Procarbazine, lomustine and vincristine (PCV)

Procarbazine, lomustine and vincristine is a combination of chemotherapy drugs. How you pronounce the drug names are in brackets.

• Procarbazine - (pro-kar-buh-zeen)

• lomustine - (loh-must-teen). It is also known as CCNU

• vincristine - (vin-kris-teen)

 It is a treatment for a type of brain tumour called glioma.

How does procarbazine, lomustine and vincristine (PCV) work?

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

How do you have procarbazine, lomustine and vincristine (PCV)?

You have vincristine into your bloodstream (intravenously). You take lomustine and procarbazine as capsules.

Into your bloodstream

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. You have a new cannula each time you have treatment.

When taking lomustine and procarbazine capsules you swallow them whole with a full glass of water. You should not open, crush or chew the capsules.

Taking your capsules

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

How often do you have procarbazine, lomustine and vincristine (PCV)?

You usually have procarbazine, lomustine and vincristine as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.

Each cycle lasts about 42 days (6 weeks). You usually have up to 6 cycles. The treatment will stop sooner if the side effects are too bad, or the cancer progresses. 

Exactly how you have your drugs may depend on your treatment centre. The following is an example.  

You might have each cycle of treatment in the following way:

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.

What are the side effects of procarbazine, lomustine and vincristine (PCV)?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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, cough, headaches, feeling cold and shivery, pain or burning feeling when weeing, or generally feeling 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 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).

Breathlessness 

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

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Tiredness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Tummy (abdominal) pain

Tell your treatment team if you have this. You might also have a bloated tummy and feel sick or pass more wind than usual but these symptoms are less common. If you have these symptoms, your treatment team can check the cause and give you medicine to help. 

Difficulty opening your bowels (constipation)

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

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 healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Loss of appetite and weight loss

You might not feel like eating and may lose weight. 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. 

Muscle or bone pain

You might feel some pain in your muscles and bones, particularly in your legs. You might also have pain in your jaw but this is less common. Speak to your doctor or nurse about painkillers you can take to help with this. 

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. 

Flu-like symptoms

You might have headaches, aching muscles or joints, and a high temperature. Let your healthcare team know if you have any of these symptoms. 

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:

• skin problems such as a rash

• changes to the way your liver works which are usually temporary - you have regular blood tests to check this

• loose or watery poo (diarrhoea)

• a sore or painful mouth and mouth ulcers

• changes to the way your kidneys work - you have regular blood tests to check this

• problems passing urine. For example, not being able to have a wee when you feel you need to. This can cause pain and discomfort, call your hospital advice line if this happens to you

• hearing loss

• earache

• dizziness

• an unusual ringing in your ears (tinnitus)

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:

• a second cancer such as acute leukaemia or myelodysplastic syndrome some years after this treatment

• redness, swelling, pain or leaking at your drip site

• lung changes that can cause breathlessness and a cough

• confusion or disorientation

• difficulty in walking or speaking

• problems with your eyesight such as loss of vision

• risk of losing consciousness

• heart problems

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:

• 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 you notice any of these symptoms
• high blood pressure that might cause headaches, confusion, vision problems or chest pain
• low blood pressure that can cause you to feel lightheaded or dizzy 
• vincristine may leak outside of the vein and damage the tissue around while being given (extravasation). Tell the nurse straight away if you have any stinging, pain, redness, or swelling around the vein. Although uncommon, it is important that this is dealt with quickly

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

• procarbazine
• lomustine
• vincristine

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 medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Alcohol

Avoid drinking alcohol while having this treatment. It may cause a reaction. Symptoms include flushing in your face and neck, an increased body temperature, sweating, feeling and being sick, itching and a headache.

Procarbazine can interact with alcohol, non alcoholic beers and other foods which are not fresh. More so if they have been fermented, pickled, smoked ‘hung’ or ‘matured’. Some of the foods that could cause an interaction include:

• mature or processed cheeses

• yeast or meat extracts - such as Marmite, Oxo or Bovril

• salami and pepperoni

• overripe fruit

• wines and lagers

• fermented or pickled foods

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for 7 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility 

You may not be able to become pregnant or get someone pregnant 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 and for 1 month after finishing your treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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 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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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