Oral CMF

Apr 06, 2021

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What is Oral CMF:

This is a chemotherapy treatment with combination of three drugs used

to treat breast cancer.

C; Cyclophosphamide

M; Methotrexate

F; Fluorouracil

Cyclophosphamide is given as oral tablets, and both methotrexate and fluorouracil will be given through infusion in the veins.

How oral CMF Works:

o Cyclophosphamide is a type of chemotherapy medicine called an alkylating agent and also called Cytoxan. It stops cancer cells from reproducing.

o Both Methotrexate and Fluorouracil are related to another type of chemotherapy medicine called antimetabolites. They stop DNA synthesis in cancer cells thus preventing cancer cells growth and division.

Who Gets oral CMF:

• CMF is one of the chemotherapy regimens commonly used to treat early invasive breast cancer that has not spread to other body organs.
• It can be given before surgical removal of the cancer to shrink the tumor, this is called  Neoadjuvant treatment. It can also be given after surgical removal of the cancer to kill any remaining cancer cells and prevent the return of cancer, in this case it is called Adjuvant treatment.
• It can also be used in people who have had a recurrence or spread of cancer depending on the medicines you received before.

How is oral CMF Given:

• Please tell your doctor about any medicines you are taking, including vitamins, herbal

supplements and over-the-counter medicines, to make sure they won’t interfere with your CMF treatment.

• This regimen is given in a chemotherapy clinic outpatient, which means you can go home after you receive your medications.

• Cyclophosphamide is taken as a tablet once daily starting from day 1 of the treatment cycle and for 14 days continuously.
• To take a cyclophosphamide tablet safely, make sure you swallow it as a whole, don’t cut or crush it before swallowing. 
• It is very important with cyclophosphamide to drink plenty of fluids, at least 2-3 liters of water each day, and to not take cyclophosphamide tablets before bedtime.
• Both methotrexate and fluorouracil are given by vein in the same day, at day 1 and day 8 of each treatment cycle.
• This cycle is repeated every 28 days. You should receive 6 cycles of CMF for a total duration of treatment of 6 months.

What are the side effects from Oral CMF treatment:

 It is important to remember that different medicines have different side effects for different people.

You may not have every side effect related to each medicine of the combination therapy.

Common side-effects of CMF include: 

1. Low blood counts: CMF chemotherapy affects rapidly dividing cancer cells but also some of the normal cells as blood cells.

Your doctor will be monitoring your blood counts weekly in the first two weeks of each cycle.

• Low red cell counts. referred to as Anemia. If you get too anemic, you may experience a lot of fatigue, palpitations/ increased heartbeat and shortness of breath with exertion. If you have symptoms and significant anemia, your doctor may choose to give you blood transfusions.
• Low white blood cell counts can result in reduced immunity and increased susceptibility to Infections. 
• Low platelet counts can result in increased bleeding tendency, as heavy bleeding from small wounds, nose bleeding, bruising, coffee ground vomiting or blood in urine or stool.

• If you develop very low white blood cell or platelet count, the next cycle of treatment might be deferred until these counts rise to normal again. 
• Your doctor might also decide to reduce the dose of medications or omit one or two if the counts remain very low.
• Watch for signs of anemia and bleeding tendency and call your doctor if any of these symptoms are bothering you.

2. Infections: they can follow a low white blood count. 

• Watch for signs of infection as; high fever, cough, sore throat, skin changes, burning urine, or diarrhea. Call your doctor whenever one of these symptoms are bothering you. Also call your doctor in case of fever > 100 degree F.

3. Nausea and vomiting: you may experience nausea alone or with vomiting, as a result of CMF chemotherapy. Your doctors give you one or more anti-nausea medications before each cycle to prevent early nausea and vomiting which can happen in the first hours. You will also be given an oral medication to take for a few more days at home, and as needed after that.

It is very important to follow your doctor’s instructions regarding taking the antinausea medications, to avoid this side-effect and its complications.

4. Bladder irritation: this is a side-effect of cyclophosphamide that happens in case of decreased fluid intake. It’s very important to drink plenty of fluids and at least 2-3 liters of water each day throughout your treatment duration.

5. Diarrhea or constipation.
6. Mouth sores and changes in taste.
7. Fatigue.
8. Loss of concentration.
9. Hair loss or thinning.
10. Eye soreness.
11. Effects on fertility and symptoms of menopause: as hot flashes and mood changes. Your doctor will discuss with you the available options for preserving your fertility.

Less common but more serious side effects include: 

1. Heart changes: 

This can sometimes occur with fluorouracil. Call your doctor right away in case you had chest pain, tightness at the center of your chest, palpitations or bounding chest.

2. Allergic reactions: your doctor prescribes medications to prevent allergic reaction before chemotherapy infusion. If you have an allergic reaction, you may show symptoms such as chills, difficulty breathing or shortness of breath, flushing, rash, itching, face and tongue swelling. If you have any of these symptoms at any time call your healthcare team right away.
3. Skin changes: ulceration, pigmentation or light sensitivity are less common symptoms. But to avoid more serious forms of skin problems, avoid excess sun exposure and make sure you wear sunscreen.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you

manage them. For managing a specific side effect, please watch our symptom specific video.