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Fludarabine, cyclophosphamide and rituximab (FCR)

Find out what FCR is, how you have it and other important information about having FCR.

FCR is a combination of cancer drugs used to treat chronic lymphocytic leukaemia (CLL). It is made up of the drugs:

  • fludarabine
  • cyclophosphamide
  • rituximab

Fludarabine and cyclophosphamide are chemotherapy drugs. Rituximab is a type of targeted cancer drug. 

How it works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have it

You usually have FCR as a combination of tablets and a drip into your bloodstream (intravenously). You may also have all the drugs as a drip into your bloodstream. 

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.

Taking your tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

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.

Never stop taking a cancer drug without talking to your specialist first.

When you have it

You usually have FCR as cycles of treatment. Each cycle of treatment lasts 4 weeks. Depending on your needs you may have up to 6 cycles, taking about 6 months in total. 

You have each cycle of treatment in the following way:

Day 1
  • You have fludarabine as tablets or as a drip into your bloodstream over 30 minutes
  • You have cyclophosphamide as tablets or as a drip into your bloodstream over 30 minutes
  • You have rituximab as a drip into your bloodstream
Day 2 and 3
  • You have fludarabine as tablets or as a drip into your bloodstream over 30 minutes
  • You have cyclophosphamide as tablets or as a drip into your bloodstream over 30 minutes
Day 4 to 28
  • You have no treatment

Then your next cycle of treatment starts. 

On your first treatment cycle, you may have a split dose of rituximab over 2 days. You have it on day 1 and day 2. 

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.

Side effects

Important information

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.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. 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.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

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 shingles vaccine (Zostavax).

You can:

  • 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, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

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.

Last reviewed: 
21 Nov 2017
  • Electronic Medicines Compendium 
    Accessed November 2017

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott, Williams and Wilkins, 2012

  • Fludarabine, Cyclophosphamide, Rituximab (FCR) for CLL

    South East London Cancer Alliance

    Accessed November 2017 

  • Chemoimmunotherapy With Fludarabine, Cyclophosphamide, and Rituximab for Relapsed and Refractory Chronic Lymphocytic Leukemia

    W Wierda and others

    Journal of Clinical Oncology, 2005. Vol 23, issue 18

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