Skip the secondary navigation if you do not want to read it as the next section.
Take part in the Great Scottish Run and support the work of Cancerbackup. |
Skip the main content if you do not want to read it as the next section.
Skip the location trail if you do not want to read it as the next section.
This information is about a chemotherapy treatment for breast cancer called E-CMF. 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.
E-CMF, which is also known as Epi-CMF, is named after the initials of the four chemotherapy drugs involved:
E-CMF treatment can usually be given to you as a day patient. Before starting treatment you will need a blood test 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 fine 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 fine 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.
The nurse will attach a drip (infusion) to your cannula and make sure that it is flowing freely. The drip will normally contain a sterile saline solution. If you have a PICC or central line this may not be necessary.
The nurse will give you some anti-sickness (anti-emetic) drugs, either as an injection or sometimes as tablets. The chemotherapy drugs are then given separately.
Epirubicin is a red fluid. It comes in a syringe. The nurse will inject the fluid slowly into the drip (infusion) or through your central or PICC line.
Cyclophosphamide can be given in a number of ways:
Your doctor or nurse will explain which is the most suitable for you.
Methotrexate is a clear, yellow fluid given in a syringe. The nurse will inject this slowly through the drip (infusion) or through your central or PICC line.
5FU is a colourless fluid and will normally be in one or two syringes. The nurse will inject the fluid slowly into the drip or through your central or PICC line.
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, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
You may hear your doctor use the word 'regimen' (eg the E-CMF regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.
Usually E-CMF is divided into two (the E part and the CMF part) with four doses of epirubicin given during the first few months, followed by the CMF over the next few months. The following are descriptions of two different schedules for giving E-CMF. You can ask your doctor or nurse to explain which one you are having.
During the first three months of your chemotherapy you will be given four cycles of epirubicin. This is given once every three weeks. You will have a total of four injections over this time. The CMF part of the regime is given next.
Cyclophosphamide, methotrexate and 5FU are given on the first day (day one) and again a week later (day eight). After this you will have a rest period with no chemotherapy for the next three weeks, before starting your next cycle. This four week cycle will be repeated four times over a four-month period.
As in schedule A, the epirubicin is given for the first four cycles, once every three weeks. Then the CMF part of the regime is given for the last four cycles. On the first day of your CMF 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. One week later you will be given injections of 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 the next two weeks. You will start the next course of CMF treatment after the rest period, which will be four weeks after your first injection.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is having E-CMF chemotherapy. We have outlined the most common side effects, so you can be aware of them if they occur. However, we have not included those which are rare and therefore unlikely to affect you. If you do notice any effects that you think may be due to the drug, but that are not listed here, let your nurse or doctor know.
Lowered resistance to infection E-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 E-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 E-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.
Feeling sick (nausea) and being sick (vomiting) There are 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 dose of epirubicin, although it may happen earlier. Hair may be lost completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will regrow once the treatment is finished.
Sometimes it is possible to have scalp cooling during your treatment to help prevent hair loss. However, this is not always successful and some people find it very uncomfortable. You may want to discuss this with your chemotherapy nurse or doctor.
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 come back after the treatment finishes.
Diarrhoea If you 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 2–3 litres of fluid 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. This side effect tends to happen more with the CMF part of the treatment.
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 prevent this. Tell your doctor if you have any discomfort when you pass urine.
Skin changes Epirubicin and CMF can cause a rash, which may become itchy. Your doctor can prescribe medicine to help with this. Areas which have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens. The skin over the vein used for the injection may become discoloured. Your skin may darken, due to excess production of pigment. The darkening usually returns to normal a few months after the treatment has finished.
Sometimes the vein can become sore or irritated along where the epirubicin is injected. It is important that you let your doctor or chemotherapy nurse know if this happens during or after the drug is injected.
If the veins are particularly sensitive or it is difficult to put the needle in, your nurse or doctor might discuss putting a permanent line into one of the veins in your arm, (called a PICC line), or a line which is inserted under the skin of your chest into a vein (called a central line).
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.
Discoloured urine Your urine may become a pink-red colour. This may last up to a day after you have had epirubicin and is due to the colour of the drug. It is quite normal.
Changes in the way your heart works Higher doses of epirubicin may cause changes in the muscle of the heart. It may not be suitable to have this chemotherapy regime if you have an existing heart condition, as epirubicin can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected if you have standard doses. Tests, such as an echocardiogram, which measures how well the heart muscle pumps, and/or an electrocardiogram (ECG) which measures the electrical conductivity, may sometimes be carried out before the drug is given.
Change to nails Your nails may become darker. White lines may appear on them. These changes grow out over a few months once treatment has finished.
Always let your doctor or nurse know about any side effects you are having. There are usually ways in which they can be controlled or improved.
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 further doses of the methotrexate.
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.
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 this drug, 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 E-CMF chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
Make a gift today to support the work of Cancerbackup. Donate online >> |
Cancerbackup is a national charity and we rely on voluntary donations. To donate, please call 020 7696 9003 and tell us you have visited our website. Thank you.
