1. What is FEC-T?
2. Who might be offered FEC-T?
3. How FEC-T works
4. How FEC-T is given
5. Common side effects of FEC-T
6. Less common side effects of FEC-T
7. Sex and contraception
8. Travel and vaccinations
FEC-T is a combination of four chemotherapy drugs. It takes its name from the initials of these drugs:
- 5 fluorouracil (also known as 5FU)
- docetaxel (also known as Taxotere)
Before you start your treatment, many hospitals will arrange a chemotherapy information session. At this appointment a nurse will discuss how and when your chemotherapy will be given and how side effects can be managed.
Contact numbers will also be given so you know who to phone if you have any questions or concerns.
Chemotherapy is commonly given to reduce the risk of breast cancer returning.
FEC-T is used to treat primary breast cancer – breast cancer that has not spread beyond the breast or the lymph nodes (glands) under the arm.
Sometimes, FEC-T may be given before surgery. This is known as primary or neo-adjuvant chemotherapy.
Chemotherapy drugs interfere with how cancer cells develop and grow, and different drugs do this in different ways.
FEC-T works by stopping the cancer cells from dividing and multiplying which blocks the growth of the cancer.
Different chemotherapy drugs attack the cancer cells at different phases of their growth. This is why a combination of drugs is often used instead of one single drug.
FEC–T chemotherapy is given in two parts.
You’ll start by having 5 fluorouracil, epirubicn and cyclophosphamide (FEC). This is given every three weeks. You’ll have three or four sessions (cycles) of FEC.
After this you will have the drug docetaxel every three weeks. Again you’ll have either three or four cycles.
The interval between each course of treatment gives your body time to recover, and may vary depending on whether the number of blood cells has returned to normal between each cycle (see the section on Common side effects for more details).
The drugs are usually given through a drip into a vein (intravenously) in the hand or arm.
Sometimes, if it’s difficult to find a suitable vein, another device is used. Find out more about the different ways chemotherapy is given.
Everyone reacts differently to drugs and some people have more side effects than others. These can usually be controlled and the side effects described here won’t affect everyone.
If you’re concerned about any side effects, regardless of whether they’re listed here, talk to your chemotherapy nurse or cancer specialist (oncologist).
Effects on the blood
FEC-T can temporarily affect the number of healthy blood cells in the body.
You’ll have regular blood tests to check your blood count. If the number of blood cells is too low, your next course of treatment may be delayed or the dose of chemotherapy reduced.
Not having enough white blood cells can increase the risk of getting an infection.
If you feel unwell, develop a sore throat or shivering or have a temperature above 38°C at any time during your treatment, contact the hospital immediately, even if this happens at the weekend or during the night.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your specialist team know.
You may also bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your specialist team if you have any of these symptoms.
Hair loss (alopecia)
FEC causes hair loss. Most people will lose all their hair, including eyebrows, eyelashes and body hair. Hair loss should be temporary and in most cases your hair will begin to grow back a few weeks after your treatment has ended.
Nausea and vomiting
You may experience nausea and vomiting, but many people will not actually be sick. You’ll be given anti-sickness medication into your vein before the chemotherapy is given, and you’ll be prescribed anti-sickness drugs to take home to reduce nausea or stop it happening.
Diarrhoea or constipation
You may have diarrhoea or constipation but your specialist or GP can prescribe medicine to help control it. Contact your specialist chemotherapy team if you have four or more episodes of diarrhoea within a 24-hour period.
Sore mouth and taste changes
You’ll be given mouthwash to try to reduce soreness of the mouth and gums and to try to stop mouth ulcers developing. Good mouth hygiene is very important during treatment. It’s advisable to see your dentist for a dental check-up before chemotherapy begins, but avoid dental treatment during chemotherapy.
While you're having FEC-T your taste can change and some food may taste different (for example more salty, bitter or metallic).
Pain in the injection site
If chemotherapy leaks out of the vein it’s being given in (called extravasation), it can damage the surrounding soft tissue. Tell the nurse giving the chemotherapy immediately if you have pain, stinging or a burning sensation around the cannula (small plastic tube) while the drug is being given.
After treatment, pain can occur where the needle has been inserted or along the vein. After a few weeks you may notice tenderness, darkening and hardening around where the needle was inserted. This should fade in time.
It’s common to feel extremely tired during your treatment. For some people, fatigue can last for several weeks or even months after the treatment has finished, but your energy levels will gradually return.
There are different ways of coping with fatigue.
Change in the colour of urine
Epirubicin is red. You may notice when you go to the toilet that your urine is red or pink. This is not blood but the epirubicin being passed through your kidneys and bladder. This can last for one to two days after treatment.
It’s important to drink plenty of fluids around the time you have your treatment because chemotherapy drugs (particularly cyclophosphamide) can irritate the lining of the bladder. Try to empty your bladder regularly, as soon as you feel the urge. Tell your specialist if you notice any irritation or a burning/stinging sensation when passing urine.
Effects on your concentration
Your ability to concentrate or think clearly can also be affected, which can be very frustrating. This is sometimes referred to as ‘chemo-brain’ or ‘chemo-fog’ and usually improves over time after treatment has finished.
Effects on fertility
FEC-T chemotherapy causes changes in the ovaries, which may lead to infertility in women who haven’t been through the menopause. The likelihood of you becoming infertile may also depend on whether you have had chemotherapy in the past and your age.
In men, FEC-T chemotherapy can affect sperm production which can lead to temporary or permanent infertility.
