What If I Miss An Infusion Appointment
If you miss an appointment for an infusion, reschedule it as soon as possible. The doctors office staff may have to adjust the timing of your future visits.
To help make sure that you dont miss an appointment, try setting a reminder on your phone. You can also write your treatment schedule on a calendar.
What Else Contributes To Hair Loss
There are a number of non-cancer related medications that are associated with hair loss that might accentuate the effects of chemotherapy drugs if used in combination.
Some of these include retinoids , anti-thyroid medications, L-Dopa , amphetamines, non-steroidal anti-inflammatory medications, and several antidepressants such as tricyclic antidepressants and Wellbutrin .
In addition to medications, illness, surgery, or dietary changes may lead to hair loss.
Thyroid disease may cause hair loss and may occur with cancer treatment .
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How Should I Care For My Hair While Receiving Chemotherapy
Even if your chemotherapy treatment is not expected to cause significant hair changes, some precautions are still recommended. If hair thinning is expected, these precautions may decrease damage to your hair:
- Use a soft bristle hairbrush.
- Use a gentle, pH balanced shampoo.
- Avoid using hair dryers, hot rollers or curling/flat irons too often.
- Avoid bleaching or coloring your hair.
- Avoid permanent waves.
How Should I Use This Medication
The recommended adult dose of obinutuzumab is 1000 mg, given by intravenous infusion , into a site specially prepared for giving this medication. Obinutuzumab is given as a series of 6 cycles, each lasting 28 days.
For the first cycle, 100 mg of obinutuzumab is given on Day 1, and the remaining 900 mg is given on Day 2. A dose of 1000 mg is given on Days 8 and 15. For the remaining cycles, a dose of 1000 mg is given on Day 1 of each cycle only.
Very careful handling of this medication is required, and it is always given in a hospital or similar setting with access to sterile equipment for preparation of the medication and facilities to treat medical emergencies, such as infusion reactions.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important this medication be given exactly as recommended by your doctor. If you miss an appointment to receive obinutuzumab, contact your doctor as soon as possible to reschedule your appointment.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
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What Should I Discuss With My Healthcare Provider Before Receiving Obinutuzumab
You should not receive this medicine if you have ever had a severe allergic reaction to obinutuzumab, including a condition called serum sickness.
Tell your doctor if you have ever had:
- high blood pressure or
- if you have an active infection.
It is not known whether obinutuzumab will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.
Indication And Important Safety Information
Indication
What is the most important safety information I should know about GAZYVA?
Tell your doctor right away about any side effect you experience. GAZYVA can cause side effects that can become serious or life-threatening, including:
-
Hepatitis B Virus : Hepatitis B can cause liver failure and death. If you have a history of hepatitis B infection, GAZYVA could cause it to return. You should not receive GAZYVA if you have active hepatitis B liver disease. Your doctor or healthcare team will need to screen you for hepatitis B before, and monitor you during and after, your treatment with GAZYVA. Sometimes this will require treatment for hepatitis B. Symptoms of hepatitis include: worsening of fatigue and yellow discoloration of skin or eyes
-
Progressive Multifocal Leukoencephalopathy : PML is a rare and serious brain infection caused by a virus. PML can be fatal. Your weakened immune system could put you at risk. Your doctor will watch for symptoms. Symptoms of PML include: confusion, difficulty talking or walking, dizziness or loss of balance, and vision problems
Who should not receive GAZYVA?
-
Do NOT receive GAZYVA if you have had an allergic reaction to GAZYVA. Tell your healthcare provider if you have had an allergic reaction to obinutuzumab or any other ingredients in GAZYVA in the past
What are the additional possible serious side effects of GAZYVA?
The most common side effects of GAZYVA in CLL were infusion-related reactions and low white blood cell counts.
