POMB/ACE is a chemotherapy treatment used to treat testicular cancer and a rare type of ovarian cancer.
This information should ideally be read with our general information about chemotherapy and the type of cancer you have.
The drugs used in POMB/ACEBack to top
POMB/ACE is named after the initials of the chemotherapy drugs used:
POMB/ACE is given as two separate treatments – POMB and ACE. You usually have the POMB treatment during a short stay in hospital. The ACE treatment is given either in the chemotherapy day unit, or during a short stay in hospital. A chemotherapy nurse will give it to you.
During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness (anti-emetic) drugs before the chemotherapy. They will also give you extra fluids through a drip before and during your treatment. They give you the drugs and fluids through one of the following:
- a short, thin tube that they put into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Some drugs are given as an injection with a drip (infusion) of fluids to flush it through. Some drugs are given as a drip (infusion). Your nurse will usually give any infusions through a pump, which gives you the treatment over a set time.
When POMB/ACE is being given
Some people might have the following side effects while they are having the chemotherapy:
Rarely, chemotherapy may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy, flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having chemotherapy, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens, it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Pain along the vein
If you have this, tell your nurse straight away. They will check your drip site and slow the drip to ease the pain.
Bleomycin may cause flu-like symptoms, such as:
- feeling hot or cold and/or shivery
- a headache
You may have these symptoms while the drug is being given or several hours after. Your nurse will tell you if this is likely to happen. They may advise you to take paracetamol. Drinking plenty of fluid will also help. Your nurse may give you a drug before your chemotherapy to reduce the risk of these symptoms happening.
If the symptoms are severe or don’t improve after 24 hours, contact the hospital.
Flushes, dizziness, a strange taste and a blocked nose
If you have any of these symptoms, tell the doctor or nurse. Slowing down the drip should reduce these effects.
Your course of POMB/ACE
You will have chemotherapy as a course of several sessions (cycles) of treatment over a few months. Each cycle of POMB or ACE takes 14 days (two weeks).
On the first day (day 1), your nurse will give you vincristine as a short infusion. They will then give you the methotrexate. You may have an injection of methotrexate followed by an infusion of methotrexate over 12 hours.
On day 2, the nurse will give you bleomycin as an infusion over 24 hours.
On day 3, they will give you cisplatin as an infusion over 8–12 hours. Before and after treatment with cisplatin, you will have fluids through your cannula or line to keep your kidneys working normally.
You will also be given another drug called folinic acid (sometimes called leucovorin). It is given either as a series of injections into the vein or as tablets. It’s important to take this exactly as you are told, as it helps reduce the side effects of methotrexate. You normally start taking the folinic acid 24 hours after the start of the methotrexate. Your nurse or doctor will tell you more.
You then have a rest period with no chemotherapy (apart from folinic acid) for 11 days. This completes a cycle of POMB.
On the first day of ACE chemotherapy (day 1), your nurse will give you an injection of dactinomycin into a fast-flowing drip to flush it through. You will then be given etoposide as a short infusion over about an hour. You will have the same treatment again on day 2 and day 3.
On day 3, you will also be given cyclophosphamide as an infusion over an hour or as a slow injection.
After this, you'll have a rest period with no chemotherapy for the next 11 days. This completes a cycle of ACE treatment.
At the end of each cycle (either POMB or ACE), you start the next cycle of your treatment. The number of cycles you have will depend on your situation and on the level of tumour markers in your blood.
The treatments are given in the following order: POMB-POMB-ACE-POMB-ACE. This is followed by alternating cycles of POMB and ACE until the tumour markers return to normal. If you need more than four cycles of POMB, you will usually only be given the vincristine, methotrexate and bleomycin part of the treatment (OMB).
Your doctor or nurse will tell you the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as explained to you.
Before you leave hospital after the POMB treatment, the nurse or pharmacist will give you folinic acid tablets to take when you are at home. Always take your tablets exactly as explained. This is important to make sure they work as well as possible for you and to help prevent serious side effects.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
- Keep them in the original package at room temperature, away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
Possible side effects of POMB/ACEBack to top
We explain the most common side effects of POMB/ACE here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It’s very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, they will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice at any time of the day or night. Save these numbers in your mobile phone or keep them somewhere safe.
