PCV

PCV is a combination of the chemotherapy drugs procarbazine, lomustine (CCNU) and vincristine. It is used to treat brain tumours.

What is PCV?

PCV is used to treat brain tumours. It is best to read this information with our general information about chemotherapy and the type of cancer you have.

PCV 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.

How PCV is given

You will have PCV 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 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.

You take lomustine and procarbazine as capsules that you swallow. You have vincristine as an injection into your bloodstream (intravenously).

Your nurse usually gives you anti-sickness drugs before you have the vincristine injection. Vincristine can be given through:

  • a short thin tube the nurse puts 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).

Your course of chemotherapy

You usually have a course of several cycles of treatment over a few months. Each cycle of PCV takes 42 days (6 weeks):

  • On day 1 – you usually have the vincristine injection and lomustine capsules.
  • On day 1 or day 2 – you start the procarbazine capsules. You take these once a day for 10 days.
  • You then have a rest period with no treatment for the next 32 days. This completes your first cycle of PCV.

At the end of your rest period you start your second cycle of PCV. This is exactly the same as your first cycle.

Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your capsules and tablets exactly as your nurse or pharmacist explains.

Your nurse or doctor will discuss your treatment plan with you. They may give you a copy of the treatment plan to take home with you.

Taking lomustine and procarbazine capsules

Lomustine and procarbazine capsules must be swallowed whole with a glass of water. They should not be chewed, opened or crushed.

You have lomustine on day 1. You start procarbazine on day 1 or 2 and take it for 10 days. Take it at the same time every day.

It is important to take these capsules exactly as your nurse or pharmacist explains. This means they will be more likely to work for you.

If you forget to take the procarbazine, you should take the missed dose as soon as possible, unless your next dose is due within 2 hours. In this case, you should skip the missed dose and continue with taking it at your regular time. Always let your doctor know if you have missed a dose. Do not take a double dose unless your doctor tells you to.

Other things to remember about your capsules:

  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • Other people should avoid direct contact with the chemotherapy drugs.
  • Wash your hands before and after handling your capsules.
  • If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
  • If your treatment is stopped return any unused capsules to the pharmacist.

After taking procarbazine

Use gloves when handling any urine or vomit for up to 48 hours after a dose of procarbazine has been taken.

You usually have a course of several cycles of treatment over a few months. Your nurse or doctor will talk to you about how the treatment will be given. They may give you a copy of a treatment plan to take home with you.

About side effects

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 and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

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) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.

Side effects while given

Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed
  • shivering
  • itching
  • 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

This can happen when you have the drug vincristine. If this happens 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 is important that it is dealt with quickly.

If you get any of the symptoms after you get home, contact the doctor or nurse straight away on the contact number they gave you.

Common side effects

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
  • breathlessness
  • diarrhoea
  • 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.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red or purple spots on the skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

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.

Feeling sick

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.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Feeling tired

This treatment will make you feel very tired and you will need a lot of rest. You will get tired easily for some months after treatment has finished. Gentle exercise, like short walks, can give you more energy. The tiredness will slowly get better.

If you feel sleepy, do not drive or use machinery.

Problems passing urine (peeing)

If you are passing either more or, less urine (pee) than usual, or have pain when you passing urine, contact the hospital straight away.

Hair loss

Your hair will get thinner. Or you may 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.

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 almost always temporary. Your hair will usually grow back after treatment ends.

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.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Tummy (abdominal) pain

Vincristine can cause abdominal cramps. Tell your treatment team if you have this. They can check the cause and give you medicine to help.

Jaw pain

Vincristine may cause pain in your jaw. Tell your nurse or doctor if you notice this.

Muscle or joint pain

You may get pain in your muscles or joints. If this happens, tell your doctor so they can give you give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Effects on the liver

Treatment may affect how your liver works. This is usually mild. You will have regular blood tests to check how well your liver is working. Tell your doctor if you have a history of liver disease.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.

It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.

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.

Skin reactions

PCV can affect your skin and may cause a rash. Your doctor or nurse can tell you what to expect.

If your skin feels dry, try using an unperfumed moisturising cream every day. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Less common side effects

Effects on the nervous system

PCV can affect the nervous system. You may

  • have pins and needles in your hands and feet
  • have tingling in your arms and legs
  • feel drowsy or confused
  • feel dizzy or unsteady.

Rarely, PCV can cause you to have seizures (fits). Your doctor can prescribe drugs to stop fits. They will explain more about this.

Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment. It is important not to drive or operate machinery if you notice these effects.

Hearing changes

This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes usually get better after this treatment ends. But some can be permanent. Tell your doctor if you notice any changes in your hearing.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Eyesight changes

Rarely, PCV may affect your eyesight. Contact your doctor straight away if you have any eye pain or notice any changes to your eyesight. You may also have an eye check with a specialist eye doctor (ophthalmologist).

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Changes in blood pressure

Vincristine may cause high or low blood pressure. If you already have high blood pressure and are on treatment to control it, tell your doctor. You may need to have regular blood pressure checks.

Second cancer

PCV treatment can slightly increase the risk of developing a second cancer years later. But the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Other information

Effects of alcohol and some foods

Alcohol and some food can cause a reaction when you are taking procarbazine. They can make you feel sick and cause headaches, sweating, drowsiness and breathing problems. It is best to avoid:

  • alcohol
  • alcohol-free beers and wines
  • mature cheeses (including processed cheeses)
  • salami, pepperoni and bologna sausage
  • yeast or beef extracts (Oxo®, Marmite® and Bovril®)
  • over-ripe fruit
  • any pickled, fermented, smoked and matured foods

Your doctor, nurse or pharmacist will give you more advice on foods to avoid.

Coeliac disease or wheat allergy

Lomustine capsules contain wheat. If you have coeliac disease or a wheat allergy, let your doctor know before taking lomustine capsules.

Lactose intolerence

Lomustine contains lactose. Lactose is a type of sugar found in milk and dairy products. If you have a lactose intolerance, talk to your doctor before taking lomustine capsules.

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.

Other medicines

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.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant

If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.

There may be ways to preserve fertility for men and women. If you are worried about fertility, it is important to talk with your doctor before you start treatment.

Contraception

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.

Sex

If you have sex during a course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

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.

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.

Vaccinations

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.