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Cindy Cherry, MSN, AGNP-C, on the right with colleague Paul R. Walker, MD, FACP, on the left. Courtesy of Cindy Cherry, MSN, AGNP-C.

Disclaimer: Please note that all opinions from this article are Cindy Cherry's. Talk with your doctor before considering any of the suggested tips below.

Extensive-stage small cell lung cancer (ES-SCLC) is a type of cancer that is known to be aggressive because it can quickly spread to other parts of the body—that’s what extensive stage means. Once you are diagnosed with ES-SCLC, you may have a lot of questions and feel unsure about where to start. As a nurse who treats people with ES-SCLC, I hope that by sharing my experiences, you may feel more prepared for the treatment journey ahead.

Focus on moving forward by letting go of the past

When beginning treatment, try to focus on the future, not what happened in the past. You may experience feelings of guilt following a diagnosis, but it’s important to know that it’s not your fault. Guilt is not a part of my vocabulary, and it should not be part of yours either. My number one goal is to help make sure my patients understand that no one deserves cancer—it comes from an evil source, and it is something you and your care team will fight together. Concentrate on moving forward.

The unknowns of treatment can be unsettling, and it’s easy to get a set idea in your mind of how the process will go. While it might be difficult, try to listen to your care team with an open mind and then explain any goals that you want to accomplish during treatment. If your goals don’t match what your care team has planned for you, that’s okay too—don’t be afraid to speak up and discuss this with your doctor.

Your care team is full of advice, ask them anything

It’s common to feel a wide range of emotions and be overwhelmed by your new treatment regimens. If you’re unsure of what your care team is explaining, ask them to slow down, repeat things, or explain something in a new way so you can understand it better. I recommend bringing someone with you to your appointments in case you happen to miss any important information your care team is explaining—the more ears the better. I also encourage people to ask their care team if there is literature you can bring home to review on your own terms. Most importantly, I remind everyone to stay hydrated—this helps to protect your kidneys during treatment and helps to keep your energy up, too.

Treatment may cause side effects, but there is medicine to help

While you may experience side effects as a result of the cancer treatment, your care team will try to make you feel as comfortable as they can. There are medicines available for the more common side effects of chemotherapy, like nausea, vomiting, diarrhea, and constipation. We do our best to try to make sure your side effects are as tolerable as possible with all the different medicines that are available. If you do experience any side effects, it is important to let your care team know as soon as possible. Remember that your care team is in this with you and we want to keep you out of the hospital as best as we can.

Myelosuppression is a big word and a serious side effect

One important side effect of chemotherapy that may not be top of mind for you is myelosuppression (my-low-suh-preh-shun). Myelosuppression is one of my biggest worries because it can happen during treatment with chemotherapy—it’s important to understand how serious it is. Myelosuppression means that chemotherapy treatment may be hard on your bone marrow, which could affect your blood cell counts. This results in fewer white and red blood cells, which can cause other side effects like neutropenia and anemia.

Neutropenia is a side effect that occurs when white blood cell counts drop too low and means you could be at risk for infection. Anemia is a side effect that occurs when red blood cell counts drop too low and can make you feel very tired, weak, dizzy, or make breathing more difficult.

There is a treatment available that can help with myelosuppression

To help reduce the occurrence of low blood cell counts caused by myelosuppression, COSELA™ (trilaciclib) is available for people with an ES-SCLC diagnosis receiving certain types of chemotherapy. COSELA is given up to 4 hours before each chemo treatment to help keep chemotherapy from damaging bone marrow while chemotherapy works to destroy the cancer cells. Helping to protect cells in the bone marrow may help keep certain blood cell counts from dropping too low—which is what can cause side effects like neutropenia and anemia. This proactive protection of the bone marrow is what doctors call 

(my-low-proh-TEK-shun) and may help you stay on track with your scheduled treatment plan.

 during the next scheduled treatment. Your doctor will decide if COSELA is right for you.

