This information is about a chemotherapy treatment for breast cancer called TC. 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.
The drugs that are used
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TC is named after the initials of the chemotherapy drugs used. These are:
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
How treatment is given
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TC chemotherapy is usually given to you as a day patient. Before you start your treatment you'll need to have a blood test, either on the same day or a day or two beforehand. You'll 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.
Before you start the chemotherapy you will be asked to start taking a short course of steroid tablets. This helps prevent you having an allergic reaction to the docetaxel, and can also help prevent sickness. It's very important to take these tablets.
If for some reason you haven't taken them, you should let your doctor or specialist nurse know before you start your chemotherapy, as this could affect your treatment on the day.
When the chemotherapy drugs are ready, you will either be given them through a cannula, a central line or a PICC line. A cannula is a thin, flexible tube that the nurse puts into a vein in your hand or arm. This is used to give the treatment, and is removed afterwards. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a central line, which is a thin plastic tube inserted under the skin and into a vein near the collarbone, or through a PICC line, which is a thin plastic tube passed through a vein in the crook of your arm.
Central lines and PICC lines are usually inserted under a local anaesthetic, although a general anaesthetic is sometimes used. They are usually put in some time before you start your treatment, and they can stay in place throughout your treatment period. You will be shown how to look after your line at home. Your doctor or nurse can explain more about cannulas, central lines and PICC lines.
Before the chemotherapy, you’ll be given an anti-sickness (anti-emetic) drug as tablets or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion).
The chemotherapy drugs are then given separately. This involves:
an infusion of cyclophosphamide, a colourless liquid, over about 30-60 minutes
an infusion of docetaxel, a colourless liquid, over about 60 minutes.
Cyclophosphamide can also be given as a slow injection into the cannula or line, over 3-5 minutes. The order in which the drugs are given won’t alter their effectiveness. However, research has shown that giving cyclophosphamide before the docetaxel helps to reduce the risk of some side effects, and some hospitals are giving them in this order.
You'll be given a supply of anti-sickness drugs to take home with you. It's important to take these as directed, even if you aren't feeling sick. This is because anti-sickness drugs are generally much better at preventing sickness than stopping it once it begins.
How often treatment is given
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Your doctor or nurse may use the word 'regimen' (eg the TC regimen) when talking about your chemotherapy. This means the whole plan or schedule of the treatment you are having.
On the first day of your treatment, you'll be given cyclophosphamide and docetaxel as described. After this, you'll have a rest period with no chemotherapy for the next three weeks. This completes what’s called a cycle of treatment.
After the rest period the same drugs will be given again, which begins the next cycle of your treatment. Usually four cycles of treatment are given over a period of three months (12 weeks), although up to six cycles can be given. Together all the cycles make up a course of treatment.
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 having TC 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, specialist nurse or pharmacist.
Risk of infection
TC 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 will be more prone to infections. A low white blood cell count is called neutropenia. This begins 5-7 days after treatment and your resistance to infection is usually at its lowest 10-14 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 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.
You may be given injections of G-CSF to help prevent the number of white blood cells getting too low. G-CSF is a type of protein that can stimulate the bone marrow to produce white blood cells. G-CSF is given as an injection under the skin (subcutaneously).
Bruising and bleeding
TC 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.
TC 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)
Sickness may begin a few hours after the treatment is given and can last for up to a day. It’s usually mild and your doctor can prescribe 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.
You may notice that you gain weight and/or your ankles and legs swell. Sometimes you may also feel breathless. This decreases slowly once your treatment has finished. To help reduce the chance of fluid retention, you'll be given steroid tablets (usually dexamethasone) to take for three days, beginning on the day before your treatment.
If your ankles and legs do swell it can help to put them up on a footstool or cushion while resting. However, if symptoms persist, you may need to seek further advice from your doctor or specialist nurse.
TC can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues despite medication. It's important to drink plenty of fluids if you have diarrhoea.
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.
Your nails may become darker and white lines may appear on them, or they may become brittle, chipped and ridged. These effects usually grow out over several months once the treatment has finished.
Docetaxel can cause a skin rash. It’s important to let your doctor know if this happens as they can prescribe medicines to help.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but you should wear a sun cream with a high sun protection factor (SPF) of at least 30 and cover up with clothing and a hat.
Sometimes areas of skin that have been previously treated with radiotherapy may become red and sore. Tell your doctor if this happens
We have more information about taking care of your skin after cancer treatment.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and might only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Pain in joints or muscles
This may be caused by docetaxel and can happen during or after treatment. It can sometimes last for up to a year. It's important to tell your doctor about this so they can prescribe painkillers to help.
Numbness or tingling in the 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 with doing up buttons or other fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. It's 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.
Some people can have an allergic reaction to docetaxel while it’s being given. Signs of this can include flushing of the face and neck, a high temperature, shivering, dizziness, pain in the lower back and breathlessness. The symptoms may develop very quickly.
Usually you'll be given a three-day course of steroid tablets to start taking at home the day before treatment, to reduce the chance of this happening. It’s important to take the steroid tablets as directed by your doctor.
You'll be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or specialist nurse if you have any of these symptoms. If you do have a reaction, it can usually be treated quickly. You may be given a steroid to help and an antihistamine as an injection into a vein (intravenously). The next time you have TC chemotherapy your doctor may suggest that you have intravenous steroids and antihistamines before the docetaxel, to help prevent another allergic reaction.
Less common side effects
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Pain along the vein
Docetaxel can cause pain along the vein that is used to give you your chemotherapy. If you feel any pain, tell your doctor or specialist nurse straight away so that they can check the infusion site. They may slow the infusion down to reduce pain.
Cyclophosphamide may irritate your bladder. It’s important to drink as much fluid as you can (at least two litres) on the day before treatment and during the 24-48 hours after it. Let your doctor know if you have any pain or discomfort when you pass urine, if you notice any blood in your urine, or if you need to pass small amounts of urine frequently.
Increased production of tears
This may be caused by docetaxel and is temporary. You may also notice that your eyes become sore and inflamed (conjunctivitis). Let your doctor know so they can prescribe soothing eye drops if necessary.
Soreness and redness of the palms of the hands and soles of the feet
This is known as palmar plantar or hand-foot syndrome. It's temporary and improves when the treatment finishes. If you get hand-foot syndrome, contact your specialist doctor or specialist nurse for advice.
Your doctor may prescribe creams, 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.
You should avoid activities that rub, put pressure on or expose heat to your hands. This could include gripping tools, having hot baths or vigorously washing.
The muscle of the heart may be affected; usually temporarily. This is very rare with standard doses of cyclophosphamide but may occasionally occur with high-dose treatment. If you experience any chest pain you should tell your doctor straight away. 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.
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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. Your doctor or specialist 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 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 TC, as it may harm the developing baby. It’s important to use effective contraception while having this chemotherapy, 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 (such as a condom, cap or diaphragm) for about 48 hours after chemotherapy.
Loss of periods in women
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and 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.
We have more information about menopausal symptoms and breast cancer treatment, including a video of Diane talking about her personal experience.
There's a risk that chemotherapy drugs may be present in breast milk. 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’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. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This fact sheet has been compiled using information from a number of reliable sources, including:
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed April 2012).
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.