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What Other Drugs Could Interact With This Medication
There may be an interaction between obinutuzumab and any of the following:
- acetylsalicylic acid
- alpha agonists
- amifostine
- angiotensin converting enzyme inhibitors
- angiotensin receptor blockers
- anti-psychotics
- apixaban
- barbiturates
- BCG vaccine
- beta-adrenergic blockers
- bortezomib
- calcium channel blockers
- clopidogrel
- diuretics
- echinacea
- low molecular weight heparins
- natalizumab
- non-steroidal anti-inflammatory medications
- pentoxifylline
- phosphodiesterase 5 inhibitors
- pimecrolimus
- selective serotonin reuptake inhibitors
- serotonin/norepinephrine reuptake inhibitors
- tacrolimus
How Is Obinutuzumab Given
Obinutuzumab is given as an infusion into a vein. A healthcare provider will give you this injection.
Obinutuzumab is given in a 28-day treatment cycle. You may need to use the medicine only on certain days of each cycle. Your doctor will determine how long to treat you with obinutuzumab.
On the days you receive this medicine, plan to spend most of the day at the hospital or infusion clinic.
You may be given other medications to help prevent serious side effects or allergic reaction. Keep using these medicines for as long as your doctor has prescribed.
Obinutuzumab can lower blood cells that help your body fight infections and help your blood to clot. Your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests.
If you’ve ever had hepatitis B, using obinutuzumab can cause this virus to become active or get worse. You may need frequent liver function tests while using this medicine and for several months after you stop.
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What Other Drugs Will Affect Gazyva
Tell your doctor about all your other medicines, especially:
-
medicine to treat or prevent blood clots – cilostazol, clopidogrel, dipyridamole, ticagrelor, ticlopidine, and others.
This list is not complete. Other drugs may interact wth obinutuzumab, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Your Course Of Treatment
You usually have a course of several cycles of treatment over a few months. Your nurse, pharmacist or doctor will discuss your treatment plan with you
If you have follicular lymphoma, you might continue to have obinutuzumab on its own after you have finished chemotherapy. This is called maintenance therapy. This can continue for up to 2 years.
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Do All Chemotherapies Cause Hair Loss
Many chemotherapy drugs have no effect on your hair. Others cause mild hair thinning or complete hair loss. Your care team can tell you if hair loss is expected with your treatment. Scalp hair is the most frequently affected, but loss of eyelashes, eyebrows, facial hair, pubic hair and body hair can also occur. The degree of hair loss will depend on several factors, including the chemotherapy drug and dose received, how it is given, and other treatments.
Food And Drug Interactions
- There are no known interactions of obinutuzumab with food and other medications.
- Tell your doctor and pharmacist about all the prescription and over-the-counter medicines and dietary supplements that you are taking at this time. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions.
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Can I Apply Cold Caps To My Scalp To Decrease Hair Loss
Discuss this option with your healthcare provider. Small studies have shown that products marketed as “cold caps” can reduce or prevent hair loss from chemotherapy in some patients. These work by decreasing the blood flow to the scalp, preventing the chemotherapy from affecting the hair follicles . Some practitioners are concerned that this may also prevent the chemotherapy from reaching cancer cells that may be in the scalp area.
Gazyva Generic Or Biosimilar
Gazyva is available only as a brand-name medication. Its not currently available in biosimilar form.
A biosimilar is a medication thats similar to a brand-name drug. A generic medication, on the other hand, is an exact copy of the active ingredient in a brand-name drug.
Biosimilars are based on biologic drugs, which are made from parts of living organisms. Generics are based on regular medications made from chemicals. Biosimilars and generics also tend to cost less than brand-name drugs.
Gazyva contains the active drug obinutuzumab. This means obinutuzumab is the ingredient that makes Gazyva work.
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What Are The Possible Side Effects Of Obinutuzumab
Get emergency medical help if you have signs of an allergic reaction:hives, rash fever, joint pain fast heartbeats, chest pain, wheezing, difficult breathing swelling of your face, lips, tongue, or throat.
Obinutuzumab may cause a serious brain infection that can lead to disability or death. Call your doctor right away if you have problems with speech, thought, vision, or muscle movement. These symptoms may start gradually and get worse quickly.