COSELA is a prescription medicine used to help reduce the occurrence of low blood cell counts caused by damage to bone marrow from chemotherapy. COSELA is used to treat adults taking certain chemotherapies (platinum/etoposide or topotecan) for extensive-stage small cell lung cancer.

COSELA is an injection for intravenous (IV) use given within 4 hours before chemotherapy.

Do not take COSELA if you have had a serious allergic reaction to COSELA.

What are the possible serious side effects of COSELA?

 Pain, irritation, swollen veins, or blood clots may form at or near the injection site. Signs and symptoms may include swelling, pain, redness, tenderness, itchy skin that feels warm to the touch, and the appearance of inflamed veins.

 Signs and symptoms of an allergic reaction to COSELA can include hives, itching, flushed or pale skin, trouble breathing, swollen face, eyes, tongue or throat, and dizziness or fainting.

 Lung problems (pneumonitis or interstitial lung disease).

 Signs or symptoms may include trouble breathing at rest or aggravated by exertion, cough, tiredness, unintended weight loss, loss of appetite, and chest pain. Report any new or worsening problems with breathing to your doctor right away.

 Females should use effective birth control during treatment with COSELA. COSELA may cause fertility problems in females, which may affect your ability to have children. Talk to your doctor if you have concerns about fertility.

Call your doctor or get medical care right away if you develop any of these symptoms or conditions.

Before taking COSELA, tell your doctor about all of your health conditions, including if you:

- are taking medication for diabetes, heart disease, or multiple sclerosis

- are pregnant or plan to become pregnant. COSELA can harm your unborn baby. Tell your doctor right away if you become pregnant or think you may be pregnant during treatment with COSELA. Females who are able to become pregnant:

-- your doctor should give you a pregnancy test before you start treatment with COSELA

-- you should use an effective method of birth control during your treatment for at least 3 weeks after the last dose of COSELA

- are breastfeeding or plan to breastfeed. It is not known if COSELA passes into your breast milk. Do not breastfeed during treatment and for at least 3 weeks after the last dose of COSELA.

Tell your doctor about all the medications you are currently taking, including prescription and over-the-counter medicines, vitamins, supplements, and herbal supplements. COSELA and other medicines may affect each other. Keep a list of the medicines you take to show to your healthcare provider or pharmacist when you get a new medicine.

The most common side effects of COSELA include:

- low levels of calcium, potassium, or phosphate in your blood

- high levels of a liver enzyme called aspartate aminotransferase

- a high blood sugar level (hyperglycemia)

These are not all of the possible side effects of COSELA. Call your healthcare provider for medical advice about any side effects you may be experiencing. You are encouraged to report any negative side effects to G1 Therapeutics at 

COSELA (trilaciclib). Prescribing Information. G1 Therapeutics, Inc; 02/2021.

Articles

Cindy Cherry, MSN, AGNP-C, is an oncology nurse practitioner in Greenville, North Carolina. She treats patients with all types of cancers, including extensive-stage small cell lung cancer (ES-SCLC).

Tips From an Oncology Nurse Practitioner That May Help With Treatment

In the United States, about 30,000 to 35,000 people are newly diagnosed each year with small cell lung cancer (SCLC). Extensive-stage small cell lung cancer (ES-SCLC) means that the cancer has spread to other parts of the body. When confronting this diagnosis, self-education may be comforting while on this journey. In particular, understanding the word 

 may be helpful before your next doctor appointment.

After a diagnosis is received, treating the cancer is the next step. Chemotherapy—commonly referred to as “chemo”—is a type of cancer treatment that uses strong chemicals to destroy fast-growing cells, like cancer cells. But cancer cells are not the only types of fast-growing cells in the body. There are other types that could be targeted by chemo too—normal, healthy cells like those in the bone marrow.

