This information is about a chemotherapy treatment for brain tumours called PCV.
PCV is named after the initials of the chemotherapy drugs used, which are:
How treatment is given
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PCV chemotherapy can usually be given to you as a day patient. Before you start treatment, you'll need to have a blood test on the same day or a few days before. You'll 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 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 shouldn't take long.
Once your chemotherapy is ready you'll be given an anti-sickness (anti-emetic) drug by injection through the cannula or as a tablet.
You will then be given the chemotherapy. This involves:
a drip (infusion) of vincristine (a colourless fluid) that takes about 10–15 minutes
lomustine capsules, which are blue in colour
procarbazine capsules, which are ivory in colour.
The lomustine and procarbazine capsules should be swallowed whole with a glass of water. Sometimes you'll be given the lomustine and procarbazine capsules to take at home.
The cannula will be removed after treatment is finished and you can go home. You may be given anti-sickness tablets to take with you. It's important to take the anti-sickness tablets regularly, even if you aren't feeling sick. This is because most anti-sickness tablets are more effective at preventing sickness than at stopping it once it has started.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the PCV regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the treatment that you are receiving.
On the first day of your treatment you'll be given an infusion of vincristine and a dose of lomustine capsules. You'll also begin a 10-day course of procarbazine capsules, which may start on the following day. When you have completed the procarbazine capsules, you'll have a rest period with no treatment for the next 32 days. This completes what is called a cycle of your treatment. Each cycle lasts for 42 days (six weeks).
The course of procarbazine capsules can vary from hospital to hospital and may be more or less than 10 days. Your doctor, nurse or pharmacist will explain exactly how many days you need to take the procarbazine for and how many days rest you'll have.
After the rest period the same treatment will be repeated, which will be six weeks after your first infusion. This begins the next cycle of your chemotherapy. Usually two or three cycles are given, then the treatment is reviewed.
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 won't affect everyone who has PCV chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and 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
PCV chemotherapy 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.
Neutropenia can begin three weeks after treatment, and your resistance to infection usually reaches its lowest point 4–6 weeks after chemotherapy. The number of white cells in your blood then increases steadily and usually returns 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 (100.5°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 in your blood. Occasionally, it may be necessary to delay your treatment if the number of your blood cells (blood count) is still low.
Bruising and bleeding
PCV 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 may need to have a platelet transfusion if your platelet count is low.
PCV 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) and being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and 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 some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Numbness or tingling in hands or feet
This is due to the effect of vincristine and procarbazine on the nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms or have difficulty carrying out fiddly tasks, such as doing up buttons. This problem usually improves slowly a few months after the treatment has finished. Sometimes these symptoms can persist; tell your doctor if this happens.
Very rarely, other nerves may be affected, such as the neck nerves. This may cause pain in the jaw or double vision.
You may develop flu-like symptoms a few hours after the treatment has been given. These include headaches, aching joints or muscles, a temperature, lack of energy (lethargy) and chills. If this happens, it's important to drink plenty of fluids and get some rest. If these symptoms continue for more than a day contact your doctor.
Less common side effects
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This is rare. If it happens, it usually begins 3–4 weeks after starting treatment, although it can occur earlier.
Procarbazine can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken due to the excess production of pigment. It usually returns to normal a few months after the treatment has finished.
Changes to the lungs
Lomustine may cause some changes to the lungs. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
Rarely, procarbazine may interact with certain drinks and foods causing sickness, headaches, sweating, drowsiness and breathing problems. You may need to avoid red wine, alcohol and alcohol-free beers, mature cheeses, certain meats (salami, pepperoni) and yeast or beef extracts (OXO®, Bovril® and Marmite®). Your nurse or doctor will give you more advice on which foods to avoid.
Lomustine may affect your eyesight, however this is very rare. Let your doctor know if you notice any change in your vision.
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.
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Leakage into the tissue around the vein (extravasation)
If this happens when vincristine is being given, the tissue in that area can become 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're at home, ring 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.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by taking this drug. For men, it may be possible to organise sperm banking prior to 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 PCV treatment, 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 or nurse.
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.
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're 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.
About procarbazine and lomustine capsules
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It's important to take your capsules 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 chemotherapy tablets that shouldn't be stopped or restarted without the advice of your cancer specialist.
Store the capsules in a dry place away from direct sunlight.
Keep the capsules in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the capsules, let your doctor or chemotherapy nurse know as you may need to take another dose.
Don't take another capsule without telling your doctor or nurse first.
If you forget to take a capsule, don't take a double dose. Tell your doctor or nurse and keep to your regular dose schedule.
This section is based on our PCV 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. 58th edition. 2009. 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.