More information about these drugs
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information, you can visit the electronic Medicines Compendium (eMC).
Risk of infection
POMB/ACE can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Your nurse may give you injections of a drug called G-CSF under the skin (subcutaneously). It encourages the bone marrow (where blood cells are made) to make more white blood cells.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell , even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Your white blood cells usually increase steadily and return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your number of white blood cells is still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
POMB/ACE can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
POMB/ACE can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Feeling sick and being sick
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you. Some anti-sickness drugs can make you constipated. Let your doctor or nurse know if this is a problem.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures every morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or to use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
The folinic acid tablets you have been given will help to reduce the risk of a sore mouth. It is important that you take the tablets as instructed.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
You may get a bitter or metallic taste in your mouth or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluid every day if you have diarrhoea. The folinic acid tablets you have been given will help to reduce the risk of severe diarrhoea. It is important that you take the tablets as instructed.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
POMB/ACE may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
Your skin may darken during treatment. Occasionally, bleomycin causes long, thin streaks that look a bit like scratches to appear on one or more areas of skin. If you’ve had radiotherapy recently or in the past, the area that was treated may become red or sore.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Try to avoid scratching, as this can cause brown marks on the skin. Any changes to your skin are usually temporary and improve when treatment finishes.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of ACE. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Your nails may become darker or ridged. These usually grow out over several months after treatment ends.
Numb or tingling hands or feet
These symptoms are caused by the effect of vincristine and cisplatin on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
Vincristine may make you constipated and cause tummy pain. Drinking at least two litres (three and a half pints) of fluid every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and do some regular, gentle exercise.
If you haven’t had a bowel motion for two days, contact the hospital for advice. Your doctor can prescribe laxatives to help you. Waiting more than two days can make constipation more difficult to treat. Contact the hospital straight away if you are constipated and have tummy pain or are being sick.
Methotrexate can cause your eyes to become watery. They may also become sore and inflamed (conjunctivitis). Your doctor can prescribe eye drops if you need these.
Changes in hearing
You may have ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Very occasionally, your sense of balance may be affected.
Any hearing loss and balance changes, if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Changes in the way your kidneys work
This doesn't usually cause any symptoms, and the effect is generally mild.
Before each treatment, your kidneys will be checked with a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine (either tablets or injections) to help you pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this, so let your doctor know if this is a problem, for example if you're feeling sick.
Less common side effects of POMB/ACEBack to top
Changes in the way your liver works
POMB/ACE may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Changes to lungs
Bleomycin can cause changes to the lungs. These are more likely if you already have lung problems. Always tell your doctor if you develop wheezing, a cough, a fever or breathlessness. You should also let them know if any existing breathing problems get worse. You may have lung tests before starting bleomycin and again during the treatment. Cyclophosphamide and methotrexate may cause less serious changes to lung tissue.
Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine. Drink at least two litres (three and a half pints) of fluid during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.
Contact the hospital straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.
Rarely, POMB/ACE can increase the risk of developing a second cancer many years later. But the benefits of treatment usually far outweigh this risk. Your doctor or nurse can discuss this with you.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about POMB/ACEBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis), and having chemotherapy can add to this risk. A clot can cause symptoms such as:
- pain, redness and swelling in a leg
- chest pain.
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some people having POMB/ACE are given medicine to thin their blood (anticoagulants), to help prevent blood clots. It is usually given as an injection under the skin during your stay in hospital.
Some other medicines can interact with chemotherapy. Medicines that can make the side effects of POMB/ACE worse include:
- some painkillers, such as ibuprofen
- drugs to control high blood pressure
- the drug allopurinol.
Tell your doctor if you are taking any of these.
Chemotherapy may affect how some other drugs work. Tell your doctor if you are taking phenytoin (used to control fits), as it may be less effective than normal.
Medicines you can buy in a shop or from a chemist may also be harmful when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
POMB/ACE may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you should talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there are any chemotherapy drugs in your semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there are chemotherapy drugs in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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