Chemo can damage the blood-forming cells in the bone marrow

Bone marrow makes blood-forming cells, which are the “parent cells” that make white and red blood cells. White blood cells help fight off infection and protect the body from viruses and bacteria while red blood cells pick up oxygen from the lungs and carry it to cells throughout the body. Both cells play important roles during treatment. When going through chemo treatment, chemo can't tell the difference between fast-growing cancer cells or the fast-growing healthy cells—like the cells that make white and red blood cells—and can damage both along the way, causing a reduction in the amount of white and red blood cells in the body. This is called bone marrow suppression, or 

Damage to blood-forming cells from chemo can make white blood cell counts drop too low, causing a side effect called neutropenia—this means there could be an increased risk for infection. Similarly, red blood cell counts can also drop too low, causing a different side effect called anemia—this can make someone feel very tired, weak, dizzy, or make breathing more difficult. When going through treatment, your care team will be testing for side effects such as these. If side effects do occur, the chemo dose may have to be reduced, taking the treatment plan off track.

Not having to reduce the chemo dose may help treatment stay on track

To help reduce the potential occurrence of low blood cell counts caused by myelosuppression, COSELA™ (trilaciclib) is available for people with an ES-SCLC diagnosis receiving certain types of chemotherapy. COSELA is given up to 4 hours before each chemo treatment to help keep chemo from damaging bone marrow while chemo works to destroy the cancer cells. Helping to protect the parent cells in bone marrow may help keep blood cell counts from dropping too low—which is what can cause side effects like neutropenia and anemia. This proactive protection of the bone marrow is what doctors call 

(my-low-proh-TEK-shun) and may help you stay on track with your scheduled treatment plan. After each treatment with COSELA and chemo is complete, the bone marrow can start making blood cells again.

To learn more about COSELA and how it works for people with ES-SCLC, visit 

Lung problems (pneumonitis or interstitial lung disease).

are taking medication for diabetes, heart disease, or multiple sclerosis

are pregnant or plan to become pregnant. COSELA can harm your unborn baby. Tell your doctor right away if you become pregnant or think you may be pregnant during treatment with COSELA. Females who are able to become pregnant:

your doctor should give you a pregnancy test before you start treatment with COSELA

you should use an effective method of birth control during your treatment for at least 3 weeks after the last dose of COSELA

are breastfeeding or plan to breastfeed. It is not known if COSELA passes into your breast milk. Do not breastfeed during treatment and for at least 3 weeks after the last dose of COSELA.

low levels of calcium, potassium, or phosphate in your blood

high levels of a liver enzyme called aspartate aminotransferase

1. COSELA (trilaciclib). Prescribing Information. G1 Therapeutics, Inc; 02/2021.

2. Small Cell Lung Cancer. National Organization for Rare Disorders. Updated 2019. Accessed June 25, 2021. 

https://rarediseases.org/rare-diseases/small-cell-lung-cancer/

3. Lung Cancer – Small Cell: Stages. American Society of Clinical Oncology. Updated January 2021. Accessed June 25, 2021.

https://www.cancer.net/cancer-types/lung-cancer-small-cell/stages

4. Chemotherapy Side Effects. American Cancer Society. Updated May 1, 2020. Accessed July 20, 2021. 

https://www.cancer.org/treatment/treatments-and-side-effects/treatment types/chemotherapy/chemotherapy-side-effects.html

5. Low Red Blood Cell Counts (Anemia). American Cancer Society. Updated February 1, 2020. Accessed March 18, 2021. 

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/anemia.html

6. Low White Blood Cell Counts (Neutropenia). American Cancer Society. Updated February 1, 2020. Accessed March 18, 2021. 

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/neutropenia.html

Learn more about the protection of bone marrow and how it may help lower the risk of bone marrow suppression for certain people with small cell lung cancer.

How much do you know about certain chemotherapy side effects?

Dr. Spira is a director at the Virginia Cancer Specialists Research Institute, Co-Chair of the US Oncology Thoracic Oncology Committee, and a faculty member at Johns Hopkins School of Medicine where he serves as Assistant Professor of Oncology. Dr. Spira explains the science of the KRAS gene and introduces KRASRegeneration.com, a website for HCPs that builds awareness of the KRASG12C mutation.

The conversation focuses on the importance of educating oncologists around the KRAS mutation in lung cancer. KRASRegeneration.com is sponsored by Mirati Therapeutics, Inc.

