Guide for Patients Receiving PCV Chemotherapy
Barbara Rattner, R.N., M.S., Karen Murtagh, R.N., John
W. Henson, M.D., and Fred H. Hochberg, M.D.MGH Brain Tumor
booklet is designed to help you and your family have a
better understanding of the PCV chemotherapy you will
be receiving. Topics which are covered include:
-the drugs which will be used
-when each drug will be given
-the possible side effects of each drug
-how to minimize possible side effects
-schedule of follow up tests and visits
is hoped that by providing you with this information,
you will experience a greater sense of control over your
disease and treatment, and feel more comfortable participating
in your own care.
of PCV Chemotherapy Regimen
letters "PCV" refer to the three chemotherapy
drugs which will be used in your treatment. The "P"
stands for procarbazine, the "C" stands for
CCNU, and the "V" stands for vincristine. These
drugs also have other names, but these are the names used
is usually described as being given in cycles. A cycle
is the time period during which the scheduled chemotherapy
will be given. It also includes rest periods. For example,
the PCV regimen is made up of a six week cycle (42 days).
You will receive chemotherapy on day 1, days 8-21, and
day 29 of the cycle. On the other days you will not receive
chemotherapy. Your treatment will most likely consist
of six cycles of PCV.
entire treatment is performed as an outpatient. You will
need to visit your doctor three times during each cycle
(day 1, 8, and 29). Your doctor will examine you and look
at your blood count results. You will be checked for any
side effects and the size of the tumor will be checked
on follow-up scans.
of Drugs During a Cycle
will be receiving chemotherapy on certain days of each
cycle. The actual schedule of what drug(s) you will receive
on which days is:
pills - day 1
injection - day 8 and day 29
pills - days 8 through 21 (every day for 2 weeks)
Information About Chemotherapy
when a person receives chemotherapy, more than one drug
is used. This is because each drug acts in its own way
to keep cells from dividing. By using multiple attacks
on the tumor cells, there is a better chance of reducing
the size of your tumor. This is why three drugs are being
used in this regimen.
addition to the cells in your tumor, there are normal
cells in your body which are dividing. These normal cells
can also be temporarily affected by chemotherapy and may
lead to side effects. Specifically, the cells which can
be affected are the cells in your bone marrow and the
cells which line your gastrointestinal tract. The cells
in the bone marrow form the blood cells that are circulating
in your body. These cells include white blood cells which
fight infection, red blood cells which carry oxygen and
platelets which prevent bleeding. PCV chemotherapy rarely
causes injury to the cells lining the gastrointestinal
tract. Two other types of cells which may be affected
temporarily or permanently are the female egg cells and
those cells which produce sperm in the man. In men, chemotherapy
can cause sterility, and therefore may make men unable
to father a child. Men should discuss this with the doctor
BEFORE starting PCV.
possible side effects of chemotherapy will be discussed
with you before you begin treatment. After your questions
are answered, you will be asked to sign a consent form
for your treatment. A copy of the consent form can be
given to you if you wish.
you are a woman of child-bearing years you need to use
a reliable birth control method for the entire time, including
the rest periods, you are receiving chemotherapy. If you
are a man you should use a condom when you have sexual
relations within 3 days of getting chemotherapy to protect
your partner from exposure to the drug. The effects of
many chemotherapy drugs can be harmful to the growth and
development of a fetus, therefore you should not try to
become pregnant or father a child while receiving chemotherapy.
you are receiving chemotherapy, and for 3 days after,
it is important that careful attention be paid to hand
washing after urination. Since many chemotherapy drugs
are removed from the body by the urine, careful handwashing
will prevent family members from being exposed to the
chemotherapy. If family members help you with personal
care, they should wear rubber gloves when handling urine
or vomitus. Clothing soiled with urine, vomit, or feces
should be washed separately in hot soapy water.
Information About Each Drug
comes in capsule form and is taken by mouth on day 1 of
your chemotherapy cycle. Your dose is decided upon by
a calculation using your height and weight. Usually more
than one capsule will be needed to make up your dose.
most common side effect of CCNU is nausea and vomiting.
