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

You may be offered EC-T chemotherapy if you have primary breast cancer.

Before surgery

You may have EC-T chemotherapy before surgery to shrink a larger breast cancer.

This may mean breast-conserving surgery (a lumpectomy or wide local excision) is an option, rather than a mastectomy.

Or you might have it before surgery to slow down the growth of a fast-growing breast cancer and reduce the chance of it spreading to other parts of the body.

You may be more likely to have chemotherapy before surgery if you have a certain type of breast cancer, such as inflammatory breast cancer, HER2-positive breast cancer or triple negative breast cancer.

When you have chemotherapy before surgery, it’s called primary or neo-adjuvant chemotherapy.

After surgery

You may have EC-T chemotherapy after surgery to reduce the risk of breast cancer coming back in the future. It usually starts a few weeks after your operation.

If you’re going to have radiotherapy, you will usually finish your course of EC-T chemotherapy first.

When chemotherapy is given after surgery, it’s called adjuvant therapy.

If your breast cancer has come back

You may be offered EC-T chemotherapy if your breast cancer has:

• Come back in the chest, breast or in the skin near the original site or scars (local recurrence)
• Spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the arm or breastbone, but has not spread to other areas of the body (locally advanced breast cancer)

Before starting your treatment, a member of your 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:

• An ECG (electrocardiogram) – a simple test that checks your heart rhythm
• An echocardiogram (echo) – an ultrasound scan of the heart
• A MUGA (multiple-gated acquisition) scan – an injection and heart 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 overnight or at the weekends.

EC-T is given into a vein (intravenously).

This will usually be through a cannula, a small tube that’s inserted into a vein in the back of your hand or lower arm.

You could also have EC-T through:

• A skin-tunnelled catheter (Hickman line): a tube inserted into a vein in your chest
• A peripherally inserted central catheter (PICC): a tube inserted into a vein in your arm at or above the bend in your elbow
• An implanted port: a small device with a tube that goes into a vein that’s put under the skin, usually in your chest or arm

EC-T chemotherapy is given in 2 parts.

1. EC (epirubicin and cyclophosphamide)

You will usually start by having the EC.

EC is usually given once every 2 or 3 weeks, over about 1 hour.

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

Docetaxel is usually given once every 3 weeks, over about 1 hour. 

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

You’ll have 3 or 4 cycles of docetaxel or paclitaxel.

The time it takes for treatment to be given can vary depending on your individual circumstances and how you respond to chemotherapy.

Why is there a gap between each treatment?

The gap between each cycle of treatment gives your body time to recover.

Chemotherapy can reduce the amount of blood cells in your body. You might have a longer gap between cycles if your blood tests show that the number of blood cells hasn’t returned to normal.

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

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

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

Common side effects

Effects on the blood

EC-T chemotherapy 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. If these show the number of blood cells is too low, your next cycle of treatment may be delayed or the dose of chemotherapy reduced.

Risk of infection

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

Before starting chemotherapy, 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 overnight or at the weekends

You may need treatment if you get an infection.

Sometimes your treatment team may recommend injections of drugs called growth factors. This helps the body make 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. Platelets help the blood to clot.

If your platelets are low you may:

• Bruise more easily
• Have nosebleeds
• Notice your gums bleed when you brush your teeth
• Take longer to stop bleeding if you cut yourself

Tell your treatment team if you have any of these symptoms.

Nausea and vomiting

You may feel sick (nausea) or be sick (vomit).

You’ll be given anti-sickness medication, as tablets or into a vein, before each cycle of chemotherapy.

You’ll also have some anti-sickness drugs to take home.

If nausea and vomiting are affecting you, tell your treatment team.

Contact your treatment team or the 24-hour helpline number if you have severe vomiting and cannot drink any fluids without vomiting, even if it happens at the weekend or during the night.

Diarrhoea or constipation

You may have diarrhoea or constipation.

Your chemotherapy team can give you medicine to help control it and can give you information about diet.

Drinking plenty of fluids can also be helpful.

Contact your chemotherapy team if you have diarrhoea 3 or more times in 24 hours, compared to what’s usual for you.

See more about diet during treatment.

Hair loss or thinning

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

You may begin to lose your hair about 2 weeks after the first treatment, but it can happen earlier. Although hair loss is usually gradual, it can happen quickly, possibly over a couple of days.

You can try scalp cooling to stop you losing some or all of the hair on your head. Ask your treatment team if scalp cooling is available in your hospital.

Hair loss should be temporary and in most cases your hair will begin to grow back in the weeks and months after chemotherapy has finished.

There’s some evidence that docetaxel treatment may result in longer-term or permanent hair loss. But this is very rare.

Find out more about hair loss. 

Extreme tiredness

Fatigue is extreme tiredness that does not go away with rest or sleep. It’s a very common side effect of EC-T chemotherapy and may last for weeks or months after your treatment has finished.

If you think you have fatigue, tell your GP or treatment team. They can assess you and offer advice on how to manage your energy levels.

Find out more about managing fatigue.

Numbness and tingling in your hands and feet

You may have pain, numbness or tingling in your hands and feet while having EC-T.

This is called peripheral neuropathy and happens if docetaxel and paclitaxel affect the nerves.

Reaction in the injection site

You might get pain, redness, discolouration or swelling where the small plastic tube (cannula) has been inserted or anywhere along the vein, during or after treatment.

If chemotherapy drugs leak out of the vein they’re being given in (called extravasation), it can damage the surrounding tissue.

Tell your treatment team immediately if you have pain, stinging or a burning feeling around the cannula while the drug is being given.

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

Bladder irritation and pink or red urine

Chemotherapy drugs (particularly cyclophosphamide) can irritate the lining of the bladder.

