FEC–T (also known as FEC-D) is the abbreviation for the 4 cytotoxic
drugs used in the breast cancer treatment protocol.
The drugs are:
F - fluorouracil (also
called 5FU)
E - epirubicin
(Pharmorubicin ®)
C - cyclophosphamide
T - docetaxel (Taxotere
®)
Each
cycle of FEC-T takes 21 days (three weeks). FEC–T chemotherapy is divided into
two parts. In my case, I have to go through three cycles of FEC (5FU,
Epirubicin and Cyclophosphamide) over the first few weeks followed by another
three cycles of docetaxel on its own over the next 9 weeks.
Patients’ responses to the same
chemotherapy regimen may certainly differ. As for me, I would love to say that
I sailed through the 3 cycles of FEC-T treatment with ease as compared with other
patients’ account of their ordeal, which I truly empathize.
Here I did some post-mortem on
the common side effects which I have experienced and/or probably circumvented.
Chemotherapy-induced nausea and vomiting (CINV)
A good pre-medication regimen is definitely
crucial to ensure good quality days after each chemotherapy session, which simply
meant the ability to eat, drink and feel good. I understood that some of these
new drugs such as palanosetron HCl injection (Aloxi) and aprepitant capsules
(Emend) are expensive and may not within reach for some. For example, the price
of Aloxi Injection is RM 599.50 (before reconstitution) and the price of Emend
(which comes in 3 capsules for 3 days) is RM 443.90.
FEC-T regimen is categorized as
highly emetogenic chemotherapy, meaning there is a high risk for patients
developing severe nausea and vomiting (>90%). Aprepitant is NK1 receptor
antagonist given orally up to Day 3, meanwhile palonosetron HCl is a long
acting 5-HT3 receptor antagonist given as IV on Day 1 only. Although both anti-emetics
are indicated for this regimen, not all oncology clinics are prescribing them.
Aprepitant is a substance
P/Neurokinin-I receptor antagonist. Substance P is an important first responder
to most noxious and extreme stimuli and acts as an immediate defence, repair
and survival system. The release of substance P during an episode of stress,
for example, in response to cytotoxic drugs as in chemotherapy, stimulates the
vomiting reflex in the brain. Aprepitant acts by inhibiting this substance
effectively.
In addition to substance P, cytotoxic
drugs also cause the release of serotonin, which triggers CINV by binding to
the 5-HT3 receptors in the brain. Panolosetron binds tightly and selectively
onto the 5-HT3 receptors, inhibiting the activation of this receptor by serotonin,
and subsequently preventing nausea and vomiting. The anti-emetic effect of a
single injection is known to last up to a few days, thus very effective for
delayed CINV.
These newer generation of
anti-emetics targeting different pathways, were truly helpful, in my case. I do
hope these drugs will be made accessible to as many patients as possible, as there
is a significant difference in the quality of life one gets. There are also
plenty of clinical studies to support this claim.
Anticipatory nausea is common
among some women, including me. Strangely, I felt nauseous a day or two before
my 2nd and 3rd cycle! Although these anti-emetic drugs
are superb, there may be some tolerance effects after several cycles. One may still feel a queasy after Day 3 of subsequent
cycles. For instance I have to take metoclopramide for another 1-2 days after
Day 3 of Cycle 3. However, the queasiness did not prevent me from eating
normally. Yes, I would also like to add that having no issues with mouth sores
or ulcers throughout the cycles helped a lot too.
Hair, scalp, skin and nails
In my case, significant hair loss
occurred following 1-2 days of scalp tenderness and sensitivity at about Day 15
of Cycle 1. Sleeping on the pillow was a bit tricky; it may be due to the
weight of the hair. As soon as I got it shaven, the pain was gone.
 |
| my long hair |
 |
| shorter hair to face chemotherapy |
 |
| getting used to scarves, hats and bandanas! |
In some oncology setting, the
nurses would recommend the use of cooling cap to reduce the incidence of hair
loss. Apparently this practice works for some patients. Sadly, the nurses here
did not offer me this!
Surprisingly I did not experience
anymore hair loss in subsequent cycles of FEC treatment. Tiny hairs were seen
growing and existing hair grew longer over time. Fortunately, my eyebrows and
eyelashes were spared and I had to shave my legs and armpits throughout the 3
cycles. I wash my scalp every day with L’Occitane repairing shampoo followed by
L’Occitane scalp essence, and I think it works to keep the scalp moist and free
from dandruff.