In order to prevent or minimize this an anti-nausea drug
will be prescribed for you. Some people find that taking
the CCNU before they go to sleep and taking the anti-nausea
medicine one hour before that, helps greatly in preventing
nausea and vomiting. For example, if you normally go to
bed at 11 PM, you would take the anti-nausea medicine
at 10 PM and the CCNU at 11 PM. The nurse will review
with you the time schedule for taking the CCNU and the
anti-nausea medicine at the chemotherapy appointment.
side effect of CCNU which is common is a decrease in the
number of white blood cells and platelets. This does not
happen immediately, but occurs in a few weeks to a month.
You probably will not notice any change in your day to
day activities if this occurs, or you may feel a bit tired.
A blood sample will be taken within 24 hours before your
expected chemotherapy appointment; the results will help
the doctor and nurse decide if you can receive chemotherapy.
If the white blood cell count is low you may need to watch
for and report any signs of an infection. If the platelet
count is low you may need to be careful to avoid cutting
and symptoms of infection include: fever, chills, sore
throat, painful urination, chest congestion, headache,
stiff neck or abdominal pain. You should call the doctor
immediately if you have any of these symptoms. Good oral
hygiene and handwashing can help prevent infections.
may also need to be alert to signs of bleeding. Any unusual
bruising, the appearance of tiny red dots on your skin,
nosebleeds or blood in your urine or bowels or an unusual
severe headache should be reported as soon as possible.
who have menstrual cycles and have not gone through menopause
will probably notice a change in their cycle. The bleeding
may lessen, become spotty or stop completely. The time
between cycles may also change. The menstrual cycle usually
changes after one or two complete cycles (42 - 84 days)
of chemotherapy. Some women whose menstrual cycles stop
undergo menopause, with or without symptoms. Women who
are closer to the age of menopause may not go back to
menstruating once chemotherapy stops.
chemotherapy agents in the PCV regimen rarely cause hair
loss. Sometimes CCNU can affect how the lungs work, but
this effect is rare at the dose of CCNU used in this regimen.
Other possible side effects of CCNU which are not common,
include sensitive gums, sores in the mouth, and fatigue.
is given by vein through a small needle placed in your
arm which is connected to a small bag of salt water and
tubing. The vincristine is in a small syringe which is
then connected to the tubing and injected by the nurse.
The injection only takes a few minutes.
and vomiting are rare so no anti-nausea medicine needs
to be taken. Vincristine does not affect the blood counts.
major side effect of vincristine is damage to nerves in
the hands and feet or in other parts of the body. Some
symptoms include tingling or numbness of the fingertips
and/or toes, an achy jaw and constipation. These side
effects are related to the total dose given over time,
so if they occur, it may not be until after several treatments
with this drug. Tingling or numbness can make it difficult
to button or zip; it is usually a reversible condition,
resolving after about six weeks. You should report this
symptom at your next visit.
a diet high in fiber, with plenty of fresh fruits or fruit
juices and vegetables will help prevent constipation.
Maintaining an active physical program, if possible, will
also help prevent constipation. Your doctor should be
called if you become unable to move your bowels, have
swelling of your legs, or unusual stomach pain or bloating,
or pain in your bones.
is a capsule and is taken for 14 days: from day 8 through
day 21. The major side effects of procarbazine are nausea
and vomiting and a decrease in blood counts. A prescription
for anti-nausea medicine will be given to you along with
the prescription for the procarbazine. The procarbazine
can be taken at bedtime, like the CCNU was, with the anti-nausea
pill an hour before.
has less of a tendency to cause nausea and vomiting than
CCNU. In addition, the nausea usually appears with the
first three doses, and then disappears for the following
11 days. However, if you do experience nausea and vomiting
which is severe, you should call your doctor. A change
in the anti-nausea medicine may make you more comfortable.
are certain foods which should not be eaten on the days
you are taking procarbazine. Eating these foods may cause
you to have headaches, nausea and a rapid pulse. If you
eat a restricted food by mistake, the risk of side effects
is very low, and you only need to notify your doctor if
you develop symptoms.
foods to avoid are:
Meats (smoked, cured, prime), alcohol, avocado, bananas,
broad bean pods, canned figs, aged cheeses, chocolate,
cream, fava beans, game, kippered herring, licorice,
liver, meat extracts, meat tenderizers, pickled herring,
raisins, sour cream, soy sauce, yeast extracts, yogurt
should also avoid over-the-counter cold medicines, nose
drops, cough medicines, or diet pills, and reduce the
amount of coffee you drink daily. In fact, it is a good
idea to ask your doctor before starting any new medication
while on procarbazine.
also may cause fatigue and loss of appetite and a rash.
