EC-T chemotherapy

EC-T is a combination of 3 chemotherapy drugs.

It takes its name from the initials of the 3 drugs:

• E – epirubicin
• C – cyclophosphamide
• T – docetaxel (Taxotere) or paclitaxel (Taxol), which belong to a group of drugs called taxanes

Primary breast cancer

Chemotherapy can be given to people with primary breast cancer to reduce the risk of breast cancer returning or spreading.

EC-T chemotherapy may be given:

• Before surgery, known as neo-adjuvant treatment (sometimes called primary chemotherapy)
• After surgery, known as adjuvant treatment

If breast cancer has come back

EC-T chemotherapy may be given to people whose breast cancer has:

• Come back in the chest/breast area or in the skin near the original site or scar (local recurrence)
• Spread to the tissues and lymph nodes around the chest, neck and under the breastbone (locally advanced breast cancer)

Before starting your treatment, a member of the treatment team will discuss how and when you’ll have chemotherapy and how side effects can be managed.

You’ll have blood tests and your height and weight will be measured.

You may also have tests to check your heart function, such as:

1. An ECG (electrocardiogram), a simple test that checks your heart rhythm
2. An ECHO (echocardiogram)
3. A MUGA (multiple-gated acquisition) scan

You should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including at night or at the weekends.

EC-T is given into a vein (intravenously). This will usually be as a drip, also called an infusion, into your hand or arm.

How long treatment takes

It normally takes:

• About an hour for the EC drugs to be given
• 1 to 3 hours to have the T part of the treatment

But you’re likely to be at the hospital for longer than this.

Having EC-T

EC-T chemotherapy is given in 2 parts.

1. EC (epirubicin and cyclophosphamide)

You will usually start by having the EC.

This is given every 2 or 3 weeks.

If you have EC every 2 weeks, you’ll be given injections to boost your immune system and protect against infection.

You’ll have 3 or 4 sessions (cycles) of EC.

2. T (docetaxel or paclitaxel)

After you have finished all the EC sessions, you will then have docetaxel or paclitaxel.

Docetaxel is usually given every 3 weeks. Again, you’ll have either three or four sessions (cycles).

Paclitaxel can be given once every 2 weeks, over 2 to 3 hours (known as accelerated or dose dense). Or it may be given weekly in lower doses over 1 hour.

Why is there a break between each treatment?

The break between each treatment gives your body time to recover from any short-term side effects.

The exact timing of your treatments may vary depending on whether the number of blood cells has returned to within a normal range.

Like any treatment, EC-T can cause side effects.

Everyone reacts differently to drugs and some people have more side effects than others. These can usually be controlled and those described here will not affect everyone.

If you’re worried about any side effects, regardless of whether they are listed here, talk to your chemotherapy nurse or treatment team.

Common side effects

Effects on the blood

EC-T can temporarily affect the number of blood cells in the body. Blood is made up of red cells, white cells and platelets.

You’ll have regular blood tests to check your blood count.

If the number of blood cells is too low:

1. You may be given injections to improve this
2. Your next course of treatment may be delayed
3. The dose of the chemotherapy may be reduced

Risk of infection

Not having enough white blood cells can increase the risk of getting an infection.

Before starting chemotherapy your treatment team should give you a 24-hour contact number or tell you how to get emergency care. You may need antibiotics.

Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.

Anaemia

Having too few red blood cells is called anaemia.

If you feel particularly tired, breathless or dizzy, let your treatment team know.

Bruising and bleeding

EC-T can reduce the number of platelets, which help the blood to clot.

You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your treatment team if you have any of these symptoms.

Nausea and vomiting

You may feel sick (nausea) or be sick (vomit), but this can usually be controlled.

You’ll be given anti-sickness medication, by mouth or into a vein, before each cycle of chemotherapy is given, as well as some anti-sickness drugs to take home. Take these as prescribed by your treatment team.

If nausea or sickness are still affecting you, tell someone in your treatment team as they may be able to change your anti-sickness drugs.

Diarrhoea or constipation

You may have diarrhoea or constipation. Your chemotherapy team can prescribe medicine to help control it and can give you information about diet.

Contact your chemotherapy team if:

• You have 4 or more episodes of diarrhoea within 24 hours
• You have constipation for more than 48 hours

Hair loss or thinning

Most people having EC-T will lose all their hair, including eyebrows, eyelashes and body hair.

