Taxotere and cyclophosphamide (TC)

TC is a combination of 2 cancer drugs used to treat breast cancer. It includes the drugs we list below, next to each drug we have how you pronounce it.

• taxotere - (T) tax-oh-tear (also called docetaxel)

• cyclophosphamide - (C) sike-low-foss-fa-mide

How does TC work?

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

How do you have TC?

You have taxotere and cyclophosphamide 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. You have a new cannula each time you have treatment.

How often do you have TC?

You usually have taxotere (docetaxel) and cyclophosphamide as cycles of treatment. A cycle is the time between one round of treatment until the start of the next. This means that you have these drugs and then a rest to allow your body to recover.

You may have up to 4 cycles. Each cycle lasts 21 days (3 weeks) so it takes about 3 months. You have chemotherapy only on day 1 of each cycle.  

You have each cycle of treatment in the following way:

Then you start your next cycle of treatment.

Preventing allergic reactions

Taxotere can cause an allergic reaction. To try to prevent this, your doctor or nurse gives you steroid tablets to take. You usually take them for 3 days, starting the day before each treatment.

Steroids can raise your blood sugar. If you have diabetes, it may lead to higher blood sugar levels. Please speak your doctor or pharmacist if you are concerned. 

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 TC?

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, 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).

Breathlessness and looking pale

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

Loss of appetite 

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. 

Numbness of 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. 

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.

Sore mouth

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

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

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.

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. Some people may have permanent hair loss although this is rare.

Soreness and inflammation of the bladder

You might have pain, burning, and stinging when you have a wee. This is called cystitis. You might also have other symptoms such as needing to wee more often or urgently or have foul smelling wee. Less commonly you might pass blood in your wee.

Tell your nurse or doctor if you have these symptoms. 

Kidney problems

You may develop a kidney condition that affects the blood cells causing inflammation of the kidneys. This causes small blood clots in the vessels to form and stops the kidneys from working properly. 

Less commonly these drugs can cause kidney failure. Symptoms might include passing urine less often, a build up of fluid in your ankles and legs, confusion, shortness of breath and weakness. Rarely you may have a kidney condition that causes your body to change the balance of salt (sodium) and water in the body. Symptoms include muscle and joint aches and pain which may be severe and feeling or being sick.

Let your healthcare team know if you have any of these symptoms. 

Skin changes and soreness, redness and peeling on palms and soles of feet

Skin changes include darker skin and rashes, which may be itchy. The skin on your hands and feet may also become sore, red, or may peel.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy moisturise it regularly. Your healthcare team will tell you what moisturiser to use. And wear a high factor sunscreen if you’re going out in the sun.

Nail changes

Your nails may become darker or lighter during treatment. They might also be painful, become loose and come off.

Fluid build up

A build up of fluid (oedema) may cause swelling in your arms, hands, ankles, legs, and other parts of the body. Contact your doctor if this happens to you.

Lack of energy and strength

This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet.

Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.

Eye problems

You might have problems with your eyes, including watery eyes and an infection causing red, sticky, and painful eyes (conjunctivitis). Less commonly your eyes may feel itchy and rarely your eyes may become swollen, or it may affect your eyesight.

Let your doctor or nurse know if you have any problems with your eyes.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Allergic reaction

A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Changes in your periods

Your periods might be irregular, or they may stop completely (menopause) while you have this treatment. For some people this might be permanent. Symptoms of menopause include hot flushes and vaginal dryness.

Pain in different parts of your body

You might have pain in your muscles and joints. Less commonly you might have tummy (abdominal) or chest pain. Contact your advice line straight away if have pain.

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:

• breathlessness due to changes in your lung

• liver changes - you will have regular blood tests to check this

• shivering and shaking (chills)

• a fast or slow heart rate and changes to the rhythm of your heartbeat (arrhythmia), and problems with your heart pumping

• low blood pressure - tell your healthcare team if you feel dizzy, lightheaded or have shortness of breath

• difficulty swallowing

• hot flushes and sweats

• inflammation around veins and drip site causing redness, pain and swelling - tell your nurse straight away if you see this

• low sperm count or no sperm production

• feeling dizzy

• problems with hearing

• weight gain

• you may develop a cough

• you might have inflammation along your digestive system including your mouth, throat and tummy. You might have symptoms such as heartburn and pain when swallowing or pain in your tummy. Speak to your doctor or nurse if you have this

• raised blood sugar levels – you will have blood tests to check this

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

• sharp, severe, shooting pain anywhere in the body caused by a damaged nerve (neuralgia)

• feeling faint

• a second cancer developing sometime after treatment. This could be a blood cancer like leukaemia

• feeling very drowsy

• damage to the brain and nervous system (neurotoxicity). Symptoms include headaches, feeling confused and changes in your speech. Call your advice line if you have these symptoms

• dehydration

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 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.

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.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least a year 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.

Breastfeeding

Don’t breastfeed during this 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.