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This information is about a chemotherapy treatment for breast cancer called CMF. 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.
CMF is named after the initials of the chemotherapy drugs involved, which are:
CMF treatment can usually be given to you as a day patient. Before you start treatment, you will need to have a blood test – 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 then 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 which 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. These are usually given by injection through the cannula or central line or PICC line, which is connected to a drip (infusion). Some anti-sickness medicines may also be given as tablets.
The chemotherapy drugs are then given separately:
This will usually take up to an hour.
Although the cyclophosphamide is often given first, the order in which the drugs are given will not alter their effectiveness.
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. It is important to take these as directed even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
CMF chemotherapy can be given in different ways. Your doctor may use the word 'regimen' (eg CMF regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving. Below are descriptions of four different schedules for giving CMF. You can ask your doctor or nurse to explain which one you are having.
On the first day of your treatment, you will start your cyclophosphamide tablets, which you take for two weeks. On the same day you will also be given injections of methotrexate and 5FU (as described above). One week later (day 8) you will be given methotrexate and 5FU again. When you finish your cyclophosphamide tablets (a week after your last injections) you will have a rest period with no chemotherapy for two weeks. This completes what is called a cycle of your chemotherapy.
You will start the next cycle of your treatment after the rest period, which will be four weeks after your first injection.
On the first day of your treatment you will be given all three drugs (cyclophosphamide, methotrexate and 5FU) by drip and injection. One week later (on day 8) you will be given methotrexate and 5FU into the vein. After this you will have no chemotherapy for the next two weeks, before starting the next cycle of treatment.
On the first day of your treatment you will be given all three drugs (cyclophosphamide, methotrexate and 5FU) by drip and injection on one day. After this you will have a rest period with no chemotherapy for the next three weeks. This completes a cycle of your treatment.
After the rest period, the same drugs will be given to you again, beginning the next cycle of your treatment.
You will be given cyclophosphamide, methotrexate and 5FU by drip and injection on the first day of your treatment. This will be repeated one week later. After this you will have a rest period with no chemotherapy for the next two weeks, before starting your next cycle of treatment.
The above schedules are all usually given 4–6 times over a period of 3–6 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 CMF 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 drug, but which are not listed in this information, please let your nurse or doctor know.
Lowered resistance to infection CMF 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 CMF 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 CMF you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are 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.
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 can cause constipation. Let your doctor or nurse know if this is a problem.
Hair loss It is rare for your hair to completely fall out because of CMF chemotherapy, but you may notice that some of it falls out. If you experience any hair loss, it is temporary and your hair will start to grow again once the treatment has finished.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. 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.
Taste changes You may notice that your food tastes different. Normal taste will usually return when treatment ends.
Diarrhoea If you have 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 liquid a day to replace the fluid you are losing.
Gritty eyes and blurred vision If this happens let your doctor know. They can prescribe some soothing eye drops.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink as much fluid as you can (up to two litres) on the days when you have cyclophosphamide to help to prevent this. Tell your doctor if you have any discomfort when you pass urine.
Skin changes You may develop an itchy rash. Your doctor can prescribe medicine to help with this. Rarely, your skin may darken. If it does, it usually goes back to normal a few months after treatment has finished.
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 and a hat.
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 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.
Some painkillers, such as ibuprofen, can make the side effects of CMF worse. Before taking any painkillers check with your chemotherapy nurse, pharmacist or doctor.
If you have bad side effects from the methotrexate (such as a very sore mouth and gritty eyes), your doctor may give you folinic acid tablets to take 24 hours after having the methotrexate.
Fertility Your ability to become pregnant 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 while taking 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 or nurse.
Loss of periods Due to the effect of chemotherapy on the ovaries you may find that your 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 CMF 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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