Acne breakouts occurred a few
days after Cycle 1, but somehow controlled in subsequent cycles. Dexamethasone is
known to cause acne flaring up. All three cytotoxic drugs are not documented
with this side effect though. I used Retin-A and it works wonderfully fast.
Overall, there was no skin darkening and/or dryness. I guess my efforts paid
off, I have been diligently moisturizing my skin with a nice soothing cream
after shower every day, even on really tiring days!
Hardened veins
The veins on the hand where the injections
flow inevitably become hardened over time. In my case, the injections have to
be consistently on my right hand, as I had a left breast lumpectomy and
axillary clearance. Not a pleasant experience though, you won’t feel the pain
unless you massage your hand and deliberately tracking the swollen channels.
Apparently, all we can do is to start exercising the fingers by grappling a soft
toy to condition the veins again!
Eye discomfort
I had eyes discomfort and dryness
during all three cyclophosphamide infusion, but easily resolved with some eye
lubricant or artificial tears, have them with you always.
Oral hygiene and taste
I probably have circumvented the
trouble of managing mouth sores and/or ulcers throughout the FEC cycles by
being paranoid about it in the first place! I guessed my strict oral hygiene,
scheduled sodium bicarbonate solution rinsing after food, and a week of
prophylactic spraying of the gingival spray containing hyaluronic acid 0.01 %
before bed helped! Avoidance of spicy or high temperature food may also be a
contributing factor. Well, being Chinese, we are used to bland and soupy food,
thus I am not exactly sure if I ever had the metallic taste in my mouth. The
funny thing was I craved for spinach, bayam and kalian greens most of the time!
 |
| I had a nice simple meal yesterday! |
Epirubicin and pinkish pee
Epirubicin is usually infused
first before 5-FU and cyclophosphamide in a typical chemotherapy treatment session.
The oncology nurse would brief and caution you about the possible side effects such
as pain or swell at the injection site, simply because epirubicin is a vesicant!
Extravasation (leaking of
solution into surrounding tissues) of epirubicin hydrochloride injection during
the infusion may cause local pain, severe tissue lesions and necrosis. I was totally
paranoid about this and I never failed to ask for assurance before each
infusion. I knew they were dealing with
someone who is a bit of a pain in the ass!
I also developed the habit of
going to the loo before each drug infusion, just to make sure I clear the “metabolites”
before the next…oh my, more of my imagination!
Epirubicin (4'-epidoxorubicin) is
derived from doxorubicin, with lower cardiotoxicity risks. Epirubicin, like
doxorubicin, interferes with the synthesis and function of DNA, and stop cancer
cells from dividing. It is metabolized by the liver and primarily eliminated in
the bile. About 10% of the drug is eliminated in the urine. The hydrochloride
salt of epirubicin is a red, free flowing crystalline powder, hence, the scary
red solution in the infusion bag! This drug is rapidly excreted through the
kidneys, thus you will observe pinkish urine within ½ hr! Nothing alarming,
just make sure the sensitive areas are wiped clean or rinsed every time you visit
the loo. If you consistently drink water or get yourself hydrated during the
infusion, you probably won’t find the colour once you reached home!
 |
| Just imagine this solution going into the blood.... |
Minor lower rib and backache
I had minor lower rib pain and
back ache but manageable without the need of analgesics. There are different
reasons why we experienced pain or sore I guess. Well, my oncologist assured me
that the backache is a result of bone marrow cells reproducing after the great
wipe out earlier, hence explaining the sore or uncomfortable feeling around bony
areas, including the ribs.
Chemofarting
Some chemotherapy drugs alter the
motility and affect the normal flora present in the intestines causing
indigestion, stomach cramps, accumulation of gas, constipation or diarrhoea,
depending on individuals.
In my case, the first 1-2 days of
constipation was easily settled with a single Senokot tablet (available as OTC
from the pharmacy). Overall, I had a
pretty good bowel movement throughout the cycles, I swear by the daily fresh
beetroot juice!
Unfortunately I do have
flatulence issues, totally embarrassing! My diet of cruciferous vegetables may be a
major contributing factor. Ginger and regular exercises (walking) helped to a
certain extent, but decided to live with it for the time being, with the help
of some aromatherapy oils!
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| regular walking definitely helps with the windy tummy! |
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