Fluorouracil, epirubicin, cyclophosphamide and docetaxel (FEC-T)

FEC-T is the name of a chemotherapy combination that includes:

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

It is a possible treatment for breast cancer. 

How it works

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

How you have FEC-T

You have all the drugs of FEC-T into your bloodstream (intravenously).

You have the drugs through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment. Or you might have it through a long line: a central line, a PICC line or a Portacath. These are long plastic tubes that give the drug into a large vein in your chest or arm. The tube stays in place throughout the course of treatment.

When you have FEC-T

You have FEC-T every 3 weeks. Each 3 week period is called a cycle of treatment. You usually have up to 6 of cycles of treatment. 

For the first 3 cycles of treatment

You have fluorouracil, epirubicin and cyclophosphamide (FEC) on the first day of each cycle. It takes about 30 minutes to have these 3 drugs. You then have no treatment for almost 3 weeks (20 days). 

For the rest of the cycles

You have docetaxel (T) on the first day of each cycle. It takes over an hour to have it each time. You then have no treatment for almost 3 weeks (20 days). 

You might also have injections of a drug called G-CSF with each treatment. This is a type of growth factor that makes the body produce white blood cells to try to reduce the risk of infections. You might have G-CSF as an injection just under the skin (subcutaneously). 

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:

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).

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. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

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.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

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. 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.

Red or pink urine

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

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. 

Allergic reaction 

Symptoms of an allergic reaction include a skin rash, itching, back pain, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.

Numbness or tingling in fingers and toes 

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Your treatment team will keep a close eye on you. They may need to lower the treatment dose to try to stop your symptoms from getting worse.

Difficulty breathing 

You may have difficulty breathing with wheezing and coughing. Let your doctor or nurse know straight away if this happens. 

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.

Pain

You might have pain in your joints, muscles and other parts of your body. Tell your doctor or nurse if you have pain so they can give you painkillers and advice on what to do to help. 

Build up of fluid that may cause swelling

This treatment may cause swelling of the face, hands and feet, breathlessness and weight gain. This is due to a build of fluid.

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:

  • heart problems such as changes to your heart rhythm and to your blood pressure
  • liver changes that are usually mild and unlikely to cause problems
  • redness, swelling, leaking or pain at your drip site
  • constipation

Rare side effects

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

  • confusion or unsteadiness
  • urine infections
  • damage to the heart muscle that is usually temporary
  • breathless and cough due to an infection or changes to the lung tissue
  • a second cancer some years after having treatment

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 drinks 

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.

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 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 for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into 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 one of the shingles vaccines called Zostavax.

You can have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system Open a glossary item recovers from treatment.

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 as this is a live vaccine. 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: 
21 May 2019
  • Electronic Medicines Compendium
    Last accessed May 2019

  • Patient agreement to systemic anticancer therapy: FEC-T
    Consent forms for SACT (Systemic Anti-Cancer Therapy), Cancer Research UK. Last accessed May 2019 
     

  • 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

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