Decorative image

FEC

FEC is the name of a combination of chemotherapy drugs.

What is FEC?

The FEC chemotherapy combination includes:

  • F – fluorouracil (5FU)
  • E – epirubicin
  • C – cyclophosphamide

It is a treatment for breast cancer.

How does FEC work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have FEC?

You have FEC into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

How often do you have FEC?

You have FEC chemotherapy as cycles of treatment Open a glossary item. This means you have the drugs and then a rest to allow your body to recover.

Each cycle of treatment lasts 3 weeks. You usually have up to 6 cycles of treatment.

You have all 3 drugs on the first day of each 3 week cycle.

You might also have an injection of a drug called G-CSF. This is a type of growth factor Open a glossary item that makes the body produce white blood cells to try and reduce the risk of infections.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of FEC?

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Less often you might have bleeding from other areas of the body. Let your doctor or nurse know if this happens.

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Eye problems

Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). Tell your doctor or nurse if this is a problem for you. They can prescribe medicines to help. Try to avoid dust, pollen or animal hairs as they can make the watering worse. 

You might have red or inflamed eyes or eyelids. Less commonly you might have vision changes such as sensitivity to light or double vision.You might have blocked tear ducts or your eyelids might turn outwards.

Pink or red urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Inflammation of the bladder (cystitis)

You might feel that you have to pass urine more often than usual. And you may have a burning feeling when you do. Or you might feel that you can't wait when you need to go. This is called cystitis. 

It helps to drink plenty of fluids. Some people think that cranberry juice can help but others feel it makes the soreness worse. Research studies haven't found that it helps. 

You might find that some drinks increase the soreness, such as tea and coffee. You can experiment for yourself and see what works for you.

Don't take any over the counter medicines for cystitis as they could be harmful.

Tell your doctor or nurse if you have soreness. They can prescribe medicines to help.

Periods stopping

This might go back to normal after treatment. Talk to your team about this.

Less commonly you might have changes to how your ovaries are working.

Liver changes 

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Redness, soreness or peeling on hands and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.

Skin rashes

You might sore or red skin or a rash, itching, dry skin and skin colour changes . Less commonly you might have brown markings following the line of the vein where you had treatment (called vein tracking).

Hot flushes

We have some tips for coping with hot flushes and the possible treatments for men and women. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe you some medicines.

Irritation of the vein (phlebitis)

Let you team know if you have any pain along the vein during or between treatments.

Inflammation of the lining of the bowel

Inflammation of the bowel lining can cause abdominal pain, bloating or diarrhoea. Speak to your doctor if you have these symptoms.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after having this treatment.

High temperature

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and10%). You might have one or more of them. They include:

  • heart problems such as changes to your heart rhythm, inadequate pumping of the blood by the heart, chest pain and changes to a heart trace (ECG) test. Less commonly, you might have changes to the heart muscle.
  • loss of appetite
  • changes to the colour of your nails. Rarely your nails might have ridges, pain or inflammation in the nailbed, or nails might come away from the nailbed.
  • low levels of fluid in the body (dehydration)
  • redness, swelling or leaking at your drip site
  • flushing
  • pain or bleeding from damage to the lining of the bowel (ulcer)

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • feeling short of breath, cough, and a tightening of the chest. Let your team know straightaway if you are finding it difficult to breathe
  • confusion or unsteadiness
  • taste changes
  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening alert your nurse or doctor if notice any of these symptoms
  • hearing loss (deafness)
  • nerve pain (neuralgia)
  • high levels of substances in the blood such as lactate dehydrogenase, C-reactive protein or uric acid
  • heavy bleeding from the lining of the bowel
  • a second cancer some years after having FEC treatment
  • numbness or tingling in fingers or toes (peripheral neuropathy)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Alcohol

Some brands of the drugs contain alcohol (equal to half a glass of wine or half a pint of beer) and may make you drowsy or dizzy, especially if you have drunk alcohol. Don't operate machinery or drive if you feel drowsy.

Grapefruit and grapefruit juice

You should not eat grapefruit or drink grapefruit juice when you are taking these drugs because it may increase the side effects.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and some time afterwards.  During and after this treatment you should use effective contraception, speak to your doctor or nurse about this.

Women

Women should not become pregnant during treatment and for 12 months after finishing treatment.

Men

Men should not father a child during treatment and for 6 months after finishing treatment

Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
26 Apr 2021
Next review due: 
26 Apr 2024
  • Electronic Medicines Compendium 
    Accessed August 2020

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott, Williams and Wilkins, 2012

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Breast Pathway Group – FEC(100)-Docetaxel: Fluorouracil / Epirubicin / Cyclophosphamide followed by Docetaxel in Early Breast Cancer
    London Cancer Alliance (LCA) West and South, 2016

  • 5 Fluorouracil (5FU), Epirubicin & Cyclosphosphamide (FEC)
    The Christie NHS Foundation Trust, 2014

  • Sequential Adjuvant Epirubicin-Based and Docetaxel Chemotherapy for Node-Positive Breast Cancer Patients: The FNCLCC PACS 01 Trial
    H Roche and others
    Journal of Clinical Oncology, 2006. Vol 24, Number 36, Pages 5664-5671