POMB/ACE

POMB/ACE is the name of a chemotherapy combination that includes:

  • P – CisPlatin
  • O – Vincristine, which is also called Oncovin
  • M – Methotrexate
  • B – Bleomycin
  • A – Actinomycin, which is also called Dactinomycin
  • C – Cyclophosphamide
  • E – Etoposide

You also have a drug called folinic acid after you have had the methotrexate. Methotrexate stops some normal cells working properly, causing side effects. Folinic acid helps the normal cells to recover and reduce side effects. 

POMB/ACE is a treatment for germ cell tumours that have spread to the brain or the spinal cord (the central nervous system). Testicular germ cell tumours are the most common type of germ cell tumours. 

How POMB/ACE works

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

How you have POMB/ACE

You have the drugs into your bloodstream (intravenously).

You 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

When you have POMB/ACE

You have POMB/ACE as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

Each cycle of treatment lasts 2 weeks. For the first 2 cycles you have POMB. Then you alternate between POMB and ACE every 2 weeks.

Depending on your cancer type you may have between 5 and 7 cycles.

You have POMB/ACE in this order:

  • cycle 1 and 2 - POMB
  • cycle 3 - ACE
  • cycle 4 - POMB
  • cycle 5 - ACE
  • cycle 6 - POMB
  • cycle 7 - ACE

POMB:

You usually have POMB in the following way:

Day 0
  • You have continuous fluids into a drip for several days before, during and after your chemotherapy.
Day 1
  • You have vincristine as a drip over 15 minutes.
  • You have methotrexate as a drip over 24 hours.
Day 2 and 3
  • You have bleomycin as a drip over 12 hours.
Day 4
  • You have cisplatin as a drip over 12 hours.
Day 5 to 14
  • You have no treatment.

You then start a new cycle of treatment.

ACE:

You usually have ACE in the following way:

Day 1 and 2
  • You have dactinomycin as a drip over 30 minutes.
  • You have etoposide as a drip over 60 minutes.
Day 3
  • You have dactinomycin as a drip over 30 minutes.
  • You have etoposide as a drip over 60 minutes.
  • You have cyclophosphamide as a drip over 30 minutes.
Day 4 to 14
  • You have no treatment.

You then start a new cycle of treatment.

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.

Side effects

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.

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

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:

Increased 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. 

Bruising, bleeding gums or nose bleeds

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).

Rarely you might bleed from other areas of the body. Tell your medical team if you notice any bleeding.

High temperature (fever)

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.

Sore mouth, throat and lips

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

Liver changes

You might have liver changes. Symptoms might include yellowing of the skin and whites of your eyes (jaundice). Or changes might only show on your blood tests.

You have regular blood tests to check for any changes in the levels of liver enzymes. 

Indigestion or heartburn

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

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.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Kidney changes

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

Breathlessness and looking pale

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

Tiredness and weakness (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.

Diarrhoea and constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Changes in levels of minerals in your blood

You may have changes in levels of minerals and salts in your blood, including low levels of sodium, magnesium, calcium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

Inflammation around the drip site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Poor blood flow in your fingers and toes

These areas might look pale and feel cold. Tell your medical team if this is happening. 

Scleroderma

This is an autoimmune condition which can happen with bleomycin. Collagen is laid down in the skin and body organs, thickening them and stopping them working well. It can affect joints, tendons, and internal organs. 

Skin and nail problems

Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.

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. 

Soreness and inflammation of the bladder

Inflammation of the bladder causes a burning feeling when passing urine and the need to pass urine often. Tell your doctor or nurse if you have this and try to drink plenty of fluids.

Less commonly your urine might have blood in it, passing urine may be painful or you may find it difficult to pass urine.

Changes to your hearing

You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.

Occasional side effects

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

  • a serious reaction to an infection (sepsis) signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
  • headaches and dizziness
  • drowsiness
  • heart problems such as slow, fast or irregular heartbeat – rarely this can cause a heart attack
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
  • chills
  • low or high blood pressure
  • seizures (fits)
  • a second cancer called leukaemia - more rarely this could cause bladder cancer, lymphoma and myelodysplastic syndrome
  • 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

Rare Side effects

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

  • depression
  • high blood sugar levels
  • skin and eyes being sensitive to light
  • joint pain
  • weakening of the bones (osteoporosis)
  • weakness on one side of your body
  • numbness and tingling in your fingers and toes
  • ulcers and swelling (inflammation) of the stomach, bowel, bladder or vagina
  • loss of taste or a metallic taste in your mouth
  • low levels of albumin in your body that can cause swelling and weakness
  • loss of body fluid (dehydration)
  • high levels of chemicals in your blood due to the breakdown of tumour cells - you will have regular blood tests to check for this
  • difficulty swallowing
  • flushing of the skin
  • your periods may be irregular
  • reddening of skin areas that have had radiotherapy
  • eye problems – blurred or changes to your vision, swelling, infection and watery eyes
  • nerve problems – symptoms include stabbing, burning and severe pain
  • swollen breasts in men which can be painful

Other side effects

There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • inflammation of your back passage (rectum) and food pipe
  • a build up of fluid in your tummy (ascites)
  • jaw pain
  • changes to your bowel habits
  • liver condition called veno occlusive disease (VOD) – symptoms include jaundice, ascites, swelling of your liver, arms, legs and tummy

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

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?

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.

You should not eat grapefruit or drink grapefruit juice when you’re having this treatment as it can react with these drugs. 

Avoid drinking alcohol while having this treatment.

Loss of 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.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with these drugs and for at least a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

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.

Related links