VAC

VAC is the name of a combination of chemotherapy drugs used to treat a type of bone cancer called Ewings sarcoma. It is made up of the drugs

• Vincristine
• Actinomycin D (Dactinomycin)
• Cyclophosphamide

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

You usually have VAC chemotherapy after surgery. Before your surgery you may also have another type of combination chemotherapy called VIDE.

You have chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have up to 8 cycles, taking 6 months in total.

You have VAC 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 just before your course of treatment starts and it stays in place as long as you need it.

On the first day of the treatment cycle you have vincristine and dactinomycin as injections into your cannula or central line. You also have the cyclophosphamide as a drip (infusion), usually lasting about 3 hours. You usually have cyclophosphamide with another drug called mesna, either as a drip or tablets. Mesna helps to protect the bladder from bleeding when you are having the cyclophosphamide.

On the second day you have another drip of actinomycin.

You have no treatment for the next 19 days and then start your next treatment 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 VAC 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 hospital 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

• Tiredness during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Hair loss – most people have complete hair loss starting around 2 weeks after beginning treatment but the hair grows back once the treatment ends
• Feeling or being sick is usually well controlled with anti sickness drugs
• 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 and usually goes within a few months of finishing treatment
• A sore mouth
• Loss of appetite
• Diarrhoea – drink plenty of fluid and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Constipation – 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
• Skin changes – you may have darkening of your skin (particularly along the vein where you have your injection if you have a cannula)
• 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 – these drugs can affect fertility so do talk with your doctor before starting treatment if this is important to you

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

• Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Cystitis (inflammation of the bladder) can cause pain and occasionally bleeding when passing urine – you should drink 1 to 2 litres of fluid a day and will also have extra fluids through your drip. If you see blood in your urine contact your hospital straight away
• Fever or chills
• Feeling depressed
• Abdominal cramps
• Your nails may darken or become ridged
• Taste changes
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment ends, but you will have regular blood tests to check how well your liver is working

Fewer than 1 in 100 people have these.

• There is a small risk that you may get a second cancer some years after cyclophosphamide treatment
• VAC can cause temporary damage to heart muscle, which may change the rhythm of the heartbeat. In most cases this goes back to normal after the treatment is completed. There is a small, more serious risk of heart failure after a lot of treatment with VAC. Your doctor will check your heart before you start treatment, and at times during the treatment course
• Changes in lung tissue may lead to a cough or breathlessness

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 other 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, 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.

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.