This page tells you about the chemotherapy drug combination POMB/ACE and its possible side effects. There is information about:
POMB/ACE is the name of a combination of chemotherapy drugs used to treat testicular cancer and other germ cell tumours. It is made up of the drugs
- P – CisPlatin
- O – Vincristine, which is also called Oncovin
- M – Methotrexate
- B – Bleomycin
- A – Actinomycin, which is also called Dactinomycin
- C – Cyclophosphamide
- E – Etoposide, which is also known as Eposin, Etopophos or Vepesid
You also have a drug called folinic acid when you have the POMB part of the treatment. You have the folinic acid after you have had methotrexate. Methotrexate stops some normal cells working properly, causing side effects. Folinic acid helps the normal cells to recover and helps to stop side effects.
You have the 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 before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
You usually have POMB/ACE chemotherapy as cycles of treatment. Each cycle of treatment lasts 2 weeks. Depending on your needs, you may have between 5 and 7 cycles, taking up to 4 months in total.
You have POMB for the 1st and 2nd cycles of treatment. For the 3rd cycle you have ACE and then you alternate between POMB and ACE every 2 weeks.
You have POMB in the following way
- On the 1st day of the treatment you have vincristine as a drip for 10 minutes followed by a drip of the methotrexate
- On the 2nd day you have bleomycin as a drip over 24 hours
- On the 3rd day of treatment you have cisplatin as a drip over 8 to 12 hours
For the next 10 days you have no treatment. Your next cycle of treatment then starts.
You have ACE in the following way
- On the 1st and 2nd day of this treatment you have etoposide as a drip and actinomycin as an injection into your bloodstream
- On the 3rd day you have the etoposide as a drip and the actinomycin as an injection into the bloodstream. You also have cyclophosphamide as a drip over 30 minutes
The side effects associated with POMB/ACE are listed below. You can use the underlined links to find out more about each one. For general information, see our information about the side effects of cancer drugs or use the search at the top of the page.
More than 10 in every 100 people have one or more of these side 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, 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 petechiae)
- Tiredness and wekaness (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 – this is usually controlled with anti sickness medicines
- Loss of appetite
- Hair loss – most people have complete hair loss but the hair grows back once the treatment ends
- Diarrhoea or constipation – drink plenty of fluids and tell your doctor or nurse if it becomes severe or continues for more than 3 days
- Skin and nail changes – you may have a rash, itchiness, and darkening or reddening of skin in areas that had radiotherapy. You may be more sensitive to sunlight. Your nails may become thicker
- Hearing loss or ringing in the ears (tinnitus) – this nearly always gets better on its own once the treatment ends
- Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks. It usually goes within a few months of finishing treatment
- Loss of taste or a metallic taste in your mouth
- Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when your treatment finishes. You will have regular blood tests to check how well your kidneys are working
- 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.
- A sore mouth and ulcers
- Blurred vision
- Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
- Abdominal cramps
- 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.
- An allergic reaction while having this treatment, usually the first or second time – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, or swelling of the lips, face or throat
- 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
- Liver changes that are very mild and unlikely to cause symptoms – these will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
Not everyone will get these side effects. You may have 1 or 2 or several. 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 drug 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 information does not list all the very rare side effects of these drugs that are very unlikely to affect you. For further information about these drugs look at the Electronic Medicines Compendium website at www.medicines.org.uk/emc.
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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