Cancer drugs A to Z list
Midostaurin, daunorubicin and cytarabine is the name of a cancer drug combination. It includes the drugs below. How to pronounce the drug names are in brackets.
midostaurin (my-doh-staw-rin)
daunorubicin (daw-noh-roo-bih-sin)
cytarabine (sye-ta-ra-bin)
Midostaurin is a type of targeted cancer drug and daunorubicin and cytarabine are chemotherapy drugs. It is a treatment for acute myeloid leukaemia (AML).
You have this combination for AML if your cancer has a change (mutation) in the FLT3 gene. Your doctor will check for this mutation before you can start this drug.
Read more about acute myeloid leukaemia (AML)
Midostaurin is a type of cancer growth blocker called a tyrosine kinase inhibitor (TKI).
Tyrosine kinase inhibitors block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell from growing and dividing.
Daunorubicin and cytarabine destroy quickly dividing cells, such as cancer cells.
You have daunorubicin and cytarabine into your bloodstream (intravenously). You take midostaurin as capsules.
Daunorubicin is a red liquid.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
central line
PICC line
portacath
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
Risk of tissue damage
When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.
Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.
Read more about having chemotherapy into a vein
When taking midostaurin capsules you swallow them whole with a full glass of water. You take the capsules with food. You should not open, crush or chew the capsules. You usually take them twice a day, about 12 hours apart.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
You have midostaurin, daunorubicin and cytarabine as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.
Each cycle of treatment lasts 21 days (3 weeks), but you don't always start on day 22 with your next cycle. You wait until your blood counts have recovered. You have:
up to 2 cycles to get rid of the leukaemia cells (induction treatment)
up to 4 cycles to lower the risk of leukaemia coming back (consolidation treatment)
It might take around 5 to 6 months in total.
If there is no sign of your cancer (remission), you continue on midostaurin. This is called maintenance treatment. Maintenance treatment means you take midostaurin twice a day for up to 12 cycles of 28 days (4 weeks). So this can take up to 12 months.
Exactly how you have your drugs may depend on your circumstances. The following is an example.
You have each cycle of treatment in the following way:
Day 1 to 3
You have daunorubicin as a drip into your bloodstream (intravenously) over an hour
You have cytarabine as a drip into your bloodstream over 24 hours.
Day 4 to 7
You have cytarabine as a drip into your bloodstream over 24 hours.
Days 8 to 21
You take midostaurin as capsules twice a day, morning and evening, 12 hours apart.
You have each cycle of treatment in the following way:
Day 1, 3 and 5
You have cytarabine as a drip into your bloodstream (intravenously) over 3 hours twice a day.
Days 8 to 21
You take midostaurin as capsules twice a day, morning and evening, 12 hours apart.
You take midostaurin as capsules twice a day, morning and evening, 12 hours apart. Each cycle is 28 days.
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.
Side effects can vary from person to person. They also depend on what other treatments you're having.
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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
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.
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.
Blood tests might show that your blood takes longer to clot.
A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction.
You may have changes to how your heart works such as your heart rhythm. Tests such as a heart trace might pick this up.
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.
Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.
Tell your doctor or nurse if you feel light headed or dizzy, this could be a sign that your blood pressure is low.
Less commonly, you might have high blood pressure causing blurred vision, nosebleeds, shortness of breath and headaches.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). It might also be because of scarring on the lung (called fibrosis).
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.
Swollen veins near your anus (called piles or haemorrhoids) can be painful when you open your bowels. You can try a cream from your pharmacist or tell your doctor.
Less commonly, you might have discomfort in your back passage (anorectal area).
You might notice skin changes, such as dryness, itching, rashes or areas of skin which differ in appearance and are raised like bumps.
Tell your healthcare team if you have any rashes or problems with your skin and nails. They might be able to give you something to help like a cream or lotion.
Less commonly, you might have dry skin.
This drug might cause you to sweat more than usual. But there are ways to reduce sweating.
Let your healthcare team know if you are sweating much more than normal.
It is common to have pain in your throat, tummy (abdomen) and back or joints
Speak to your doctor or nurse about what painkillers you can take to help with this.
Less commonly, you might have pain in your bones, arms, legs or neck.
Rarely you might have muscle pain.
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.
You may have changes in levels of minerals and salts in your blood, such as low potassium and high sodium.
Low potassium can cause muscle weakness, muscle spasms or changes to your heart rhythm.
High sodium can cause muscle weakness, drowsiness, confusion, fits (convulsions) and feeling less awake.
You have regular blood tests during treatment to check this.
Less commonly you might have high levels of calcium in the blood causing nausea, vomiting, constipation, stomach pain, passing urine often, feeling thirsty, weakness and twitching of muscles.
High blood sugar levels can cause 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 have .
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:
high levels of uric acid in your blood which can lead to a build up of crystals in body tissues and cause inflamed joints
fainting or passing out
shaky hands (tremor)
swollen eyelids
heart problems such as a fast heart rate or a build up of fluid around the heart which can cause shortness of breath
a build up of fluid around the lungs which can cause shortness of breath
weight gain
a blood clot or swelling in the tube (line) that goes into a vein
difficulty swallowing
abdominal pain
diarrhoea
ulcers in the mouth or anus
hair loss
problems with your kidneys
fever
changes in the way your kidneys or liver work - you have regular blood tests to check this
difficulty speaking
burst blood vessels in the eye with an eye infection (conjunctivitis). You may have a dislike of bright lights, have a burning sensation in the eye or a watery eye
uncontrolled movement or shaking of the eyes
constipation
passing urine more often
high calcium levels in the blood which could make you feel weak with twitching muscles
pain in your bones
sore throat
runny nose
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
sepsis - a serious reaction to an infection - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
Posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible
Cytarabine syndrome sometimes happens about 6 to 12 hours after having this drug. It is a combination of symptoms including a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness. Steroids can help to prevent or treat this syndrome
We have more information about side effects and tips on how to cope with them.
Read more about how to cope with side effects
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.
You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.
Don’t breastfeed during this treatment and for 4 months afterwards. The drug 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 this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.
You can report any side effect you have to the Medicines and Healthcare products Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 05 Jun 2024
Next review due: 05 Jun 2027
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