This information is about a chemotherapy treatment called PCV that is used to treat brain tumours. It describes the drugs used, 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 information nurse specialists.

PCV is named after the initials of the chemotherapy drugs used, which are:

• procarbazine
• lomustine, which is also known as CCNU®
• vincristine.

PCV chemotherapy can 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 before. 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. All of this may take a couple of hours.

The nurse will then put a thin, flexible tube (cannula) into a vein in your arm. You may find this uncomfortable or a little painful, but it should not take long. Once your chemotherapy is ready you will be given an anti-sickness (anti-emetic) drug, either by injection through the cannula or as a tablet.

You will then be given the chemotherapy.

This involves:

• an injection of vincristine (a colourless fluid) that takes about 5-10 minutes
• lomustine capsules, which are blue in colour 
• procarbazine capsules, which are ivory in colour.

Sometimes you will be given the lomustine and procarbazine capsules to take at home. 

The cannula will then be removed and you can go home. You may be given anti‑sickness tablets to take with you. It is important to take the anti-sickness tablets regularly, even if you are not feeling sick. This is because most anti‑sickness tablets are more effective at preventing sickness than at stopping it once it has started.

Your doctor may use the word 'regimen' (eg the PCV regimen) when talking about your chemotherapy. This means the whole plan, or schedule, of the treatment that you are receiving.

On the first day of your treatment you will be given an infusion of vincristine and a dose of lomustine capsules. You will also begin a ten-day course of procarbazine capsules (this may start on the following day). When you have completed this course, you will have a rest period (with no treatment) for the next 32 days. This completes what is called a cycle of your treatment. One cycle of PCV lasts for six weeks.

After the rest period the same treatment will be repeated, which will be six weeks after your first infusion. This begins the next cycle of your chemotherapy. Usually two or three cycles are given, then the treatment is reviewed.

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 PCV 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 which you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.

Lowered resistance to infection PCV chemotherapy can reduce the production of white blood cells by the bone marrow, making you more likely to get an infection. This effect can begin three weeks after treatment has been given.

Contact your doctor, or the hospital, straight away if:

• your temperature goes above 38ºC (100.4ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to check your number of white blood cells. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is too low.

Bruising or bleeding PCV 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 PCV you may become anaemic. This may make you feel tired and breathless. Sometimes a blood transfusion may be required. Your doctor or nurse can discuss this with you.

Nausea (feeling sick) and vomiting Nausea may begin a few hours after treatment has been given and can last for up to three days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce this side effect. If the sickness isn't controlled, or if it continues, let your doctor know. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness and feeling weak Many people feel extremely tired (fatigued) during chemotherapy. It is important to allow yourself plenty of time to rest.

Numbness or tingling in hands or feet This is due to the effect of vincristine and procarbazine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your hospital doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after the treatment has finished.

Very rarely, other nerves may be affected (such as the neck nerves), which may cause pain in the jaw, or double vision.

Flu-like symptoms These can occur after you have had procarbazine. You may have headaches, aching joints or muscles, a temperature, lethargy (a feeling of weakness) and chills. If this happens it is important to drink lots of fluids and get plenty of rest.

Hair thinning This is a rare side effect with PCV chemotherapy. If it happens, it usually begins about 3–4 weeks after starting treatment, although it can occur earlier.

Skin changes Procarbazine can cause a rash, which may be itchy. Your doctor can give you medicine to help with this. Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Changes to the lungs Lomustine may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.

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 straight away 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 (including those you can buy in a shop or chemist) 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 vincristine 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, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse immediately.

If the area around the injection site becomes red or swollen at any time, you should either tell the doctor or nurse on the ward, or if you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.

Diet Although rare, it is possible for procarbazine to interact with some types of food. This includes mature cheese, certain meats (salami, pepperoni), red wine (especially chianti) and yeast/meat extracts (marmite, vegemite, oxo, bovril). The nurse or doctor looking after you will advise you on which foods to avoid if this is necessary.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. For men it may be possible to organise sperm banking prior to 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 whilst on this chemotherapy, as the drugs may harm the developing foetus. It is important to use effective contraception whilst on the chemotherapy and for at least a few months afterwards. Again, discuss this with your doctor.

• Store the capsules in a dry place away from direct sunlight.
• It is important to take your capsules at the right times. You must take them as directed by your doctor.
• Keep the capsules in a safe place out of the reach of children, as the capsules could harm them.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the capsules, let your doctor or chemotherapy nurse know as you may need to take another dose. Do not take another capsule without first informing your doctor or nurse.
• If you forget to take a capsule, do not take a double dose. Tell your doctor or nurse and keep to your regular dose schedule.

This section has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition), Eds Sweetman et al, Pharmaceutical Press, 2007.
• British National Formulary (56th edition), British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Chemotherapy Source Book (4th edition), Eds Perry, Lippincott, Williams and Wilkins, 2007.

For further references, please see the general bibliography.