CAV

CAV is the name of a combination of chemotherapy drugs used to treat small cell lung cancer. It is made up of the drugs

• C = Cyclophosphamide
• A = Doxorubicin (also called Adriamycin)
• V = Vincristine

The links above take you to more information about the individual side effects of each drug.

You have these drugs into your bloodstream (intravenously). Doxorubicin is a red fluid. Vincristine and cyclophosphamide are clear fluids. 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 chemotherapy through a central line, a portacath or a PICC line. These are long, flexible tubes that give the chemotherapy into a large vein in the chest. These lines stay in throughout your whole course of treatment.

You usually have CAV chemotherapy as cycles of treatment. Depending on your needs, you may have between 4 and 6 cycles. Each cycle of treatment lasts 3 weeks.

On the first day you have slow injections of doxorubicin and vincristine into your cannula or central line alongside a salt water (saline) drip. You then have a short drip (infusion) or slow injection of cyclophosphamide. It takes about an hour to give all 3 drugs. Then you have no treatment for 3 weeks. This completes one cycle of your treatment. You then begin another cycle.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with CAV are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery. 
• 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)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment team if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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 is usually well controlled with anti sickness medicines
• Complete hair loss – almost every one treated with CAV has complete head and body hair loss which usually begins 2 to 5 weeks after the treatment begins. Remember the hair will grow back after treatment. Using a cold cap may help to prevent hair loss with this combination of drugs
• A sore mouth and throat about 5 days after each treatment, which gradually clears up over a couple of weeks
• Mouth ulcers
• A metallic taste in your mouth or a loss of taste
• Urine may become a pink or red colour for 1 or 2 days after having doxorubicin, but this is not harmful
• Sensitivity to sunlight – don’t sit out in the sun, and do cover up or use sun block on exposed skin
• Changes to your nails
• Dark lines may appear in the creases of your elbows and knees
• Severe constipation with abdominal pain affects 1 out of 3 people (33%) who have vincristine – you can usually prevent this with regular laxatives but tell your doctor or nurse if you are constipated for more than 3 days
• Vincristine can temporarily stop the normal muscle contractions of the bowel, causing sickness, a swollen abdomen and cramps
• Women may stop having periods but this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk to your doctor before starting treatment if having a baby is important to you
• CAV may harm a baby developing in the womb – it is not advisable to become pregnant or father a child if you are having these drugs, so talk to your doctor or nurse about contraception before having treatment if there is any chance you or your partner could become pregnant

Between 1 and 10 in every 100 people have one or more of these.

• Inflammation around the drip site caused by chemotherapy drugs leaking into the tissues around your drip site – it is important to tell your nurse or doctor if you have any stinging or burning around your drip site, leakage of fluid, or redness or swelling around your drip site during or after treatment
• Jaw pain, caused by vincristine affecting your nerves
• Fevers and chills
• An allergic reaction to doxorubicin affects around 3 people out of 100 (3%) – you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins, which should clear up within a few days
• Skin may become dry, flaky, and feel sore and hot in areas treated with radiotherapy in the past – this goes away on its own but keep affected areas out of the sun
• Diarrhoea – drink plenty of fluid and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days

Fewer than 1 in 100 people have these effects.

A very small number of people have damage to heart muscle from doxorubicin. This is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment.

The following rare side effects usually go back to normal within 2 months of finishing vincristine treatment. Tell your doctor or nurse if you have any of them. 

• Muscle cramps
• Staggering
• Bone pain
• Blurred or double vision
• Hearing loss or dizziness
• Confusion
• Depression
• Hallucinations

Not everyone will get these side effects. You may have none 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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a contact number. You can ring them if you have any questions or problems. They can give you advice or reassure you. 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.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.