Side effects of vincristine, actinomycin D (dactinomycin) and cyclophosphamide (VAC)
Find out about the side effects of the chemotherapy drug combination VAC for bone cancer.
VAC stands for the chemotherapy drugs vincristine, actinomycin and cyclophosphamide.
Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%) having this treatment. You might have one or more of them.
You might notice you:
- bruise more easily
- have nosebleeds
- have bleeding gums when you brush your teeth
This is due to a drop in the number of platelets that help clot your blood.
If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called 
.
Tell your doctor or nurse straight away if you have this.
You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away.
Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.
Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.
Your white blood cell level begins to fall throughout your chemotherapy treatment. Then it gradually goes up again.
When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).
You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.
Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.
You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.
You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.
Your energy levels should be back to normal within 6 months to a year after finishing treatment. A low red blood cell count will also make you feel tired.
You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.
Talk to your doctor or nurse if you are finding the tiredness difficult to manage.
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.
Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.
Tips
- Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
- You could choose a wig for a whole new look.
- Think about having your hair cut short before your treatment starts.
- Some people shave their hair off completely so they don't have to cope with their hair falling out.
- Wear a hairnet at night so you won't wake up with hair all over your pillow.
Feeling or being sick can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.
Tips
- Avoid eating or preparing food when you feel sick.
- Avoid foods that are fried, fatty, or have a strong smell.
- Drink plenty of liquid to stop you from getting dehydrated.
- Relaxation techniques help control sickness for some people.
- Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
- Fizzy drinks help some people when they’re feeling sick.
Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.
Tips
- Keep your hands and feet warm.
- Wear well fitting, protective shoes.
- Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
- Use oven gloves when cooking and protective gloves when gardening.
- Moisturise your skin at least a couple of times a day.
- Take care when cutting your nails.
Your mouth and throat might get sore. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.
You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.
Tips
- Eating several small meals and snacks throughout the day can be easier to manage.
- Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
- You can make up calories between treatments for the days when you really don’t feel like eating.
- Drink plenty of fluids even if you can't eat.
- Don't fill your stomach with a large amount of liquid before eating.
- Try to eat high calorie foods to keep your weight up.
Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you.
Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.
Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.
Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.
You might have darkening of the skin, particularly along the vein where your cannula is.
Women might stop having periods (amenorrhoea) but this may be temporary.
Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men
You may be able to store sperm before starting treatment.
It can take a few months or sometimes years for fertility to return to normal. You can have sperm counts to check your fertility when your treatment is over. Ask your doctor about it.
Women
Chemotherapy can cause an early menopause. This stops you from being able to become pregnant in the future. Talk to your doctor about this before your treatment. It’s sometimes possible to store eggs or embryos before treatment.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.
Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.
You might have pain when you pass urine. Or you may see blood when you pass urine. This is caused by inflammation of the bladder. Let your doctor know if this happens.
You should drink 8 to 12 cups of fluid a day to try to prevent this.
You might get a high temperature and chills.
Tell your doctor or nurse if you’re feeling depressed. They can arrange for you to talk to someone and give treatment if necessary.
You might have abdominal (tummy) cramps. Let your nurse know. There is medication that can help.
Your nails may darken or become ridged.
Changes in taste can make you go off certain foods. Many people go off tea and coffee, for example. You might also find that some foods taste different. Some people find that they prefer to eat spicier foods.
Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.
Tips
- Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
- Season your food with spices or herbs, such as rosemary, basil and mint.
- Garnish cold meat or cheese with pickle or chutney.
- Try lemon or green tea if tea or coffee taste strange.
- Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
- Some people find that cold foods taste better than hot foods.
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.
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.
There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.
Changes to the heart muscle may happen in some people. This is usually temporary but for a small number of people might be permanent. Your doctor will check your heart before and after your treatment.
There is a small, more serious risk of heart faliure after a lot of treatment with VAC. Your doctor will talk with you about this.
This might be because of changes in lung tissue. Let your doctor or nurse know straight away if you are breathless.
About VAC
More information about this treatment
We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.
You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
