FEC chemotherapy. The drugs that are used. How treatment is given

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1 Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. FEC chemotherapy This fact sheet is about a chemotherapy treatment for breast cancer called FEC. It describes the drugs used, how they are given and some of the possible side effects. It should ideally be read with our general information about chemotherapy and breast cancer. You will see your doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy. This fact sheet should help you to discuss any queries about your treatment and its side effects with your doctor, chemotherapy nurse or pharmacist. If you d like to discuss this information with our cancer support specialists, call the Macmillan Support Line free on , Monday Friday, 9am 8pm. If you re hard of hearing you can use textphone , or Text Relay. For non English speakers, interpreters are available. Alternatively, visit macmillan.org.uk Includes the following information The drugs that are used How treatment is given How often treatment is given Possible side effects Less common side effects Additional information Things to remember about cyclophosphamide tablets Related Macmillan information The drugs that are used FEC is named after the initials of the chemotherapy drugs used, which are: fluorouracil, which is also known as 5FU epirubicin cyclophosphamide. How treatment is given FEC treatment can usually be given to you as a day patient. Before you start treatment, you will need to have a blood test either on the same day or a day or two beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours. The nurse will then insert a thin, flexible tube (cannula) into a vein in your hand or Page 1 of 6 Macmillan fact sheet 2011: FEC chemotherapy

2 arm. You may find this uncomfortable or a little painful but it shouldn't take long. Some people have their chemotherapy given through a thin plastic tube, which is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you. You will be given some anti-sickness (anti-emetic) drugs either as tablets, or more usually by injection through the cannula, which is often connected to a drip (infusion). The chemotherapy drugs are then given separately: epirubicin (a red fluid) is given as an injection along with a drip (infusion) of salt water (saline) into your cannula or line 5FU (a colourless fluid) is given in the same way cyclophosphamide (a colourless fluid) can be given either as an infusion or as an injection alongside a drip of saline. The cyclophosphamide can also be given as a course of (pink or white) tablets over two weeks see Schedule B. The chemotherapy will usually take about an hour, but may take longer. Although the epirubicin is often given first, the order in which the drugs are given won't alter their effectiveness. If you are having your treatment as a day patient you can then go home, and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line. You will be given a supply of anti-sickness drugs to take home with you. It is important to take these regularly as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts. How often treatment is given Your doctor may use the word 'regimen' (eg FEC regimen) when talking about your chemotherapy. This means the whole plan or schedule of your particular chemotherapy treatment. There are two different schedules for giving FEC. Ask your doctor or nurse to explain if you aren't sure which one you are having. Schedule A On the first day of your treatment you will be given all three drugs (5FU, epirubicin and cyclophosphamide) by infusion and injections into the cannula or line. After this you will have a rest period with no chemotherapy for the next three weeks. This completes a cycle of your treatment. After the rest period the same drugs will be given to you again, beginning the next cycle of your treatment. Usually 4 6 cycles are given over a period of 3 4 months. This makes up a course of treatment. Schedule B On the first day of your treatment you will be given 5FU and epirubicin. You will also begin a two-week course of cyclophosphamide tablets. One week later (on day 8) you will be given the 5FU and epirubicin again. When you have finished taking your cyclophosphamide tablets you will have a rest period with no chemotherapy for the next two weeks. This completes a cycle of your chemotherapy. You will start the next cycle of your treatment after the rest period, which will be four weeks after your first injection. Usually 4 6 cycles are usually given over a period of 4 6 months. This makes up a course of treatment. Possible side effects Each person s reaction to chemotherapy is different. Some people have very few side effects while others may have more. The side effects described here won't affect everyone who is having FEC chemotherapy. Page 2 of 6 Macmillan fact sheet 2011: FEC chemotherapy

