POMB/ACE chemotherapy

What is POMB/ACE?


How POMB/ACE is given

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 all right 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.


Side effects during treatment

Some people might have the following side effects while they are having the chemotherapy:

Allergic reaction

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

  • feeling hot or flushed 
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless 
  • 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 can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.

The drug leaks outside the vein

If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens it is important that it’s dealt with quickly. Tell your nurse straight away if you have any around the vein:

  • stinging
  • pain
  • redness
  • swelling.

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.

Flu-like symptoms

Bleomycin may cause flu-like symptoms, such as:

  • feeling hot or cold and/or shivery
  • a headache
  • aching.

If you have this, tell your nurse or doctor straight away.

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 do not 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).

POMB

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.

ACE

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.

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.

Going home

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.


Common side effects

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

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 called neutropenia.

If you have an infection, it is important to treat it as soon as possible. 

Contact the hospital straight away on the 24-hour contact number you have 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.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

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.

Bruising and bleeding

This treatment 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 that you cannot explain. 

This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them 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. 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. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days after this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. 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 and eat small amounts often. 

If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. 

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth 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.

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.

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.

Diarrhoea

This treatment may cause severe diarrhoea. Your nurse or doctor may give you anti-diarrhoea drugs to take at home.

If you have diarrhoea:

  • follow any advice you have been given about taking anti-diarrhoea drugs
  • 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 straight away if:

  • you have diarrhoea at night
  • you have diarrhoea more than 6 times in a day
  • the anti-diarrhoea drugs do not work within 24 hours.

Some people may need to go to hospital to have fluids through a drip. You may need to take antibiotics.

Feeling tired

Feeling tired is a common side effect. 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 operate machinery.

Skin changes

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.

Hair loss

Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or 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. It is important to cover your head to protect your scalp when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Nail changes

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.

Constipation

This treatment can cause constipation. 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.

Eye problems

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.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys are working.

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


Less common side effects of POMB/ACE

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.

Bladder irritation

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.

Second cancer

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/ACE

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

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.

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 in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

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.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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.


References and thanks

This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC). 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. Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to develop.

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