Some side effects may occur during the injection, or within 24 hours afterward. Tell your caregiver if you feel feverish, chilled, tingly, light-headed, nauseated, or if you have diarrhea, chest pain, or trouble breathing.
- fever, swollen glands, itching, joint pain, or not feeling well
- pale skin, easy bruising, unusual bleeding
- pain or burning when you urinate
- cough with mucus, chest pain, feeling short of breath
- right-sided upper stomach pain, loss of appetite, yellowing of your skin or eyes
- dizziness, loss of balance or coordination
- confusion, vision problems, problems with speech or walking or
- signs of tumor cell breakdown–weakness, muscle cramps, decreased urination, tingling in your hands and feet or around your mouth.
Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.
Common side effects may include:
- fever, weakness, low blood cell counts
Gazyva For Follicular Lymphoma Thats Relapsed Or Refractory
Gazyva is also FDA-approved to treat follicular lymphoma thats relapsed or refractory. You must have tried rituximab for FL, but the cancer relapsed or was refractory .
Youll fist use Gazyva along with bendamustine . After treatment is complete, you may keep taking Gazyva by itself.
FL is a type of non-Hodgkin lymphoma . This is a type of cancer that affects white blood cells called lymphocytes. These blood cells usually help you fight infections. With FL, your lymphocytes grow abnormally, which can cause them to not work properly.
Effectiveness
In a clinical trial, Gazyva was shown to be an effective treatment for FL thats relapsed or refractory. The trial lasted for 21.1 months and compared people who took Gazyva with bendamustine and people who took only bendamustine.
- FL did get worse after about 13.8 months for people who received just bendamustine.
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What Is The Most Important Information I Should Know About Obinutuzumab
If you’ve ever had hepatitis B, using obinutuzumab can cause this virus to become active or get worse. Tell your doctor if you don’t feel well and you have right-sided upper stomach pain, vomiting, loss of appetite, or yellowing of your skin or eyes.
Obinutuzumab may cause a serious brain infection that can lead to disability or death. Call your doctor right away if you have problems with speech, thought, vision, or muscle movement.
Chemo Less Likely To Cause Hair Loss
Some chemotherapy drugs result in only minimal hair loss, though these are often combined with drugs that cause more hair loss. These include:
- The platinums: Paraplatin , Platinol , Eloxatin
- Antitumor antibiotics: Bleo 15K , Mutamicin , low doses of epirubicin or doxorubicin
- Antimetabolites: Trexall, Otrexup, Rasuvo
- Oral cyclophosphamide
- Topoisomerase inhibitors: Novantrone , Hycamtin or Potactasol
- Alkylating agents: Hexalen
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What You Need To Know About Immunotherapy Side Effects
In 2003, at age 43, Laura Porter, MD, was in her second year of her residency in her medical training, when she was diagnosed with stage 4 colon cancer. She has had recurrences in her ovary, liver, pancreas, and abdominal lymph nodes. In May 2006, she became cancer-free. Since 2005, she has been a patient advocate and medical consultant in the field of colorectal cancer, sharing her survival experience and medical expertise.
For the past 3 years, the American Society of Clinical Oncology has named some form of immunotherapy the Advance of the Year in its annual Clinical Cancer Advances report. This treatment approach has offered many successes in treating different types of cancers. Immunotherapy is exciting, but we also need to be aware of the risks of taking the brakes off the immune system.
Immune checkpoints are proteins that act as brakes on the immune system. Immune checkpoint inhibitors, a type of immunotherapy, target these proteins. Blocking these checkpoints takes the brakes off the immune system and allows it to attack cancer cells. These treatments are at the center of important developments in the treatment of lung cancer, bladder cancer, melanoma, and other types of cancer.
Realizing this, ASCO and the National Comprehensive Cancer Network collaborated to create guidelines to help patients, caregivers, and clinicians recognize, assess, and manage the possible side effects of immune checkpoint inhibitors. As a patient advocate, I served on this guideline panel.