Levamisole/Chemo/Radiation

drmrgirl47

I would like to talk to someone who has rectal cancer. My tumor was removed January 27, 2004. I have a temporary colostomy. I am undergoing chemo and will get radiation and chemo starting April. I also take Levamisole. It is a pill. I was wondering about the side effects of all this. I only had one round of chemo. All this makes me nervous. I went in the chat room, but so far no one there has had anything similar to my situation. Just looking to share with someone.

jsabol

Hi dreamer, I'm sure there will be others here who can give you some info. My situation is a little different, but there are many of us here to help. I have found this board to be more helpful in getting specific info re my stuff; the chat room can be more hit or miss. Stay tuned for other responses and welcome, Judy

KrisS

I would discuss it with your oncologist. I am very curious, how did you come to be put on Levamisole? It is a drug that originally used as a dewormer medication for large animals, and later shown to have some immune stimulating properties. I don't think after trials, veterinarians are using it for this purpose any more, however.

I checked Medline briefly with "Levamisole and Cancer". A recent abstract evaluating 40 patients receiving chemo versus 40 receiving levamisole as well showed no survival advantage, and some increase in liver toxicity with the use of both.

This was the URL

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14628428&dopt=Abstract

Best wishes,

Kris

aspaysia

Levamisole is a cancer (antineoplastic) medication. Levamisole interferes with the growth of cancer cells and slows their growth and spread in the body. It is an immunomodulator that restores depressed immune function and an immunoadjuvant, since its effect on the immune system depends in part on the presence of antigenic stimulation. Levamisole can stimulate antibody formation to various antigens, enhance T-cell responses by stimulating T-cell activation and proliferation, and potentiate monocyte and macrophage functions. It is currently indicated in combination with 5-fluorouracil as adjuvant treatment after surgical resection with colon cancer; however, the exact mechanism of action of levamisole HCl in combination with 5-fluorouracil is unknown. Levamisole can stimulate a normal and a depressed immune system, and is often classified as both an immunoregulator and immunostimulant.

SIDE EFFECTS/MANAGEMENT
Nausea may occur. Many people have little or no nausea. Take your levamisole right after eating. If you take it 3 times a day, take each dose after a meal. You may be given an anti-nausea prescription to take at home. It is easier to prevent nausea than treat it once it has occurred.
Drink plenty of liquids. Eat often in small amounts.
Diarrhea may occur. Drink plenty of fluids. Eat often in small amounts. Eat low fiber foods such as cheese, rice, white bread and cooked vegetables. Avoid high fiber foods such as bran, whole grain breads and cereals, nuts, raw fruits and raw vegetables.
Note: If milk usually gives you diarrhea, the lactose in the tablet may be causing your diarrhea. Take Lactaid

KrisS

KrisS said:

I would discuss it with your oncologist. I am very curious, how did you come to be put on Levamisole? It is a drug that originally used as a dewormer medication for large animals, and later shown to have some immune stimulating properties. I don't think after trials, veterinarians are using it for this purpose any more, however.

I checked Medline briefly with "Levamisole and Cancer". A recent abstract evaluating 40 patients receiving chemo versus 40 receiving levamisole as well showed no survival advantage, and some increase in liver toxicity with the use of both.

This was the URL

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14628428&dopt=Abstract

Best wishes,

Kris

Sorry, I did not mean to insinuate that levamisole had not been used as chemotherapeutic agent. I just remember the veterinary connection because, when the immune stimulating functions were reported 25 yrs ago in the press, people were asking about buying the drug from them.

I was suprised because I had seen no reports of its use recently for cancer (in pets or people). You learn something new every day, however. On further browsing of Medline, it seems the 5-FU/ levamisole combination has been used quite a bit more in Europe.

People at Mayo Clinic apparently also have used it. It seems there are conflicting reports of its efficacy when combined with 5-FU compared to 5FU and leucovorin, or when given along with 5-FU and leucovorin. It seems that in the United States, 5-FU combined with leucovorin has become more the standard.

If you go to the URL I posted earlier and click on related articles, you can read a number of abstracts. Of the three pages worth that I skimmed through, only the one I posted mentions side effects in the abstract, although I suspect the others discuss this in the body of the papers.

