FCR

FCR is the name of a combination of cancer drugs used to treat chronic lymphocytic leukaemia. It is made up of the drugs

• Fludarabine
• Cyclophosphamide
• Rituximab

The links above take you to more information about the individual side effects of each drug. Fludarabine and cyclophosphamide are chemotherapy drugs and Rituximab is a biological therapy.

You usually have FCR chemotherapy as cycles of treatment. Each cycle of treatment lasts 4 weeks. Depending on your needs, you may have up to 6 cycles, taking about 6 months in total.

You may have FCR as a combination of tablets and a drip into your bloodstream or all of the drugs into your bloodstream (intravenously).

The drugs can be given into your bloodstream 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 have each cycle of treatment in the following way

• On the first day you have all 3 drugs – fludarabine, cyclophosphamide and rituximab
• On the second and third day you have fludarabine and cyclophosphamide

The rituximab is always a drip into your bloodstream, but you may have fludarabine and cyclophosphamide as tablets.

After the third day you have no treatment for 25 days. Your next cycle of treatment then starts. So the whole cycle takes 4 weeks (28 days).

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 FCR 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 the side effects listed below.

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

• 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 centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

• Feeling or being sick happens in about 4 out of every 10 people (40%) but it is usually well controlled with anti sickness medicines
• Tiredness (fatigue) affects 2 in 10 people (20%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling weak occurs in just over 1 in 10 people (10%)
• Constipation affects just over 1 out of 10 people (10%) – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Diarrhoea happens in 1 out of 10 people (10%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
• Flu like symptoms, including a cough, headache, and fever and chills occur in 1 in 10 people (10%) – taking paracetamol can help
• These drugs may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – we don’t know exactly how this combination of drugs affects fertility so do talk with your doctor before starting treatment if having a baby is important to you

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

• Loss of appetite
• Warmth and reddening of the face during the rituximab drip occurs in about 1 in 20 people (5%) – tell your nurse straight away if this happens to you
• Dizziness
• Indigestion
• Skin and nail changes including a rash, and darkening of your nails and skin
• About 1 in 20 people (5%) have a more severe allergic reaction to the rituximab, with wheezing, an itchy rash and a drop in blood pressure – your doctor or nurse will give you medicines beforehand to try to prevent a reaction. If you do have a reaction, your nurse will slow or stop your drip for a while

Fewer than 1 in 100 people have these effects.

• There is a small risk that you may get a second cancer some years after cyclophosphamide treatment
• Damage to your kidneys may be caused by chemicals from the broken down cancer cells collecting in the blood (tumour lysis syndrome). You will have regular blood tests to check the chemical balance of your blood and your doctor may give you allopurinol tablets
• Damage to the heart muscle is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment

Not everyone will get these side effects. You may have one or two 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.

Tell your doctor, nurse or pharmacist 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 chemotherapy 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 from your chemotherapy.

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.