3 We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects which aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist. Lowered resistance to infection (neutropenia) FEC can reduce the number of white blood cells produced by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment, with your resistance to infection usually reaching its lowest point days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due. Contact your doctor or the hospital straight away if: your temperature goes above 38 C (100.4 F) you suddenly feel unwell, even with a normal temperature. You will have a blood test before having more chemotherapy to make sure that the number of white blood cells has recovered. Occasionally, it may be necessary to delay treatment if the number of blood cells (blood count) is still low. Bruising or bleeding FEC can reduce the production of platelets, which help the blood to clot and stop bleeding. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. drugs, which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem. Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it's important to try to get as much rest as you need. Hair loss This usually starts 3 4 weeks after the first course of treatment. Hair usually falls out completely. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start grow back once treatment has finished. Your nurse can give you advice about coping with hair loss. Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it's available at your hospital. Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear any mouth infections. Taste changes You may notice that food tastes different. Normal taste usually comes back after treatment finishes. Anaemia (low number of red blood cells) You may become anaemic while having treatment with FEC. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce this. If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness Irritation of the bladder Cyclophosphamide may irritate your bladder. It is useful to drink plenty of fluid (up to about two litres) on the day following chemotherapy to prevent this. Tell your doctor if you notice any blood in your urine. Epirubicin is red and due to this your urine may become a pink/red colour. This is normal and may last up to 24 hours after treatment. Page 3 of 6 Macmillan fact sheet 2011: FEC chemotherapy

4 Diarrhoea If you have diarrhoea it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2 3 litres of liquid a day to replace the fluid you are losing. Gritty eyes and blurred vision If this happens, let your doctor know. They can prescribe soothing eye drops. Less common side effects Skin changes You may develop an itchy rash. Your doctor can prescribe medicine to help with this. Sometimes areas which have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens. The skin over the vein used for the injection may become discoloured. Also, your skin may darken. This will slowly return to normal a few months after the treatment finishes. During the treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat. Nail changes Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once treatment ends. Your liver may be temporarily affected The treatment can cause changes in the way that your liver works, although your liver will return to normal when the treatment finishes. This is very unlikely to cause you any harm, but your doctor will monitor you carefully. They will take samples of your blood from time to time to check your liver is working properly. Changes in the way your heart works This is very rare with usual doses of these drugs, but may occasionally happen when high doses are used. Tests to see how well your heart is working may be carried out before you start treatment. Always let your doctor or nurse know about any side effects you are having. There are usually ways in which they can be controlled or improved. Additional information Leakage into the tissue around the vein If this happens while epirubicin is being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given, tell your doctor or nurse immediately. Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straight away if you have any of these symptoms. Most clots can be treated with drugs that thin the blood. Your doctor or nurse can give you more information. Other medicines Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs. Fertility Your ability to conceive a child may be affected by this treatment. It's important to discuss fertility with your doctor before starting treatment. Contraception It's not advisable to become pregnant or father a child while having this treatment, as it may harm the developing baby. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. You can discuss this with your doctor. Page 4 of 6 Macmillan fact sheet 2011: FEC chemotherapy

5 Loss of periods Due to the effect of chemotherapy on the ovaries, you may find that your periods become irregular and may eventually stop. In younger women this may be temporary but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness. Things to remember about cyclophosphamide tablets It is important to take your tablets at the right times, as directed by your doctor. Always tell any doctors treating you for any non-cancerous conditions that you're taking a course of steroid tablets that shouldn't be stopped without the advice of your cancer specialist. Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight. Keep the cyclophosphamide in a safe place, out of the reach of children. If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away. If you are sick just after taking the tablet, let your doctor know. You may need to take another dose. Don't take another tablet without telling your doctor first. If you forget to take a tablet don't take a double dose. Let your doctor know and keep to your regular dose schedule. Related Macmillan information Avoiding infection when you have reduced immunity Breast cancer and menopausal symptoms Cancer treatment and fertility Central lines (skin-tunnelled venous catheters) Controlling nausea and vomiting Coping with fatigue Coping with hair loss Diet and cancer Mouth care during chemotherapy PICC lines (peripherally inserted central catheters) Scalp cooling Understanding breast cancer Understanding breast cancer in men Understanding chemotherapy For copies of this related information call free on , or see it online at macmillan.org.uk This fact sheet has been written, revised and edited by Macmillan Cancer Support s information development nurses and editorial team. It has been approved by our medical editor, Dr Terry Priestman, Consultant Clinical Oncologist. With thanks to Christine Clarke and the people affected by cancer who reviewed this edition. This fact sheet has been compiled using information from a number of reliable sources, including: Sweetman, et al. Martindale: The Complete Drug Reference. 36 th edition Pharmaceutical Press. British National Formulary. 58 th edition British Medical Association and Royal Pharmaceutical Society of Great Britain. Perry MC. The Chemotherapy Source Book. 4 th edition Lippincott, Williams and Wilkins. This fact sheet was revised in The next edition will be available in Page 5 of 6 Macmillan fact sheet 2011: FEC chemotherapy

6 We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ. MAC11748_11 Page 6 of 6 Macmillan fact sheet 2011: FEC chemotherapy

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