Your doctor has recommended a chemotherapy regimen called PCV as one of the treatments for your brain tumour. PCV consists of three chemotherapy drugs:

Procarbazine Cream capsules taken on day 1-10 of the cycle, Lomustine (CCNU) Blue/white capsules, taken on the first day, and Vincristine which is given as an injection into the vein on the first day. This cycle is repeated every six weeks. CT or MRI scans will usually be performed after every three cycles to assess the effectiveness of your chemotherapy. 

The exact dose of chemotherapy will be calculated from your height and weight, which are used to calculate your surface area. Swallow (do not chew) the capsules whole with a drink and try to take the tablets on an empty stomach, for example, at least one hour before breakfast. It is best to take it at approximately the same time each day. If a capsule is damaged, avoid contact of the powder with your skin, eyes and nose. If you do accidentally get some in your eyes wash with warm water. 

Before each course of chemotherapy you will see a doctor and have a blood test.

If your blood count is low then chemotherapy may be delayed or the dose reduced.

It can take 2-3 cycles of chemotherapy to see any improvement in your condition physically, in terms of quality of life and a reduction in size of the tumour on a scan. We have outlined side effects you may experience during treatment. It is important that you feel free to ask questions so that you understand what to expect and what to do. Occasionally people have rare side effects that are not expected or mentioned on this sheet.  If in doubt please ask!  

Side effects 

Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different  tablets can be prescribed for the next cycle. Some self help tips may also be useful.

• White Blood Cells (WBC) Shivering or shaking attacks of fever (flu like symptoms). If you feel hot or unwell check your temperature. A raised temperature indicates you have an infection which could be life threatening. A normal temperature is between 36^oC and 37.2^oC. If it is 38°C (100F) telephone the Hospital or cancer unit immediately and they will advise you. Do not take Paracetamol or Aspirin as this will bring your temperature down and mask the signs of infection.  This is most likely to happen in the middle week (7-14 days) between cycles.

• Haemoglobin (Hb) Tiredness, lethargy, breathlessness, dizziness (particularly on standing) and pale facial colour. Occasionally patients require a blood transfusion at some point during the whole course.

• Platelets If you notice any bleeding, i.e. nose bleeds, unexplained bleeding, bruising or persistent headaches contact the Hospital immediately.

Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.

Contact to chicken pox; If you can't remember whether you've had Chicken Pox as a child and you come in contact with a person who as it or shingles you should contact your oncology team. They will arrange a blood test to find out if you are immune to chicken pox (the varcella virus). If not a series of injections can be administered to offer you temporary immunity.

Weight gain; Over the entire course of chemotherapy many patients complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake.

Weight loss may also be experienced by some patients during their course of chemotherapy particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.

Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash. If you develop mouth ulcers you should contact your clinic and they can prescribe special mouthwashes to help. 

Hair loss; This chemotherapy does not usually cause hair loss. However, if you experience some hair loss, this is temporary and your hair will regrow after treatment. Some departments use a cold cap system to minimise hair loss. Your clinic nurse can arrange for you to have a wig before your treatment starts (NHS prescription charge, prices are approximately £55 for an acrylic wig, £140 for half real hair wig and  £205 for a full real hair wig).  

Fertility may be affected by chemotherapy, in both men and women.  It is important to discuss fertility with your doctor before starting treatment. For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent causing menopausal symptoms. You should not become pregnant during chemotherapy, as chemotherapy will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant.Men must also use a barrier contraceptive whilst receiving chemotherapy as sperm is damaged by chemotherapy. 

Diarrhoea; This chemotherapy can cause diarrhoea, which can be easily controlled with medicine, but you should inform your doctor if it is severe or continues. It is important to drink plenty of fluids if you do get diarrhoea. If you have any alteration in bowel pattern tell your doctor.

Altered taste; You may also experience an alteration in your taste.  Food may taste slightly more salty, bitter or metallic. Normal taste will return once your treatment has finished, but may take several months to do so.  

Your veins Three types of damage can occur, listed in order of seriousness:

• You may experience darkening of the veins in your hands and arms. This is normal, usually doesn't hurt and should fade once your course of treatment has been completed.

• Towards the end of your chemotherapy course, some veins may feel hard and 'cord-like'. In these veins the blood has clotted (superficial thrombosis) which may take several months to resolve Your doctor may recommend a low dose of aspirin (ask before taking it yourself).

• These chemotherapy drugs can cause irritation and tissue damage if they leak out of the vein whilst injected. This is called extravasation. All nurses who administer chemotherapy have completed an intensive training programme and are fully aware of what to do if extravasation occurs. Rarely problems can start after you have left the Hospital. Look out for pain, stinging or burning sensations, redness or swelling around the area where the chemotherapy was given. If you notice any of these symptoms after you have left the Hospital, contact the emergency numbers you have been given. In the meantime, keep the arm raised and place a cool (not ice) pack on the area.

Increase risk of blood clots - during chemotherapy there is an increased risk of blood clots, most commonly in the legs (deep vein thrombosis) or more seriously to the lungs (pulmonary embolus). If you get unexplained swelling and discomfort in the calf report this to the oncology unit. Likewise if you start experiencing unexplained breathlessness, cough up any blood or have a pain in the chest particularly when you breath contact the clinic as soon as possible. To avoid clots its important to stay as active as possible and (exercise & chemotherapy) taking light walks two to three times a day and avoid sitting around for long periods of time. If you are required to sit (for example while receiving the chemotherapy drugs) try to move your legs and ankles regularly. Occasionally, if your doctor feels you are at high risk of developing clots you may be started on drugs to thin your blood during chemotherapy.

Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team. 

Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally.

Side effects specific to individual chemotherapy drugs:

PROCARBAZINE

Alcohol and certain foods that contain 'tyramine' can interact with Procarbazine and should be avoided.  Your chemotherapy unit will give you a list of these foods. This problem also occurs with anti-depressants called monoamine oxidase inhibitors.

Skin changes.  Procarbazine can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

A flu-like effect can occur after taking Procarbazine. You may experience headaches, aching joints or muscles, lethargy and chills.  It is important to monitor your temperature closely and report to the hospital if it is above 38°C 

Rare side-effects of Procarbazine

Numbness or tingling in hands or feet.  This is due to the effect of the drug on the nerves. Inform your doctor if you notice this. Occasionally the drug will be withdrawn from the regime.

Procarbazine may cause depression, bad dreams, sleeplessness, nervousness and feelings of fear.  However this is very rare.  These symptoms should be discussed with your doctor if they occur 

Side-effects of Lomustine (CCNU)

Lomustine is usually well tolerated at this low dose, although there are some side-effects with high doses.

It can cause temporary changes in the liver function, which returns to normal when the treatment is completed. This is unlikely to cause you harm, but your doctor will monitor it closely.

Lung changes can cause coughing or shortness of breath. Inform your doctor if you notice these symptoms developing.

Lomustine can affect your eyesight, although this is very rare. Inform your doctor if you notice any change in your vision 

Side-effects of Vincristine

Some patients experience abdominal cramps and constipation.  It usually helps to drink plenty of fluid, eat a high fibre diet and take gentle exercise.  If this doesn't help, your doctor can prescribe some medicine to help.

Numbness or tingling in hands or feet.  This is due to the effect of the drug on the nerves. Inform your doctor if you notice this.  Occasionally the drug will be withdrawn from the regime.[i] 

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.