Find out more about hair loss. 

Cooling the scalp can sometimes help minimise hair loss.

Extreme tiredness

Fatigue is a very common side effect of EC-T and may last for weeks or months after your treatment has finished.

The purple bookmark on the right-hand side has information and tips to help you manage fatigue.

Numbness and tingling in hands and feet

Some people having paclitaxel or docetaxel experience numbness or tingling in their hands and feet.

This is due to the effect of docetaxel or paclitaxel on the nerves and is called peripheral neuropathy.

Pain in the injection site

Tell the nurse giving the chemotherapy immediately if you have pain, stinging or a burning sensation around the cannula (small plastic tube) while the drug is being given.

If epirubicin leaks out of the vein it’s being given in (called extravasation), it can damage the surrounding tissue.

After treatment, you may have pain where the needle was inserted, or along the vein.

After a few weeks you may notice tenderness, darkening and hardening around where the needle was inserted. This should fade over time.

Change in the colour of urine

You may notice your urine is red or pink when you go to the toilet.

This is because epirubicin is red and it’s being passed through your kidneys and bladder. This can last for one to two days after treatment.

Bladder irritation

Chemotherapy drugs and cyclophosphamide in particular can irritate the lining of the bladder.

It’s important to drink plenty of fluids around the time you have your treatment and to empty your bladder regularly and as soon as you feel the need to.

Tell your treatment team if you notice any irritation, or a burning or stinging sensation when passing urine.

Sore mouth and dental problems

Looking after your mouth, including your teeth and gums, is very important during treatment.

You’ll be given mouthwash to try to reduce soreness and stop mouth ulcers developing.

It’s advisable to see your dentist for a dental check-up before chemotherapy begins and to avoid dental treatment during chemotherapy if possible.

If you do need to have dental treatment during chemotherapy, talk with your treatment team about the best time to have this.

Taste changes

While you’re having EC-T your taste may change.

Our information on diet during breast cancer treatment includes tips on dealing with taste changes.

Your taste should return to normal once your treatment has finished, although for some people taste changes can last after treatment.

Loss of appetite

You may lose your appetite while having EC-T.

Talk to your specialist or breast care nurse about this. They’ll give you advice and information to help deal with loss of appetite and may refer you to a dietitian if needed.

Effects on your concentration

Some people find treatment affects their ability to concentrate and makes them more forgetful.

This is sometimes referred to as ‘chemo brain’ or ‘chemo fog’, but your treatment team may call it cognitive impairment.

It usually improves over time after treatment has finished.

Menopausal symptoms

If you have not yet reached the menopause, your periods may stop or become irregular during chemotherapy.

Other menopausal symptoms include:

• Hot flushes
• Night sweats
• Mood changes
• Joint aches and pains
• Vaginal dryness
• Reduced sex drive

You can talk to your breast care nurse or treatment team about ways of coping with any of these symptoms.

Effects on fertility

EC-T chemotherapy causes changes in the ovaries, which can affect your ability to become pregnant.

If you’re concerned about your fertility, talk to your treatment team before you begin your treatment.

Find out more about fertility and breast cancer treatment.

Painful muscles and joints

Your muscles or joints may ache or become painful two to three days after you have your treatment, particularly when having docetaxel or paclitaxel.

This usually wears off after a few days. However, it can be very painful and you may need to take mild pain relief such as paracetamol or anti-inflammatory drugs such as ibuprofen. It’s a good idea to have some of these available before starting your treatment just in case you need them.

Fluid retention and weight gain

You may develop a build-up of fluid in the body (oedema), particularly when having docetaxel or paclitaxel.

This can take a few weeks to get better. It may cause swollen ankles and legs and shortness of breath.

You’ll be given steroid drugs to prevent an allergic reaction to docetaxel, which will also help reduce the chance of fluid building up.

You may put on weight, but will usually lose it again once the treatment has finished. However, this may take up to several months.

Less common side effects

Heart changes

Epirubicin can affect the heart and blood pressure. This is usually temporary but for a small number of people it may be permanent.

You may have tests to check how well your heart is working before, during and after your treatment.

Heart problems as a result of epirubicin are not common.

