ABCP is used to treat non-small cell lung cancer that has spread to other parts of the body (advanced or metastatic cancer). It may sometimes be used to treat other cancers. It is best to read this information with our general information about chemotherapy and the type of cancer you have.
ABCP comes from the initials of the drugs used:
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You will be given ABCP in the chemotherapy day unit. A chemotherapy nurse will give it to you.
During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.
You will see a doctor or nurse before you have chemotherapy. They will talk to you about your blood results and ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. The chemotherapy drugs can be given through:
Your course of chemotherapy
You usually have a course of several cycles of treatment over a few months. Each cycle of ABCP takes 21 days (3 weeks).
On day 1 the nurse will give you:
- Atezolizumab as an infusion over 60 minutes
- Bevacizumab as an infusion over 90 minutes
- Carboplatin as an infusion over 60 minutes
- Paclitaxel as an infusion over 3 hours.
You then have a rest period with no treatment for 20 days. This completes your first cycle of ABCP. At the end of the rest period, you start your second cycle of ABCP.
Some of the drugs can cause a reaction in some people. The nurse will give you drugs to help prevent or reduce this. A reaction is most likely with the first or second time you have the drug, so they are given more slowly. If you don’t have a reaction after the first or second time, your nurse may give you some of the drugs over a shorter time.
Your nurse or doctor will discuss your treatment plan with you and tell you the number of cycles you are likely to have.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious or delayed side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your doctor or nurse can explain the risk of these side effects to you.
This treatment may cause delayed side effects. These can start weeks, months, or sometimes more than a year, after you finish treatment.
If you have any symptoms or side effects that start during treatment or after treatment finishes, contact your doctor or hospital straight away. Side effects can become serious if they are not treated.
Your patient alert card
Your doctor, nurse or pharmacist will give you a card with information about your treatment on it. It is important to always have the card with you during treatment and after treatment finishes. You should show it to any doctor or healthcare professional you need to see.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Sometimes side effects can become serious very quickly. It is important to contact the hospital straight away if you have new symptoms or side effects.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Some people have an allergic reaction while having this treatment. Before treatment, you will be given medicines to help prevent or reduce any reaction.
Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.
The drug leaks outside the vein
The drug may leak outside the vein. If this happens it can damage the surrounding tissue. This is called extravasation. Extravasation is not common but if it happens it is important to treat it quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.
Pain along the vein
Muscle or joint pain
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
This treatment can sometimes cause bleeding problems, such as:
- bleeding gums
- blood spots or rashes on the skin.
Tell your doctor if you are taking any medicines that may affect bleeding.
Contact your doctor straight away if you have any unusual bleeding. This includes:
- vomiting or coughing up blood
- unexpected vaginal bleeding
- blood in your poo (stools).
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Your doctor will give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.
If you feel sleepy, do not drive or use machinery.
High blood pressure
This treatment can cause high blood pressure (hypertension). Your doctor or nurse will check your blood pressure regularly. If you have headaches, nosebleeds or feel dizzy, let your doctor know. They can prescribe tablets to control high blood pressure.
If you have high blood pressure before you start treatment, your doctor will monitor you closely during treatment.
Effects on the lungs
This treatment can cause changes to the lungs. Contact the hospital straight away if you notice any of these changes during treatment or after it finishes:
- a cough
- a fever, with a temperature over 37.5°C (99.5°F).
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. You may need steroids or other treatments.
You usually lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.
Scalp cooling is a way of lowering the temperature of your scalp to help reduce hair loss. Your nurse can tell you if this is an option for you.
Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. Your scalp may be sensitive. It is important to cover your head to protect your skin when you are out in the sun.
Hair loss is usually temporary. Your hair will usually grow back after treatment finishes. Rarely, hair may not grow back. Or it may grow back thinner than before. If you are worried about this, talk to your cancer doctor or nurse.
Diarrhoea or tummy pain
You may have diarrhoea or tummy pain.
Contact the hospital straight away if you have any of these symptoms during treatment or after it finishes:
- passing stools (pooing) more than 4 times a day
- waking up at night to pass stools
- pain in your tummy (abdomen)
- being sick
- blood or mucus in your stools
- a fever, with a temperature over 37.5°C (99.5°F).
You may need to go into hospital to have fluids through a drip (infusion) or other treatments, such as steroids.
Loss of appetite
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
Chemotherapy 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. You may get a rash, which may be itchy.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Very rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. Contact the hospital straightaway if this happens.
Sore and red palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It usually gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve any symptoms you may have. It can help to:
- keep your hands and feet cool
- moisturise regularly
- avoid tight-fitting socks, shoes and gloves.
This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. Sometimes nails can become loose or fall out. When treatment finishes, any changes usually disappear as the nails grow out.There are things you can do to look after your nails:
- Moisturise your nails and cuticles regularly.
- Keep your nails clipped short.
- Wear gloves to protect your nails when you are doing things in the house or garden.
- Keep your hands and nails clean to help avoid infection, but avoid bathing in very hot water.
- Do not use false nails, gels or other acrylics during this treatment, as they may increase the risk of infection.
- It is fine to wear nail varnish, but try to use a water-based polish. Avoid using harsh chemicals, such as acetone, when taking off the polish.
- If your toenails are affected, wear well-fitted shoes to cushion them.
Tell your doctor or nurse if you notice changes to your nails. They can give you advice or arrange for you to see a podiatrist for foot care advice if needed.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may 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 for some people they may never go away. Talk to your doctor if you are worried about this.
Your eyes may become watery and feel sore. Your doctor can give you eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. You may need antibiotic eye drops.
Always tell your doctor or nurse if you have pain in your eyes or notice any change in your vision.
This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Effects on the heart
This treatment can affect how the heart works.This is not common, but it can be serious. You may have tests to see how well your heart is working. These may be done before, during and after treatment.
Call your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
- pain or tightness in your chest
- changes to your heartbeat
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
If your symptoms are caused by this treatment, you may need steroids. You may be monitored in hospital for a time.
Effects on the liver
This treatment can affect how your liver works. You will have regular blood tests to check this. Your doctor may give you steroids if the blood tests show liver changes.
Sometimes liver changes can be serious. Contact the hospital straight away if you have any of these symptoms during treatment or after it finishes:
- yellow skin or eyes
- feeling very sleepy
- dark urine (pee)
- unexplained bleeding or bruising
- loss of appetite.
You may need steroids or other treatments, and may be monitored until your liver recovers.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
If you have sex in the first few days after this treatment, you should use barrier protection such as a condom or dental dam. This will protect your partner if any of the drug is in your semen or vaginal fluids.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.