Podcasts

In this episode of the “Cure Talks Cancer” Podcast, Dr. Spira a medical oncologist of the Virginia Cancer Specialists’ (VCS) discusses why KRASG12C is a prolific problem.

What you need to know about KRASG12C 

The importance of proper care and perseverance

Nancy is a paid Bristol Myers Squibb ambassador.

After spending 30 years working as a banker, Nancy began enjoying her days of well-deserved retirement with her husband, Al, spending time with her two children and four grandchildren. In their free time, Nancy and Al love to cook, go on walks and play cards.

The couple also has a passion for travel, and their most memorable trips include exploring Europe, the Caribbean and Alaska. One day, Nancy is hopeful she can travel again alongside her husband, however, in the meantime, she continues enjoying the simple things in life—which she appreciates now more than ever.

While Nancy and Al have become accustomed to their daily routine, they cannot forget how suddenly things changed one morning. Nancy woke up with a fever and body aches and, with encouragement from Al, went to see her doctor. She was prescribed antibiotics for a suspected infection; however, her symptoms continued to worsen, landing her back at the doctor’s office four days later.

Following blood work and a chest x-ray, Nancy’s doctor called and directed her to go to the emergency room immediately.

“I said to him, ‘Do I have leukemia?’ And I have no idea, to this day, why that even popped up into my mind,” Nancy recalls.

Upon arrival at the emergency room, Nancy was assessed, and it was a bone marrow test that confirmed her suspicion – it was acute myeloid leukemia (AML), a rare type of blood cancer.

AML is characterized by the rapid growth of abnormal cells in the bone marrow and as such interferes with normal blood cell production and function. This year alone, it is estimated there will be nearly 20,000 new cases of AML in the United States, accounting for about 1% of all cancer cases.

As quickly as she was diagnosed with AML, Nancy began rounds of chemotherapy and other treatments that kept her in the hospital for 45 days.

Fortunately, Al and her children formed an incredible support system. Her daughter Danielle slept in the hospital room every night despite juggling her own family life and continuing her education. Al made the long drive to the hospital daily to be with her, while managing his own medical needs.

The response to treatment in AML may be of short duration, meaning following patients' initial response to chemotherapy, there is still a high risk of relapse. There is also an unmet need for continued treatment options that can help prolong overall survival.

Nancy’s condition was deteriorating. She was put on a ventilator, a time she does not remember. After some time, the medical team suggested taking her off the ventilator, leaving Danielle questioning the best course of action. One day, under heavy sedation, Nancy motioned for a pen and piece of paper, which she used to write, “I love you. I will win.”

Danielle and Al were left in awe of Nancy’s message. In that moment, Danielle knew her mother wasn’t finished fighting. She had beat breast cancer decades earlier. Why not this? Danielle said, “That was the point I thought, she's got this. No matter what she's going to beat this."

After rounds of intensive chemotherapy, Nancy's cancer was in remission. Her oncologist suggested a clinical trial for a then-experimental therapy now known as 

® (azacitidine) tablets. Primed with encouragement from her family and knowledge from her oncologist, Nancy moved forward with the trial, and feels fortunate that she made this decision. “My family convinced me that I should try it. I really did it more for them than for me,” she recalls. “It was my children, my husband and my grandchildren that made me strong. They really did give me the strength that I needed to keep going every single day.”

Nancy’s doctor discussed possible side effects that may occur with 

, including the most common symptoms such as nausea and vomiting, diarrhea, tiredness or weakness, constipation, stomach area (abdominal) pain, pneumonia, joint pain, decreased appetite, pain in arms or legs, and dizziness. Find the complete list of symptoms in 

Fast forwarding to the present day, Nancy is enjoying life at home with her husband Al. They have recently taken up cooking healthy stir fries, sometimes using vegetables from their own garden. If Nancy gets tired, she can take a break and sit on the couch. “My husband has been my rock,” she said, “and if I need a break, he’s always there for me.” Nancy continues to be monitored for disease progression and side effects from 

Despite the adversity she has faced, Nancy remains hopeful about her health and focuses on being present with her family. She encourages others to take their condition one day at a time and to accept help where they can. For her, she describes her experience in the clinical trial as positive and a good decision. Her advice to other patients is to start a conversation with their healthcare team to better understand if a clinical trial is right for them.

