This information is about a chemotherapy treatment for breast cancer called FEC–T.
The drugs that are used
Back to top
FEC–T is named after the initials of the chemotherapy drugs used, which are:
Throughout this fact sheet we will refer to fluorouracil by its more common name, 5FU.
How treatment is given
Back to top
FEC–T chemotherapy is divided into two parts. The FEC (5FU, epirubicin and cyclophosphamide) part is given separately to the T (docetaxel) part. Three or four doses of FEC are given during the first few months, followed by three or four doses of docetaxel over the next few months.
FEC–T treatment is usually given to you as a day patient. Before you start treatment you'll need to have a blood test, either on the same day, or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood tests are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will insert a thin, flexible tube (cannula) into a vein in your hand or arm, through which your chemotherapy will be given. 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 that is inserted under the skin and into a vein near the collarbone (central line) or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you'll 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.
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 the same way.
Cyclophosphamide (a colourless fluid) can be given either as an infusion or an injection into your cannula or line.
Docetaxel (a colourless fluid) is given as an infusion.
You'll be given a short course of steroid tablets to take the day before the docetaxel chemotherapy and for two days after. These help prevent an allergic reaction to docetaxel and help 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're having your treatment as a day patient, you can then go home and your cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for your next cycle of chemotherapy. You'll be shown how to look after the line.
Before you go home, 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're not feeling sick. This is because it's easier to prevent sickness than to stop it once it has started.
How often treatment is given
Back to top
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'll 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 docetaxel. You will be given docetaxel as an infusion, usually over an hour. After this you'll have a rest period of three weeks followed by another two or three cycles of docetaxel.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here will not affect everyone having FEC–T chemotherapy.
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 that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
FEC–T can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
While you're having the FEC part of treatment, your white blood cell count may reduce from seven days after treatment. Your resistance to infection is usually at its lowest 10–14 days after chemotherapy. During the docetaxel treatment the white blood cells can be reduced earlier, from 5–7 days after treatment and your resistance to infection usually reaches its lowest point 7–10 days after the docetaxel 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'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising or bleeding
FEC–T can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
FEC can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 2–3 weeks after the first dose of docetaxel, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is usually temporary and your hair will almost always start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before treatment. 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.
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 reduce the risk of this happening. Some people find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Epirubicin can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this. Areas of skin that 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. Your skin may darken because of excess production of pigment. It usually returns to normal a few months after the treatment has finished.
During treatment with FEC–T, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. 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.
Cyclophosphamide may irritate your bladder. It’s important to drink as much fluid as you can (at least two litres) during the 24 hours following chemotherapy to help prevent this. Epirubicin is red and, as a result, your urine may become a pink-red colour. This is normal and can last up to 48 hours after your treatment. Let your doctor know if you have any discomfort when you pass urine, or if you notice any blood in it.
FEC–T can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Some people can have an allergic reaction to docetaxel while it’s being given. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness.
You may be given steroid tablets to take at home the day before treatment to reduce the chance of this happening. Instead of steroid tablets, you may be given a steroid by injection into a vein (intravenously) 30–60 minutes before the docetaxel. Other drugs such as antihistamines may also be injected into a vein before your treatment to prevent an allergic reaction.
You'll be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. If you do have a reaction, it can be treated quickly.
Pain in joints or muscles
This may be caused by docetaxel. It is important to tell your doctor about this so that they can prescribe painkillers to help.
Occasionally, flu-like symptoms may occur. You may have headaches, a high temperature, aching joints and muscles. It is important to let your doctor know immediately if you get a high temperature.
You may notice that you gain weight and/or that your ankles and legs swell. This decreases slowly once your treatment has finished. To help reduce the chance of fluid retention, you will be given steroid tablets (usually dexamethasone) to take for three days, beginning the day before treatment.
Less common side effects
Back to top
Numbness or tingling in hands or feet
This is due to the effect of docetaxel on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Soreness and redness of the palms of the hands and soles of the feet
This is sometimes known as palmar plantar or hand-foot syndrome. It can happen when FEC-T is given. It is usually temporary and improves when the treatment is finished.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your hands and feet cool and to avoid tight fitting clothing, such as socks, shoes and gloves.
FEC-T may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished. Some people have pain in the nail bed at the base of the nail but this is rare.
Changes in the way your heart works
This is very rare with standard doses of FEC–T, but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and sometimes before each treatment.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Back to top
Leakage into the tissue around the vein (extravasation)
If this happens when epirubicin is being given, the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, phone the clinic or ward and ask to speak to the doctor or nurse.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and 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’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Effects when treatment is given
Some people have hot flushes, dizziness, a strange taste and a feeling of having a blocked nose when cyclophosphamide is being given. If you have any of these symptoms, ask the doctor or nurse to slow down the drip, as this should reduce these effects.
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.
Your ability to become pregnant or father a child is likely to be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having FEC–T, as it may harm the developing baby. It’s important to use effective contraception while having this treatment and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
There's a risk that chemotherapy drugs may be present in breast milk so women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This is based upon our FEC–T chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.