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This information is about a chemotherapy treatment for lung cancer called CAV (sometimes called VAC). It describes the drugs, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
CAV is named after the initials of the chemotherapy drugs used, which are:
CAV treatment can usually be given to you as a day patient. You will need to have a blood test before you start treatment - either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given some anti-sickness (anti-emetic) drugs as tablets or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion).
The chemotherapy drugs are then given separately:
The whole process may take an hour or so.
If you are having your treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness drugs to take with you. You should take these regularly if you have been told to do so, even if you are not feeling sick. This is because some medicines are much more effective at preventing sickness than stopping it once it has started.
Your doctor may use the word 'regimen' (eg the CAV regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are receiving.
On the first day of your treatment, you will be given cyclophosphamide, doxorubicin and vincristine (as described) on one day only. After this you will have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of your treatment.
After the rest period, the same treatment will be repeated again, which begins the next cycle of your chemotherapy. Usually 4–6 cycles are given over a period of 3–4 months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having CAV chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed in this information, please let your nurse or doctor know.
Lowered resistance to infection CAV can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising or bleeding CAV can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with CAV you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss This usually starts 3–4 weeks after the first course of treatment. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.
Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection. Using a soft toothbrush may be helpful.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Irritation of the bladder Cyclophosphamide can irritate your bladder. It is very important to drink as much fluid as you can (at least two litres) during the 24 hours following chemotherapy to help prevent this. Doxorubicin is red and, as a result, your urine may become a pink-red colour. This can last up to 24 hours after your treatment. It is quite normal.
Diarrhoea If you do get diarrhoea, it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid you are losing.
Numbness or tingling in hands or feet This is due to the effect of vincristine on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms or have difficulty carrying out fiddly tasks. This problem usually improves slowly a few months after treatment is over.
Skin changes During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes.
Changes in nails Your nails may become darker and white lines may appear. These changes usually grow out over a few months once the treatment has finished.
Constipation This can usually be managed by eating a high-fibre diet and drinking plenty of fluids. You may also need simple laxatives. Let your doctor know if you become constipated.
Changes in the way your heart works This is very rare with usual doses of doxorubicin, but may occasionally happen when high doses are used. Tests to see how well your heart is working may be carried out before you start treatment.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg; or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If this happens while doxorubicin or vincristine are being given, the cells in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given tell the doctor or nurse immediately.
Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while having this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor.
Loss of periods in women Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In younger women this may be temporary, but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our CAV chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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