She has additional advice for others who are living with cancer. “Ask questions and collaborate with your healthcare team,” Nancy advises. “If your family is willing to help you, let them help you. I can’t tell you the number of times my husband, my children and their spouses and my grandchildren were there for me.”

As for Danielle, her experience as her mother’s care partner in the hospital and as an ongoing support to both Nancy and Al was often emotional and at times it was a struggle for her to remain positive. But her mom’s courage and strength inspired her to stay strong. From her perspective, she advises care partners to discuss their loved one’s wishes, what they find important, and to be prepared to advocate for them.

Danielle has a vivid memory of her mom’s initial journey with AML but also knows not to doubt her resilience. As she put it simply, “My mom is a superwoman.”

 to learn more about this treatment option. Individual patient experiences may vary.

These are not all of the possible side effects of ONUREG®. Call your doctor for medical advice about side effects. You may report side effects to FDA at 

General information about the safe and effective use of ONUREG®. 

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use ONUREG® for a condition for which it was not prescribed. Do not give ONUREG® to other people, even if they have the same symptoms you have. It may harm them. You can ask your pharmacist or healthcare provider for information about ONUREG® that is written for health professionals.

A Story of Resilience – Living with Acute Myeloid Leukemia

Treating your cancer should never stop you from sharing the things you love with the people you hold dearest. To learn more about treatment with CALQUENCE

CALQUENCE is a prescription oral treatment for adults with chronic lymphocytic leukemia, small lymphocytic lymphoma, or previously-treated mantle cell lymphoma. May cause serious side effects including: serious infections, bleeding problems, decrease in blood cell count, new cancers, and heart rhythm problems. Some may lead to death. Tell your doctor if you experience infections such as flu-like symptoms; unexpected bleeding such as blood in your stool or urine; or heart rhythm problems such as fast or irregular heartbeat. Use sun protection when outside.

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Keep Inspiring

Sometimes, living with previously treated MCL can be overwhelming. But with the help of your support network and access to an online community, FAQs, and more, finding a right treatment doesn't have to be intimidating. One of the options available is CALQUENCE

To learn more about treatment with CALQUENCE

CALQUENCE is a prescription oral treatment for adults with previously-treated mantle cell lymphoma. May cause serious side effects including: serious infections, bleeding problems, decrease in blood cell count, new cancers, and heart rhythm problems. Some may lead to death. Tell your doctor if you experience infections such as flu-like symptoms; unexpected bleeding such as blood in your stool or urine; or heart rhythm problems such as fast or irregular heartbeat. Use sun protection when outside. 

Your Previously Treated Mantle Cell Lymphoma (MCL)

Sometimes, living with CLL can be overwhelming. But with the help of your support network and access to an online community, FAQs, and more, finding a right treatment doesn't have to be intimidating.

Find your CLL community with the CALQUENCE

CALQUENCE is a prescription oral treatment for adults with chronic lymphocytic leukemia or small lymphocytic lymphoma. May cause serious side effects including: serious infections, bleeding problems, decrease in blood cell count, new cancers, and heart rhythm problems. Some may lead to death. Tell your doctor if you experience infections such as flu-like symptoms; unexpected bleeding such as blood in your stool or urine; or heart rhythm problems such as fast or irregular heartbeat. Use sun protection when outside.

Your Chronic Lymphocytic Leukemia (CLL) Diagnosis 

Chronic lymphocytic leukemia is different from other blood cancers in that it typically is a slow-growing disease. “It’s really more like a chronic condition, and it can be managed over a long period of time,” says Dr. Jennifer Lue, an assistant professor of Medicine with Columbia University Irving Medical Center in New York. “With recent advances in treatment, 5-year overall survival is 85%, which speaks to the chronicity of this disease and how well current treatments work.”

