Find out what ACE is, how you have it and other important information about having ACE.
ACE is the name of a combination of chemotherapy drugs which includes:
- A – Adriamycin, which is also called doxorubicin
- C – Cyclophosphamide
- E – Etoposide, also known as Eposin, Etopophos or Vepesid
It is a treatment for lung cancer.
How it works
These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.
How you have it
You have ACE into your bloodstream (intravenously).
You can also have etoposide as capsules. You take the capsules on an empty stomach.
Drugs into your bloodstream
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
When you have it
You usually have ACE chemotherapy as cycles of treatment. Each cycle of treatment lasts either 2 or 3 weeks. Depending on your needs, you may have up to 6 cycles, taking between 3 and 5 months in total.
You have ACE chemotherapy in the following way:
- on the first day you have doxorubicin and cyclophosphamide as injections and etoposide as a drip, all into your bloodstream
- on the second and third days you take etoposide capsules
If you are having the treatment every 2 weeks
You have daily injections of a growth factor drug called G-CSF (granulocyte colony stimulating factor) from the 4th to the 14th day.
G-CSF helps to stimulate your bone marrow to produce white blood cells. And it reduces the risk of infection. You have the injection just under the skin. A nurse might do the injections or they can teach you how to give them to yourself.
The 3-minute video shows how to give an injection under the skin.
Nurse: This is a short film showing you how to give an injection just under your skin. This is called a subcutaneous or sub cut injection. This does not replace what your doctors and nurses tell you, so always follow their advice.
Voiceover: Subcutaneous injections may be part of your cancer treatment. Or, you may need them to prevent side effects of treatment, such as blood clots after surgery. Or to help control cancer symptoms, such as pain or sickness.
Most injections come in prefilled syringes.
Nurse: So, today I am going to show you how to give a subcutaneous injection. I am going to start by giving it into a practice cushion and then you can have a go at giving one yourself. Before you start, you need to get your equipment together. What you are going to need is an alcohol wipe to clean your skin, some cotton wool, a prefilled syringe and a sharps bin. It is important that you wash your hands with soap and water and dry them thoroughly before you start. Check that you have got the correct drug and that it is in date.
You can give the injection into the back of your arm, your tummy, your thigh or the outer part of your bottom. It is important that you vary where you give the injection. So it may be that you give it one day in your tummy and the next in your thigh.
So you start by cleaning the skin with the alcohol wipe and allowing it to air dry. Then you take the cover off the needle and pinch the skin up and hold it a bit like a pen and in an upright position, in a quick dart like motion pop it straight down into the skin. Then you press the plunger right to the end, quickly pull the needle out, dab it with cotton wool, pop the needle into the sharps bin. And then you need to wash your hands again.
So here’s what you are going to need. If you start by checking the drug and the expiry date. And then with the alcohol wipe give your skin a clean. That’s it give it a few seconds for the air to dry it. Ok and then if you want to pick up the syringe and take the cover off the needle. Then pinch your skin up and at a ninety degree angle gently push the needle in...then press the plunger...and then quickly remove it... dab your skin with the cotton wool and put the syringe in the sharps bin.
You then start the next cycle of treatment.
If you are having treatment over 3 weeks
You don’t have G-CSF injections. So after the third day you don’t have any treatment for the next 18 days. You then start the next cycle of treatment.
Tests during treatment
You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Treatment for other conditions
Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Loss of fertility
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.
Don’t breastfeed during this treatment because the drugs may come through in your breast milk.
Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine
- be in contact with other people who've had live vaccines as injections
Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.
You also need to avoid anyone who has had oral polio or typhoid vaccination recently.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.