FEC-T

FEC-T is the name of a combination of chemotherapy drugs used to treat breast cancer. It is made up of the drugs

• F = Fluorouracil (5FU)
• E = Epirubicin
• C = Cyclophosphamide
• T = Docetaxel (Taxotere)

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

The side effects of a combination of drugs are usually a mixture of the side effects of each drug. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity. The side effects associated with FEC-T are listed below. You can use the links (underlined) to find out more about each side effect. See our cancer drugs side effects section for more detailed information.

You have FEC-T 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 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 FEC-T chemotherapy as cycles of treatment. You may have up to 8 cycles. Each cycle of treatment lasts 3 weeks.

For the first 3 or 4 cycles you have 3 drugs (fluorouracil, epirubicin and cyclophosphamide), which is the FEC part of the treatment. The drugs are given as slow injections into your cannula or central line on the first day of each treatment cycle. It takes about half an hour to give all 3 drugs. Then you have no more treatment for almost 3 weeks (20 days).

For the next 3 or 4 cycles you have docetaxel (taxotere) as a 1 hour drip (infusion) on the first day of each cycle. Then you have no treatment for almost 3 weeks (20 days).

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 doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working. Your doctor may recommend a drug called GCSF (granulocyte colony stimulating factor) to help prevent these effects. It is more common to have it with the docetaxel part of the treatment. Some people have a single injection and others have it over several days.

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
• Complete head and body hair loss occurs in almost everyone treated with FEC - it usually begins 2 to 5 weeks after the treatment starts but your hair will grow back once the treatment ends
• Feeling or being sick can be quite severe but anti sickness injections or tablets usually control it - it usually starts a few hours after each treatment and lasts for about a day. Tell your doctor or nurse if it is not controlled as you can try other anti sickness medicines that may work better for you.
• Loss of appetite
• Diarrhoea - make sure you drink plenty of fluids and if diarrhoea becomes severe or lasts more than 3 days, tell your doctor or nurse, as they can give medicines to help
• A metallic taste or loss of taste may happen on the days you have treatment and should get better when the treatment ends
• A sore mouth or mouth ulcers
• Fluid retention occurs in about half the people who have docetaxel and you may have swelling of the hands and feet, breathlessness and weight gain - your steroids will help to prevent these effects
• A skin rash which may itch affects about half the people treated with docetaxel (50%)
• Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar - plantar syndrome) which may cause tingling, numbness, pain and dryness
• Your fingernails may change colour
• Up to 1 in 4 people (25%) have an allergic reaction while having docetaxel treatment, usually the first or second time. Some people have a reaction to epirubicin. Let your treatment team know immediately if you have any skin rashes, headaches, itching, feel hot or shivery, go red in the face, feel dizzy or breathless or anxious, or have a sudden need to pass urine.
• Irritated eyes - they may feel as if they have grit in them and you may have blurred vision or watery eyes. Your doctor or nurse can prescribe eye drops to help.
• FEC-T may have a harmful effect on a developing baby so it is not advisable to become pregnant or father a child if you are having this treatment - talk about contraception with your doctor before having the treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) during the treatment but this may only be temporary
• Loss of fertility - you may not be able to get pregnant or father a child after treatment with these drugs so it is important to talk to your doctor about your fertility before starting treatment
• Your urine may become a pink or red colour the day after having epirubicin - this is nothing to worry about

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

• Skin changes - your skin may darken or be very sensitive to sunlight. Use a high factor sun cream and cover up when you go out
• Brown markings on the skin following the line of the vein where fluorouracil has been injected
• Nail changes - your nails may become ridged, darken or get brittle and chip or break easily
• Liver or kidney changes - you will have regular 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 immediately
• Cyclophosphamide can cause burning, stinging or pain on passing urine (cystitis) - if you see blood in your urine contact your doctor straight away
• Damage to heart muscle from epirubicin, which may make your heartbeat irregular - this usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
• Aching muscles and joints
• A high temperature (fever)

Fewer than 1 in 100 people have these.

• There is a small risk of developing another cancer in the future after treatment with these drugs - if this is going to happen, it most often occurs 5 to 8 years after treatment
• Confusion or unsteadiness due to the effect of fluorouracil on nerves
• Long term changes in lung tissue due to cyclophosphamide can cause a cough or breathlessness
• Burning or stinging pain on passing urine (cystitis) - if you see blood in your urine tell your doctor or nurse straight away

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 other 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, these 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. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.