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This information is about a chemotherapy treatment for breast cancer called FEC. 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.
FEC is named after the initials of the chemotherapy drugs used, which are:
FEC 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 day or two 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 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 either by injection through the cannula, which is often connected to a drip (infusion) to flush the drugs in, or they can be given as tablets. The chemotherapy drugs are then given separately:
This will usually take about an hour, but may take longer.
Although the epirubicin 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 regularly 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 starts.
Your doctor may use the word 'regimen' (eg FEC regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving. There are two different schedules for giving FEC. Ask your doctor or nurse to explain if you are not sure which one you are having.
On the first day of your treatment you will be given all three drugs (5FU, epirubicin and cyclophosphamide) by drip and injections into the cannula (on one day only). 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. Usually 4–6 cycles are given over a period of 3–4 months. This makes up a course of treatment.
On the first day of your treatment you will be given 5FU and epirubicin. You will also begin a two-week course of cyclophosphamide tablets. One week later (on day eight) you will be given the 5FU and epirubicin again. You will then have a rest period with no chemotherapy for the next two weeks. This completes 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. Usually 4–6 cycles are usually given over a period of 4–6 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 have more. The side effects described in this information will not affect everyone who is having FEC 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 which 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 FEC 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 FEC can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding.
Anaemia (low number of red blood cells) While having treatment with FEC 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) 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 is usually lost completely. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to regrow 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. Drinking plenty of fluids and cleaning your teeth regularly 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 prescribe special mouthwashes and medicines 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.
Skin changes You may develop an itchy rash. Your doctor can prescribe medicine to help with this. Sometimes 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. Also, your skin may darken. This will slowly return to normal a few months after the treatment has finished.
During the 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.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink as much fluid as possible (up to two litres) during the 24 hours after the chemotherapy to help prevent this. If you notice any blood in your urine tell your doctor.
Due to the epirubicin, a red-coloured liquid, your urine may become a pink-red colour. This may last up to 24 hours after your treatment and is quite normal.
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 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 soothing eye drops.
Changes in nails Some people may find that their nails become darker or ridged. White lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
Changes in the way your heart works This is very rare with usual doses of these drugs, 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 you are having. 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.
Fertility Your ability to conceive a child may be affected by this treatment. It may be helpful 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.
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.
Leakage into the tissue around the vein If this happens while epirubicin is being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given tell your doctor or nurse immediately.
This section is based upon our FEC 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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