CLL affects white blood cells, specifically the B lymphocytes. Essentially, B lymphocytes are healthy white blood cells that change to become abnormal and slowly grow out of control. They also do not die when they should, so over time, these abnormal cells crowd the bone marrow, preventing healthy cells from growing.

“I think when anyone receives a cancer diagnosis, their first thought is fear,” says Lue. However, with CLL, “the conversation is more about living with the disease, often for many years, and planning a lifelong relationship with your oncologist.”

B lymphocytes contain an enzyme called “Bruton tyrosine kinase,” or BTK, which helps them grow and live properly. In CLL, these abnormal B cells have too much BTK, which allows them to overproduce, preventing space for healthy cells.

“A BTKi or BTK inhibitor is a medicine that targets the enzyme that is overstimulated in CLL,” says Lue. Essentially, BTKis limit the BTK to keep the abnormal B cells from growing uncontrollably.

“BTKis are well-studied, and we know they have a very durable (prolonged) response with some cancer patients,” says Lue.

Most BTKis are what doctors call “oral agents,” or medicines you can take by mouth at home, unlike some other CLL medicines that are given by infusion into a vein.

“That’s why a lot of patients may prefertaking BTK inhibitors,” says Lue, “especially during the time of Coronavirus so they can avoid the hospital setting. This type of medicine can also be more accommodating to their schedules.”

Can you describe your experience with CALQUENCE® (acalabrutinib) in treating CLL patients?

For the most part, Dr. Lue uses the BTK inhibitor CALQUENCE when treating her CLL patients, both in patients receiving medication for the first time (first-line treatment) as well as those who have taken a previous treatment (relapsed or refractory disease).

“A lot of my patients have been on CALQUENCE for a while now,” she says.

“In the ELEVATE-TN and ASCEND clinical trials, the majority of patients with CLL responded to CALQUENCE, which means that their cancer reduced in size and did not spread,” Dr. Lue added. In the ELEVATE TN clinical trial of patients new to CLL treatment, 86% responded to CALQUENCE compared to 79% who received another treatment (chlorambucil plus obinutuzumab). In the ASCEND clinical trial of patients with previously-treated CLL, 81% responded to CALQUENCE compared to 75% who received another treatment (rituximab plus either idelalisib or bendamustine).

Like most BTKis, CALQUENCE may cause some side effects. “Some issues I’ve noticed with my patients are headache, and sometimes muscle pain, known as myalgia. For some patients, these are usually managed with over-the-counter medicines, if anything at all, because they are generally temporary and go away in time.” 

Individual results may vary. See Important Safety Information below.

With COVID, we can now offer telemedicine visits and send patients for local blood work close to home, so they can avoid having to go to a hospital,” says Lue. “I monitor my patients very closely with office visits and blood tests.”

Dr. Lue reinforces how important it is that patients tell her when they are not feeling right. “Even if it’s trivial, it’s so important for patients to call the office with any concerns, so we can help manage it and keep patients on their CLL treatment.”

Over time, as patients get used to taking CALQUENCE, they can expect to have fewer office visits, says Lue. “Sometimes the toughest part is just remembering to take their CALQUENCE.” Dr. Lue recommends people set a reminder on their phone twice a day, especially in the evening if they aren’t taking other medications before bed.

To hear from real people with chronic lymphocytic leukemia taking CALQUENCE, visit 

IMPORTANT SAFETY INFORMATION ABOUT CALQUENCE® (acalabrutinib) CAPSULES

Before taking CALQUENCE, tell your healthcare provider about all of your medical conditions, including if you:

have had recent surgery or plan to have surgery. Your healthcare provider may stop CALQUENCE for any planned medical, surgical, or dental procedure.

have or had liver problems, including hepatitis B virus (HBV) infection.

are pregnant or plan to become pregnant. CALQUENCE may harm your unborn baby and cause problems during childbirth (dystocia).