If your oncologist is using this combination commonly, however, he would be the one to ask about the side effects.

Kris

taraHK

Hi. I was diagnosed with rectal cancer in December 2002. My treatment was a little different from yours: I had 6 weeks of chemoradiation, then surgery (April 2004 - resulting in permanent colostomy), then 4 months of chemo (I was Stage III - one positive lymph node). But, I did have Levamisole, together with 5FU, as one of my chemo drugs. (at another time I had 5FU plus leucovorin). Because my presurgical treatment was radiation plus chemo, it was a little difficult to sort out the side effects. I certainly had some fatigue (certainly from the radiation, probably from the chemo too). I had some "burn" (raw skin) from the radiation -- if you get this, make sure to bring up with your health team and get their suggestions for management -- I used sitz baths, some special ointments, etc. I did have some nauseau from the chemo. For my presurgical chemo, the nausea wasn't too bad. My postsurgical chemo was more intensive (every day for one week, then 3 weeks off, for 4 cycles). If you get nausea, remember that there are many antinauseas medications. Keep trying till you get one that works for you. I had to try 3 different medications before I got one that was OK for me. I did not loose my hair at all with the chemo -- I understand there is some variation with this.

Although this sounds like a lot of "side effects", actually, I thought I got off amazingly easy - I was pretty active throughout it all. And, several months later, all the negative stuff is starting to fade - I just remember the good stuff (great friends, great staff, the laughter). I wish you all the best as you face this treatment. Feel free to ask questions anytime. You are not alone!
TaraHK

ssaye

I also have rectal cancer. I am behind you in treatment. I found out right before Christmas last year. I just finished chemoradiation and did ok with that. I am supposed to have surgery in about 4 weeks and get the temporary colostomy. How was the surgery? Is the colostomy very bothersome? My onc said that I will do atleast 4 months of post surgery chemo also. It sounds like we are on the same path. Any info you could share with me about the process would be greatly appreciated. I am a 37 male with a 3 year old and a baby due in 2 weeks. I have my hands full to say the least.

KrisS

ssaye said:

I also have rectal cancer. I am behind you in treatment. I found out right before Christmas last year. I just finished chemoradiation and did ok with that. I am supposed to have surgery in about 4 weeks and get the temporary colostomy. How was the surgery? Is the colostomy very bothersome? My onc said that I will do atleast 4 months of post surgery chemo also. It sounds like we are on the same path. Any info you could share with me about the process would be greatly appreciated. I am a 37 male with a 3 year old and a baby due in 2 weeks. I have my hands full to say the least.

I am certain dreamer will have her own input,since your situations are more similar. I just wanted you to know that I too had surgery and an ileostomy for my rectal carcinoma and it was not bad.

My situation was a bit different, because they went in to resect metastatic disease to my peritoneum as well as remove my primary tumor and redid a previous ileostomy placed because of a radiation induced stricture. (They redid it because they were worried there might be tumor in that region, not because I was having problems with it.)

They told me they would go back in 6 mths to reverse it, but I asked if I could keep it. I had heard that there is a period of adjustment for the colon after such surgery. With as serious as my metastatic disease was, I told my surgeon that if I was at high risk of recurrence, I did not want to spend precious time running in and out of the bathroom. My ileostomy was much more minimal hassle.

I did develop more metastatic disease, controlled on oxaliplatin. I have had my ileostomy since 9/02. I spend about 30 minutes a week changing the wafer. I drain my bag whenever I go to the bathroom. Early on, I visited an ostomy nurse because I developed ulceration around my stoma that I could not control. She made suggestions and I haven't had a problem since.

Two important rules...Be careful in what and how you eat. The ostomy nurses usually have great handouts about what can be potentially problem foods and start out carefully, but chew fibrous or tough foods VERY well. Drink plenty of fluids, since you are bypassing the colon which normally absorbs fluids.

I did get obstructed twice, once from eating broccholi too soon after surgery, once after eating and not chewing a steak well enough. The first time I got the obstruction relieved myself, but not without a lot of misery and vomiting. The second time I went to the ER. Two liters of IV fluids, and some antinausea medication did the trick within a couple of hours.

Best wishes for a smooth and sucessful surgery,

Kris