If you’re concerned about your fertility, it’s important to talk to your specialist team before treatment begins to discuss options for preserving fertility.
Sometimes FEC–T can cause women who haven’t been through the menopause (pre-menopausal) to experience menopausal symptoms. This is because it affects their ovaries, which produce oestrogen.
Common symptoms can include:
- hot flushes and night sweats
- mood changes
- joint aches and pains
- vaginal dryness.
Numbness and tingling in hands or feet
Some people have numbness or tingling in their hands and feet, known as peripheral neuropathy. This is due to the effect of docetaxel on the nerves.
In most cases it’s mild and goes away soon after treatment stops. If it’s severe, it may be necessary to reduce the dose of docetaxel or to stop it completely.
It normally improves a few months after the treatment has finished, but it may not disappear completely.
Mention any numbness or tingling to your specialist team when you see them next, so they can monitor the symptoms.
Fluid retention and weight gain
You may develop a build-up of fluid in the body (oedema), which may take a few weeks to resolve. This can appear as swollen ankles and legs and feeling short of breath.
The steroid drugs that you are given to prevent an allergic reaction to docetaxel will help reduce the chance of fluid building up.
You may also put on weight, but you’ll usually lose it again once the treatment has finished. However, this can vary for each person and may take up to several months. Physical activity and healthy eating may help with weight gain.
You may develop a rash anywhere on your body or your skin may discolour. This can be itchy. Your skin can also become dry and flaky or peel.
Skin reactions like this can develop on the palms of your hands and soles of your feet. This is known as palmar-plantar or hand-foot syndrome. This will improve after the treatment is finished.
Mention any skin reactions to your specialist team so they can monitor the symptoms. Ask your team if they recommend any particular creams for your skin before using anything on it yourself. Your doctor may prescribe medicine to help.
During treatment with FEC-T and for several months afterwards, your skin will be more sensitive. You’ll be more likely to get sunburnt, so it’s important to wear a high-factor sunscreen if you’re out in the sun.
Painful muscles and joints
Your muscles or joints may ache or become painful two to three days after you have your treatment. This usually wears off after a few days.
However, it can be severe and you may need to take mild pain relief or anti-inflammatory drugs. It’s a good idea to have some of these available before starting your treatment just in case you need them.
Sore eyes and runny nose
FEC-T chemotherapy can cause a runny nose. It can also cause soreness and a gritty feeling in your eyes, or your eyes may water. Eye drops can be prescribed to relieve the soreness.
Your fingernails and toenails may become darker and ridges may form. However, this is uncommon and will grow out over the months following the end of your treatment.
FEC-T can affect the heart and blood pressure. This is usually temporary but for a small number of people it may be permanent.
Before you start chemotherapy your specialist may arrange a heart (cardiac) function test. This could be an electrocardiogram (ECG), which takes an electrical recording of your heart, or an echocardiogram (echo) to make sure your heart is working normally. You may also be offered a multiple-gated acquisition (MUGA) scan to check how well the heart is pumping.
You’ll also be carefully monitored during your treatment. If changes to your heart and blood pressure happen, they can usually be treated easily and you won’t have to stop your treatment. This is not the same as having an allergic reaction.
If you have an allergic reaction to FEC-T, it will probably happen within the first few minutes of your treatment and is most likely the first or second time you have the drug. Reactions can vary from mild to severe, but severe reactions are uncommon.
An allergic reaction can be more likely with docetaxel. Before each treatment of docetaxel, you’ll be given drugs called steroids to reduce the risk of an allergic reaction. These are usually given as tablets to take for three days, starting the day before each cycle of docetaxel. Take these as directed by your specialist team and don’t stop taking them without talking to the team first.
You’ll be monitored closely during treatment so any reaction can be dealt with immediately.
Symptoms of an allergic reaction include:
- skin rash
- back pain
- shortness of breath
- fever or chills.
If you have a severe reaction, treatment will be stopped immediately.
Chemotherapy can increase your risk of blood clots. Tell your doctor straight away if you have any swelling, pain or redness in your leg, shortness of breath or chest pains.
Liver or kidney changes
FEC-T can cause irritation to the kidneys or liver. You’ll have regular blood tests to monitor your liver and kidneys throughout your chemotherapy. Any irritation is usually mild and gets better by itself.
You’re advised not to become pregnant while having treatment because FEC-T may have a harmful effect on a developing baby. If you haven’t been through the menopause, talk to your team about the most suitable method of birth control for you.
You can still have sex during treatment. It’s not known how much (if any) chemotherapy drugs pass into vaginal fluid (or semen) and whether this could pose any risk to a sexual partner. Doctors usually recommend using condoms (if you have intercourse with a man) for a few days after chemotherapy is given.
Vaccines may be less effective if given during treatment, and live vaccines can cause serious infections.
You shouldn’t have any live vaccines while having chemotherapy as they could be harmful. These include vaccines that protect against measles, rubella, yellow fever and typhoid.
It’s usually safe to have these vaccinations six months after your treatment finishes.
If you’re planning a trip and need vaccinations, discuss this with your specialist team.
Anyone with a reduced immunity to infection should have a flu vaccine. This includes people having or due to have chemotherapy.
The flu vaccine is not a live vaccine, which means there are no active viruses in it.
It’s best to have the vaccination at least two weeks before your chemotherapy starts. If you’re already having chemotherapy, talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab to ensure you gain the greatest possible effect from the vaccine. This will usually be at a point in your chemotherapy cycle when your white blood cell count is recovering.