CAV chemotherapy treatment is used to treat small cell lung cancer (SCLC). It is sometimes called VAC.
This information should ideally be read with our general information about chemotherapy and the type of cancer you have.
The drugs used in CAV chemotherapyBack to top
CAV is named after the initials of the chemotherapy drugs used. These are:
- doxorubicin, which was originally called Adriamycin ®
You have CAV 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 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 about 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.
Before giving you chemotherapy, your nurse will give you anti-sickness (anti-emetic) drugs as an injection into a vein or as tablets.
You will have the anti-sickness drugs, if given as an injection , and chemotherapy through one of the following:
- a short, thin tube 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).
Your nurse will give you:
- vincristine as a small drip (infusion) that takes about 5–10 minutes
- doxorubicin (a red fluid) as an injection directly into your vein with a drip (infusion) to flush it through
- cyclophosphamide (a colourless fluid) as an injection into your vein with a drip to flush it through, or as a short infusion.
The whole process will take about an hour.
When the chemotherapy is being given
Some people might have the following side effects while they are having the chemotherapy:
The drug leaks outside the vein
If this happens when you’re having vincristine or doxorubicin, 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 then 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 or stop the drip to ease the pain.
You may suddenly feel warm and your face may get red while the drug is being given. This is known as facial flushing and should only last a few minutes.
Your course of CAV
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of CAV takes 21 days (three weeks).
On the first day, you have vincristine, doxorubicin and cyclophosphamide as described. After this, you will have a rest period for the next three weeks.
At the end of the 21 days, you start your second cycle of CAV. This is exactly the same as the first cycle. You will have up to six cycles over 18 weeks. Your doctor or nurse will tell you the exact number of cycles that you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness (anti-emetic) drugs to take. They may also give you anti-diarrhoea tablets if you are likely to need them. Take all your tablets exactly as explained.
Possible side effects of CAVBack to top
We explain the most common side effects of CAV 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 is 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, the side effects 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 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. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
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).
Common side effects of CAVBack to top
Risk of infection
CAV can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. Your nurse can tell you when your white blood cells are likely to be at their lowest. When the number of white blood cells is low, it’s called neutropenia.
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 any symptoms of an infection such as a cold, feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Your doctor may prescribe antibiotics to help prevent an infection. Your nurse may give you injections of a drug called GCSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
CAV 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)
CAV 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 (known as a blood transfusion).
You may feel sick for the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help 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. Tell your doctor or nurse if this is a problem.
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.
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 chemotherapy. 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.
Scalp cooling is a way of lowering the temperature of the scalp to help reduce hair loss. Your nurse can tell you if this is an option for you.
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, evening and after meals, using a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
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.
Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine.
Make sure you drink at least two litres (three and a half pints) of fluids during the 24 hours following chemotherapy. It is also important to contact the hospital straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.
Your urine may be a pink-red colour for up to 48 hours after you’ve had your treatment. This is due to the colour of doxorubicin.
Numb or tingling hands or feet
These symptoms are caused by the effect of vincristine on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
It is important to tell your doctor or nurse if you have these symptoms. The dose of the chemotherapy drug may need to be lowered. Usually, the symptoms improve slowly after treatment finishes. But, in some people, they may never go away. Talk to your doctor if you are worried about this.
Your nails may become brittle and break easily. They may get darker or discolour, and they may have lines or ridges on them. Or they could have a combination of these changes. They should go back to normal after chemotherapy. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
Vincristine may make you constipated and cause tummy pain. Drinking at least two litres (three and a half pints) of fluids every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take 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. Always contact the hospital straight away if you are constipated, have tummy pain or are being sick.
Less common side effects of CAVBack to top
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
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 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 also darken. It will return to its normal colour after you finish treatment.
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. Any changes to your skin are usually temporary and improve when treatment finishes.
Changes in the way your heart works
This is rare with usual doses of doxorubicin, but may occur with high-dose treatment. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.
It is 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 CAVBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and 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 medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
CAV may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can 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 is any chemotherapy in 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 is chemotherapy 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. 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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