It’s important to drink plenty of fluids around the time you have your treatment.

Try to pee regularly, as soon as you feel the urge. Tell your treatment team if you notice:

• Blood in your urine
• Irritation, burning or stinging when you pee

Epirubicin can cause your urine to become pink or red for a couple of days. This is because of the colour of the drug and is completely normal.

Sore mouth

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

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

It’s a good idea to use a small, soft toothbrush during this time.

See your dentist for a check-up before treatment with chemotherapy begins. Avoid dental work during treatment if possible.

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

If you’re having difficulty registering with a dentist, let your treatment team know. 

Taste changes

Your taste may change while you’re having EC-T. Some food may taste different, for example more salty, bitter or metallic. You may no longer enjoy some foods you used to like.

If this is the case, speak to your treatment team. They may suggest ways to manage this.

Your taste should return to normal once your treatment has finished.

Loss of appetite

You may lose your appetite while having EC-T.

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

See our information on diet during treatment for tips on dealing with changes to your taste and appetite.

Effects on your concentration

Treatment can affect your ability to concentrate and make you more forgetful.

This is sometimes called “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

EC-T may cause menopausal symptoms if you haven’t already been through the menopause. This is because it affects the ovaries, which produce the hormone oestrogen.

Your periods may stop or become irregular during chemotherapy. Whether your periods return will depend on many things, including other health conditions, the type of drugs used, the dose given, and your age.

Other common menopausal symptoms can include:

• Hot flushes and night sweats
• Mood changes
• Joint aches and pains
• Vaginal dryness
• Changes to your sex drive

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

Painful muscles and joints

Your muscles or joints may ache or become painful 2 to 3 days after you have treatment, particularly docetaxel or paclitaxel.

This usually improves 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.

Find out more about joint and muscle pain during breast cancer treatment.

Fluid retention

You may develop a build-up of fluid in the body (oedema), particularly when having docetaxel or paclitaxel. It may cause swollen ankles and legs and shortness of breath. This can take a few weeks to get better.

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

Weight gain

You may put on weight, but you’ll usually lose it again once treatment finishes. This can vary from person to person and may take up to several months. Physical activity and eating a healthy diet may help with this.

Find out more about healthy eating during treatment.

Less common side effects

Heart changes

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

Before you start chemotherapy, your treatment team may arrange a heart (cardiac) function test.

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 your treatment team straight away.

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

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.

If you have sore eyes, you may be given eye drops 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 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 (SPF) sun cream.

Sore hands and feet

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.

Redness can be harder to see on black or brown skin.

Your treatment team or GP can prescribe creams or medication to treat hand-foot syndrome.

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 also become more brittle and cracked.

Occasionally the nail may lift off the nail bed and fall off, but it will grow back.

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

Rare side effects

Damage to the lungs

Docetaxel and paclitaxel can affect the lungs.

Contact your treatment team straight away if you have:

• Shortness of breath
• A cough, with or without a high temperature
• Any new or worsening breathing problems, such as chest tightness or wheezing

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.

The benefits of having chemotherapy to treat your breast cancer will outweigh this very small risk.

Allergic reaction

Before each treatment of EC-T, you will usually be given drugs called steroids to reduce the risk of an allergic reaction.

Take these as directed by your treatment team. Do not stop taking them without talking to your treatment team first.

If you have an allergic reaction to EC-T, it will probably happen within the first few minutes of your treatment. It’s most likely the first or second time you have the drugs.

Reactions can vary from mild to severe, but severe reactions are uncommon.

You’ll be monitored closely during your treatment so that any reaction can be dealt with immediately.

Let your chemotherapy nurse know if you start to feel unwell during treatment.

Symptoms of an allergic reaction include:

Fertility

EC-T chemotherapy causes changes in the ovaries, which can affect your ability to become pregnant (fertility). How likely you are to lose this ability (become infertile) also depends on things like whether you have had chemotherapy in the past, other health conditions and your age.

Many women stop having periods during chemotherapy, but this may be temporary.

If you’re aged around 40 and over, your periods are less likely to return after you’ve finished chemotherapy than if you’re under 40.

In men, EC-T chemotherapy can affect sperm production which can lead to temporary or permanent infertility.

Conversations about fertility can be hard, especially if you weren’t expecting to think about it at this stage. It’s important to discuss any fertility concerns with your treatment team before you begin your treatment.

Your treatment team should offer you a referral to a fertility specialist to discuss the possibility of preserving your fertility.

Find out more about fertility and breast cancer treatment.

Sex, contraception and pregnancy

You can still have sex during treatment. It’s thought chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out.

Most treatment teams will advise using barrier methods of contraception, such as condoms or female condoms, during treatment and for a few days after chemotherapy is given. 

You’re advised not to become pregnant while having treatment because EC-T can harm a developing baby. If you have not 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 are irregular or have stopped.

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

Chemotherapy can affect how you feel about sex and intimacy. You may not feel like being intimate when you’re dealing with treatment, or you may find intimacy helps you feel more normal. Everyone’s reaction will be different.

Find out more about how breast cancer and its treatment can affect sex and intimacy and read our tips on how to manage these changes.

Vaccinations and travel

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

You should not have any live vaccines while you’re having treatment.

For more information about vaccines, including COVID-19 and flu vaccines, see our information on vaccines and breast cancer.

Your treatment team and breast care nurse can help with any questions you have. You can also speak to our specialist nurses on our free helpline (see below).

You can find people going through treatment at the same time as you on the monthly chemotherapy threads on our online forum.

You can also speak to someone else who has had chemotherapy for primary breast cancer through our Someone Like Me service – see below.