If you are able to become pregnant, your healthcare provider may do a pregnancy test before you start treatment with CALQUENCE

Females who are able to become pregnant should use effective birth control (contraception) during treatment with CALQUENCE and for at least 1 week after the last dose of CALQUENCE

are breastfeeding or plan to breastfeed. It is not known if CALQUENCE passes into your breast milk. Do not breastfeed during treatment with CALQUENCE and for at least 2 weeks after your final dose of CALQUENCE.

Tell your healthcare provider about all the medicines you take,

 including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking CALQUENCE with certain other medications may affect how CALQUENCE works and can cause side effects. Especially tell your healthcare provider if you take a blood thinner medicine.

Take CALQUENCE exactly as your healthcare provider tells you to take it.

Do not change your dose or stop taking CALQUENCE unless your healthcare provider tells you to.

Your healthcare provider may tell you to decrease your dose, temporarily stop, or completely stop taking CALQUENCE if you develop certain side effects.

Take CALQUENCE 2 times a day (about 12 hours apart).

Swallow CALQUENCE capsules whole with a glass of water. Do not open, break, or chew capsules.

If you need to take an antacid medicine, take it either 2 hours before or 2 hours after you take CALQUENCE.

If you need to take certain other medicines called acid reducers (H2-receptor blockers), take CALQUENCE 2 hours before the acid reducer medicine.

If you miss a dose of CALQUENCE, take it as soon as you remember. If it is more than 3 hours past your usual dosing time, skip the missed dose and take your next dose of CALQUENCE at your regularly scheduled time. Do not take an extra dose to make up for a missed dose.

What are the possible side effects of CALQUENCE?

CALQUENCE may cause serious side effects, including:

 can happen during treatment with CALQUENCE and may lead to death. Your healthcare provider may prescribe certain medicines if you have an increased risk of getting infections. Tell your healthcare provider right away if you have any signs or symptoms of an infection, including fever, chills, or flu-like symptoms.

 can happen during treatment with CALQUENCE and can be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs or symptoms of bleeding, including blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding or bleeding that is severe or you cannot control, vomit blood or vomit that looks like coffee grounds, cough up blood or blood clots, dizziness, weakness, confusion, changes in your speech, headache that lasts a long time, or bruising or red or purple skin marks

. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with CALQUENCE, but can also be severe. Your healthcare provider should do blood tests to check your blood counts regularly during treatment with CALQUENCE.

 New cancers have happened in people during treatment with CALQUENCE, including cancers of the skin or other organs. Your healthcare provider will check you for skin cancers during treatment with CALQUENCE. Use sun protection when you are outside in sunlight.

Heart rhythm problems (atrial fibrillation and atrial flutter)

 have happened in people treated with CALQUENCE. Tell your healthcare provider if you have any of the following signs or symptoms: fast or irregular heartbeat, dizziness, feeling faint, chest discomfort, or shortness of breath

The most common side effects of CALQUENCE include

 headache, diarrhea, muscle and joint pain, upper respiratory tract infection, and bruising.

These are not all the possible side effects of CALQUENCE. Call your doctor for medical advice about side effects.

You may report side effects related to AstraZeneca products by clicking

CALQUENCE is a prescription medicine used to treat adults with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).

It is not known if CALQUENCE is safe and effective in children.

CALQUENCE is a registered trademark of the AstraZeneca group of companies.

An interview with Dr. Jennifer K. Lue, Assistant Professor of Medicine, Center for Lymphoid Malignancies, Division of Hematology and Oncology, Columbia University Irving Medical Center.

Sponsored Content

Tips From an Oncology Nurse Practitioner That May Help With Treatment

How much do you know about certain chemotherapy side effects?

What you need to know about KRASG12C

A Story of Resilience – Living with Acute Myeloid Leukemia

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Your Previously Treated Mantle Cell Lymphoma (MCL)

Your Chronic Lymphocytic Leukemia (CLL) Diagnosis

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Marialice’s Story with Chronic Lymphocytic Leukemia (CLL)

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