. The drugs may come through in the breast milk.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
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, and yellow fever.
You can usually 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 a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
Read more about immunisations and cancer treatment
For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.
You can report any side effect you have to the Medicines and Healthcare Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 02 Jun 2023
Next review due: 02 Jun 2026
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