CAVE

CAVE 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
• E = Etoposide

The links above take you to information about the individual side effects of each of these drugs.

You have some of these drugs into your bloodstream (intravenously). Doxorubicin is a red fluid. Cyclophosphamide and vincristine 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 the drugs 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 may have etoposide into a vein, or as capsules that you swallow. They are quite large, pink capsules and you need to swallow them whole with a full glass of water. It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, 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. And never stop taking a cancer drug without talking to your specialist first. 

Make sure that you wash your hands thoroughly after you take the capsules. Store them where children can’t reach them. And return any unused capsules to the pharmacy.

You usually have CAVE chemotherapy as cycles of treatment. You may have up to 6 cycles. Each cycle lasts 3 weeks.

On the first day you have slow injections of doxorubicin and vincristine alongside a salt water (saline) drip. You then have cyclophosphamide either through a drip or as a slow injection. It takes about an hour to have all 3 drugs. You may have etoposide at the same time or as capsules. If you have capsules, you take them on an empty stomach (either an hour before a meal, or 2 hours after) on the first 3 days of each cycle.

For the rest of the 3 week cycle you have no treatment. You then start the next cycle of treatment.

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 CAVE chemotherapy 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

• Feeling or being sick – this is usually well controlled with anti sickness medicines
• Complete hair loss – almost everyone treated with CAVE has complete head and body hair loss, which usually begins 2 to 5 weeks after the treatment starts. Remember your hair will grow back after the treatment. Using a cold cap may help to prevent hair loss with this combination of drugs
• A sore mouth and throat, and possibly mouth ulcers, about 5 days after each treatment – this usually clears up over a couple of weeks
• A metallic taste in your mouth or loss of taste
• Loss of appetite affects about 1 in 8 people (12%) having etoposide
• Your urine may become a pink or red colour for 1 or 2 days after having doxorubicin – 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 marks may occur in the creases of your skin
• Severe constipation with abdominal pain affects 1 out of 3 people who have vincristine (33%) – you can generally 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
• CAVE drugs 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.

• Jaw pain, caused by vincristine affecting your nerves
• Fevers and chills
• An allergic reaction to doxorubicin affects about 3 out of 100 people (3%) – you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along your veins, which should clear up within a few days
• An allergic reaction to etoposide affects 1 or 2 out of every 100 people treated (1 to 2%) – let your treatment team know immediately if you have chills, fever, wheezing, a fast heart rate, a drop in blood pressure, or swelling of the face
• Skin in areas treated with radiotherapy in the past may become dry, flaky, and feel sore and hot – this goes away on its own but keep affected areas out of the sun
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
• Inflammation around the drip site caused by drugs leaking into the tissues – tell your nurse or doctor if you have any stinging or burning, leakage of fluid, or redness or swelling around your drip site during or after treatment

Fewer than 1 in 100 people have these.

• There is a small risk that you may get a second cancer some years after CAVE treatment
• Damage to heart muscle can occur, 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

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.