However, because of the potential risk, before you start chemotherapy treatment your specialist may arrange a heart (cardiac) function test. This could be:

• An electrocardiogram (ECG), which takes an electrical recording of your heart
• An echocardiogram (echo) to make sure your heart is working normally
• A multiple-gated acquisition (MUGA) scan to check how well the heart is pumping

You will also be carefully monitored during your treatment.

If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away.

These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.

Sore eyes and runny nose

EC-T can cause a runny nose. It can also cause soreness and a gritty feeling in your eyes, or your eyes may water.

Eye drops may be prescribed to relieve the soreness.

Headaches

EC-T can cause headaches. These are usually mild and can be relieved with simple pain relief such as paracetamol.

If your headache is severe, speak to a member of your treatment team.

Skin changes

EC-T can make your skin dry, more sensitive or prone to reactions.

If you develop a rash tell your treatment team as soon as possible.

Your skin may be more sensitive to the sun, so use a high factor sun cream.

Hand-foot syndrome (Palmar-plantar syndrome)

You may develop soreness or redness on the palms of your hands and soles of your feet. This is called Palmar-Plantar or hand-foot syndrome.

Your doctor may prescribe creams to try to help with this.

Nail changes

Chemotherapy may cause changes to the appearance of your nails.

This can be a change in the nail colour or texture, such as ridges forming. Nails can become more brittle and cracked. Occasionally the nail may lift off the nail bed and fall off.

As you’re more at risk of infection while having chemotherapy, it’s important to report any signs of infection such as redness, heat, swelling or pain in or under your fingernails and toenails.

Rare side effects

Breathlessness or a dry cough

Docetaxel and paclitaxel can affect the lungs, which can cause breathlessness or a dry cough. Let your treatment team know if you have either of these symptoms.

Liver or kidney changes

EC-T can cause changes to the way the kidneys or liver work.

Changes are usually minimal and go back to normal when treatment is finished.

You’ll have regular blood tests to monitor your liver and kidneys throughout your chemotherapy.

Another cancer in the future

There’s a small risk of developing a rare type of blood cancer in the future. However, the risk is very low.

Allergic reaction

Some people have an allergic reaction to some chemotherapy drugs.

Before each treatment of docetaxel or paclitaxel, you will be given drugs called steroids to reduce the risk of an allergic reaction.

You can read more about reducing the risk of allergic reactions on our docetaxel or paclitaxel pages.

Blood clots

People with breast cancer have a higher risk of blood clots such as a deep vein thrombosis (DVT).

Their risk is higher because of the cancer itself and some treatments for breast cancer. If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk. 

People with a DVT are at risk of developing a pulmonary embolism (PE). This is when part of the blood clot breaks away and travels to the lung.  

Blood clots can be life-threatening but are treatable so it’s important to report symptoms as soon as possible. 

Sex, contraception and pregnancy

You’re advised not to become pregnant while having treatment because EC-T can harm a developing baby.

EC-T can be safely given to pregnant women with breast cancer if necessary, after the first 12 weeks of pregnancy.

If you haven’t been through the menopause, talk to your team about the most suitable method of contraception for you.

It’s still possible to become pregnant even if your periods become irregular or stop.

You can still have sex during treatment. It’s thought that chemotherapy drugs can’t pass into vaginal fluids or semen. But this can’t be completely ruled out, as chemotherapy drugs can pass into the blood and some other body fluids.

Most hospital specialists will advise using barrier methods of contraception, such as condoms, for a few days after chemotherapy is given.

Vaccinations and travel

If you’re planning a holiday or need to travel overseas, check with your treatment team first.   

You shouldn’t have any live vaccines while you’re having chemotherapy. Live vaccines include mumps, measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.   

Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.  

It’s safe to have these vaccinations 6 months after your treatment finishes. Talk to your GP or treatment team before having any vaccinations.  

If anyone you have close contact with needs to have a live vaccine speak to your treatment team or GP.

They can advise what precautions you may need to take depending on the vaccination.  

Coronavirus (Covid-19) vaccination  

People having chemotherapy or targeted therapies are advised to speak to their treatment team about the best time to have a coronavirus (Covid-19) vaccination.  

Flu vaccination 

Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have, or already having, chemotherapy.

The flu vaccine is not a live vaccine so doesn’t contain any active viruses.

Talk to your chemotherapy team or breast care nurse about the best time to have your flu jab.