If you get a rash while taking procarbazine, call your
doctor before you take the next dose.
men, procarbazine can cause sterility. And therefore may
make you unable to father a child. You should talk about
the possibility of sperm banking with your doctor BEFORE
you start taking the medicine.
will be seen by your doctor on days 1, 8 and 29. When
you arrive at the clinic, you will have your blood drawn
so that the blood count is known before your treatment.
If you are taking anti-seizure medicine, a level may be
the visit with the doctor you will have the chance to
talk about how the chemotherapy went at home and any side
effects you had. The doctor will also do a neurological
the doctor knows the blood count and has examined you
and says you can get the chemotherapy, you will go to
the Infusion Unit on Blake 2 for treatment by the nurse.
is a section at the back of this booklet for recording
any symptoms or questions you might have. You should bring
the booklet with you when you come to the doctor so that
all your questions can be answered. Feel free to ask or
call the nurses to discuss questions or concerns as well.
order to see how the tumor is responding to chemotherapy,
your doctor will schedule an MRI or CT scan periodically.
This is often done before the start of cycles 3 and 5and
after cycle 6. It is sometimes necessary to have a scan
earlier or later, depending on how you are feeling.
to Call the Doctor
should call the doctor in the following situations:
have signs of infectionfever, chills, pain on urinating,
unusual headache, stiff neck, sore throat, or abdominal
have signs of possible bleedingunusual bruising,
tiny red spots on your body, severe headache, unusual
abdominal pain, bright red blood from the nose or rectum
have severe nausea and vomiting which is not relieved
by the anti-nausea medicine, you vomit the anti-nausea
develop a skin rash
develop constipation which is not relieved by your usual
urine output decreases even though you are drinking your
are some of the situations your doctor needs to know about.
Sometimes it is hard to know whether to call your doctor
about a certain problem. If you are unsure, you should
make the call. This will help you avoid possible problems,
and put your mind more at ease. Before beginning treatment
you will be provided with phone numbers of the doctor
and a number at which the doctor on call can be reached
after hours or on weekends.
Help at Home
are some important things for you to do at home during
your treatment. These include:
a healthy dietwhile following the diet restrictions
during procarbazine, including plenty of fresh fruits,
fruit juices and vegetables to prevent constipation
adequate fluids-- at least 2 quarts a day unless
your doctor has restricted your fluid intake
to get some form of exercise-- even a little is better
good handwashing after toileting
alert to signs of infection or bleeding
good mouth care and personal care
down your questions for your next visit. It is a good
idea to keep all of your questions and notes in one notebook
which can be purchased at any pharmacy
your nurse for other pamphlets or reading material which
may be helpful
your anti-nausea medicines as directed. It is easier to
prevent nausea and vomiting than to stop it once it starts.
to the Physicians of Patients on PCV
doses of PCV agents are as follows:
110 mg/m2 orally on day 1
1.4 mg/m2 (maximum dose of 2 mg) i.v. on days 8 and 29
60 mg/m2/day (maximum dose of 100 mg/day) orally days
8 mg orally is excellent for control of CCNU-induced nausea.
Compazine 10 mg orally for the first three nights of procarbazine
is usually sufficient to control nausea, although some
patients do better with ondansetron.
values should be: ANC of 1,500 or greater and platelet
count of 100,000 or greater before proceeding with each
step of every cycle. Twenty-five percent dose reduction
of CCNU is commonly required to avoid prolonged delays
should be administered by physicians who are trained in
medical oncology. The doses of drugs in this booklet are
intended as a general guide.