This page tells you about the chemotherapy drug combination ACE and its possible side effects. There is information about
ACE is the name of a combination of chemotherapy drugs, including
- A – Adriamycin, which is also called doxorubicin
- C – Cyclophosphamide
- E – Etoposide also known as Eposin, Etopophos or Vepesid
The links above take you to information about the individual side effects of each drug.
ACE is a treatment for lung cancer.
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 drugs into your bloodstream (intravenously). You can have them through a thin, short tube (cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in place as long as you need it.
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
It is very important to take the capsules according to the instructions your doctor or pharmacist gives you. You need to take etoposide capsules on an empty stomach. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
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. You have the injection just under the skin. A nurse may do the injections or they can teach you how to give them to yourself. Or you may have 1 injection of pegfilgrastim, which releases G-CSF slowly over a week.
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.
The side effects associated with ACE are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have one or more of these effects.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Feeling or being sick affects around 4 out of 10 people (40%) but this is usually well controlled with anti sickness medicines
- A sore mouth and ulcers occur in up to 3 out of 10 people (30%)
- Hair loss – most people have complete hair loss but the hair will grow back once the treatment ends
- A high temperature (fever) or chills
- Your urine may become a pink or red colour for one or two days after treatment – this won't harm you
- Loss of appetite
- Skin sensitivity to sunlight – don’t sit out in the sun. Do remember to cover up or use sun block on exposed skin
- Watery eyes happen in about 1 in 4 people (25%) and may last for several days after the beginning of each treatment
- Taste changes
- Women may stop having periods (amenorrhoea) but this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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
Between 1 and 10 in every 100 people have one or more of these effects.
- Inflammation around the drip site – tell your nurse straight away if you notice any signs of redness, swelling or leaking at your drip site
- Reddening or darkening of the skin where you have had radiotherapy in the past. The skin may get dry, flaky and sore. This effect goes away on its own but keep affected areas out of the sun
- Skin changes – you may have skin rashes or itchiness
- Nail changes – your nails may become darker and white lines may appear on them
- Diarrhoea – drink plenty of fluids and if it becomes severe or continues tell your doctor or nurse, as you could get dehydrated
- Your blood pressure can drop if etoposide is given too quickly by drip – if you feel dizzy or faint, call your nurse straight away to slow your drip down
- Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine – if you see blood in your urine, contact your doctor or nurse straight away
Fewer than 1 in 100 people have these effects.
- Some people have an allergic reaction while having this treatment, usually at the first or second treatment. Let your treatment team know straight away if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
- There is a small risk that you may get a second cancer some years after this treatment
- Damage to heart muscle, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
- Changes in lung tissue may lead to a cough or breathlessness
- Sore eyes – your doctor or nurse can give you eye drops
You may have a few of the side effects mentioned on this page. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may 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.
Do not breastfeed during this treatment because the drugs may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about ACE drugs look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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