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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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This information is about a chemotherapy| treatment called FEC–T which is used to treat breast cancer|. It describes the drugs used, how they’re given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support specialists|.
FEC–T is named after the initials of the chemotherapy drugs used, which are:
FEC–T chemotherapy is divided into two parts. The FEC (5FU, epirubicin and cyclophosphamide) part is given separately to the T (Taxotere) part. Three or four doses of FEC are given during the first few months, followed by three or four doses of Taxotere over the next few months.
FEC–T treatment is usually 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 few days 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 put a thin flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin flexible tube, which is inserted under the skin into a vein near the collarbone (a central line|) or passed through a vein in their arm (a PICC line|). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you will be given anti-sickness (anti-emetic) drugs|. These are usually given by injection through your cannula or line, but can also be given as tablets. The chemotherapy drugs are then given:
You'll be given drugs called steroids to take the day before your chemotherapy and for two days after. These help to prevent an allergic reaction to Taxotere and to reduce some of the other chemotherapy side effects (sickness and fluid retention). It's very important to take these tablets. If for some reason you haven't taken them, it's important to let your doctor or nurse know before you start your chemotherapy.
If you are having your treatment as a day patient you can go home once it's over. Your cannula will be removed and you'll be given a supply of anti-sickness drugs to take with you. It is important to take these regularly (as directed) even if you are not feeling sick. This is because it is easier to prevent sickness than to stop it once it has started.
Your doctor may use the word regimen (eg the FEC–T regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment you are having.
You will start by having FEC. On the first day you will be given 5FU, epirubicin and cyclophosphamide as described. It takes about an hour to give the three drugs. You'll then have a rest period with no chemotherapy for three weeks. This completes one cycle of chemotherapy. After this you will have another two or three cycles of FEC.
Three weeks after your last treatment with FEC you will begin your treatment with Taxotere. You will be given Taxotere as a drip (infusion) usually over an hour. After this you'll have a rest period of three weeks followed by another two or three cycles of Taxotere.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having FEC–T chemotherapy.
Some of the side effects specific to the FEC part of the chemotherapy are unlikely to happen during the Taxotere (second part) of your treatment. You won't get side effects which only happen with Taxotere during the FEC (first part) of your treatment.
We have outlined the most common side effects so that you can be aware of them if they happen. We have not included those that are rare and therefore unlikely to affect you. If you notice any effects which you think may be due to the drugs, but which are not listed in here, please let your nurse or doctor know.
Lowered resistance to infection FEC–T can reduce the production of white blood cells by the bone marrow, making you more prone to infection|. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding FEC–T can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having the treatment you may become anaemic. This can make you feel tired| and breathless|. Let your nurse or doctor know if these effects are a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti–sickness (anti–emetic) drugs to prevent or reduce this nausea and vomiting|. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti–sickness drugs which may be more effective. Some anti–sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem for you.
Tiredness Many people feel extremely tired (fatigued|) during chemotherapy, particularly towards the end of treatment. This is a common side effect and it is 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 have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss| is temporary and your hair will start to grow again once the treatment is over.
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 is 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 and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your doctor you have any of these problems, as they can prescribe special mouthwashes and medicine to prevent or clear any mouth infection and to help relieve pain.
Taste changes You may notice that your food tastes different|. Normal taste will usually come back after the treatment finishes.
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. Your skin may darken and the skin over the vein used for the injection may become discoloured. Your skin will slowly return to normal a few months after the treatment has finished.
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 always wear a high protection-factor sun cream and cover up with clothes.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink as much fluid as possible (up to two litres/four pints) during the 24 hours after the chemotherapy to prevent this. If you notice any blood in your urine tell your doctor.
Your urine may become a pink-red colour. This is due to the epirubicin, a red-coloured liquid. This may last up to 24 hours after your treatment and is quite normal.
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 (4–6 pints) of liquid a day to replace the fluid you are losing.
Allergic reaction Some people can have an allergic reaction to Taxotere while it is being given. Signs of this can include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, a headache, breathlessness, anxiety and a need to pass urine. You will be given steroids to take before your treatment to reduce the chance of this happening.
You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse immediately if you have any of these symptoms.
Pain in the joints or muscles Taxotere can cause joint and muscle pains. It is important to tell your doctor about this, so that they can prescribe painkillers.
Flu–like symptoms If you notice any flu–like symptoms, such as headaches, chills and fevers, let your doctor or nurse know. Fluid retention You may notice that you gain weight and/or that your ankles and legs swell. This decreases slowly once your treatment has finished. The steroid tablets that you are given to take before treatment will help reduce the chance of fluid retention.
Numbness or tingling in hands or feet This is due to the effect of Taxotere on nerves and is known as peripheral neuropathy|. You may also notice that you have difficulty doing up buttons or other fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after the treatment ends.
Soreness and redness of the palms of the hands and soles of the feet If (Sometimes known as palmar plantar or hand-foot syndrome). This it temporary and will improve when treatment is finished.
Gritty eyes and blurred vision If this happens let your doctor know. They can prescribe soothing eye drops.
Changes in nails Some people may find that their nails become darker or ridged. White lines may appear on them. These changes usually grow out over a few months once the treatment is finished.
Changes in the way your heart works This is 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.
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 straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
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.
Fertility Your ability to become pregnant or father a child is likely to be affected by this treatment. It is important to discuss fertility| with your doctor before starting treatment.
Contraception It’s not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It‘s important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods in women 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.
This is based upon our FEC–T chemotherapy factsheet which has been compiled using information from a number of reliable sources including:
For further references, please see general bibliography|.
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