This page tells you about the chemotherapy combination FEC and its possible side effects. There are sections about
FEC is the name of a chemotherapy combination made up of the drugs
- F – Fluorouracil (5FU)
- E – Epirubicin
- C – Cyclophosphamide
Click on the links to find out the side effects of each individual drug.
FEC is a breast cancer treatment. It is most often used to try to stop breast cancer from coming back after surgery and radiotherapy. This is known as adjuvant therapy.
There are a number of combinations of drugs for women with breast cancer. FEC is just one type of treatment. Your doctor will decide which combination is best for you. There is more information about these combinations in our chemotherapy for breast cancer section.
You have FEC drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a 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. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.
You usually have FEC chemotherapy as cycles of treatment. You have each FEC treatment over 3 weeks. This is one cycle. It is most common to have 6 cycles of treatment with FEC. But some people have up to 8 treatments.
You have injections of all 3 drugs on the first day of each 3 week cycle.
We have listed the side effects associated with FEC below. Use the links to find out more about each one. For more information on side effects where there is no link please see our cancer drugs side effects section.
More than 10 in every 100 people have one or more of the side effects listed below.
- 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 or bleeding gums after brushing your teeth. Or you may have 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
- Hair loss happens to almost everyone treated with FEC. Complete head and body hair loss usually begins 2 to 5 weeks after the treatment starts. This is temporary and using a cold cap may help to prevent hair loss
- Loss of appetite
- Diarrhoea – make sure you drink plenty of fluids. If the diarrhoea becomes severe or lasts more than 3 days, tell your doctor or nurse. They can give you medicines to help
- Loss of taste or a metallic taste may happen on the days you are having your drugs. This should get better when treatment finishes
- Feeling or being sick can be quite severe with FEC but can usually be well controlled with anti sickness medicines. It usually starts a few hours after each treatment and lasts for about a day. If your sickness is not controlled, tell your doctor or nurse. You may be able to have other anti sickness medicines that work better for you
- A sore mouth or mouth ulcers
- Sore eyes – your doctor or nurse can give you eye drops to help
- Watery eyes due to overproduction of tears
- Women may stop having periods (amenorrhoea) but this may only be temporary
- 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
- Your urine may become a pink or red colour the day after having epirubicin – this is due to the colour of the drug and won't harm you
Between 1 and 10 in every 100 people have one or more of these effects.
- Skin changes – your skin may darken or you may have an itchy rash. Brown markings can occur in the skin following the line of the vein where you have fluorouracil injected
- Skin sensitivity to sunlight – use a high factor sun cream and cover up when you go out
- Nail changes – your nails may become ridged, darker, or may get brittle and chip or break easily
- Changes to liver function – you will have blood tests to check for this
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
- Some people have an allergic reaction while having FEC treatment, usually at the first or second treatment. Let your treatment team know straight away if you have any skin rashes, itching or feeling hot. Also tell them if you have shivering, redness of the face, dizziness, headaches, shortness of breath, anxiety or a sudden need to pass urine
Fewer than 1 in 100 people have these effects.
- Confusion or unsteadiness
- Burning, stinging or pain on passing urine (cystitis) – if you see blood in your urine contact your doctor straight away
- 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 over many years can cause a cough or breathlessness
There is a small risk that you may get a second cancer some years after FEC treatment.
You may have some of the side effects above. 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 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 yellowcard.mhra.gov.uk.
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