Bortezomib, cyclophosphamide, and dexamethasone (VCD)

VCD is the name of a cancer drug combination. It includes the drugs below. How to pronounce the drug names are in brackets.

• bortezomib (bor-teh-zoh-mib)
• cyclophosphamide (sike-low-foss-fa-mide)
• dexamethasone (deks-uh-meth-uh-zone)

It is a treatment for myeloma.

How does VCD work?

Bortezomib is a type of targeted cancer drug called a proteasome inhibitor. Proteasomes are found in cells. They help to break down proteins that the cell doesn't need. Bortezomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies. 

Cyclophosphamide is a type of chemotherapy and works by destroying quickly dividing cells, such as cancer cells.

Dexamethasone is a steroid. It works by helping to kill myeloma cells.

How do you have VCD?

You have bortezomib as an injection under the skin.

You have dexamethasone and cyclophosphamide as tablets. 

Injection under the skin

You usually have injections under the skin (subcutaneous injection) into the stomach or thigh.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

Taking your tablets

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

Swallow cyclophosphamide tablets whole with plenty of water and do not chew or crush them.

Taking dexamethasone tablets in the morning after breakfast might help with difficulty sleeping (insomnia). It might also protect your stomach from irritation.

How often do you have VCD?

You have VCD as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

There are different ways of having VCD. Your doctor plans how much treatment you need and how often you have it depending on your individual situation.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of VCD?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Damage to your nerves 

Bortezomib can cause nerve damage. For example, you might feel pain or a burning sensation when you touch something. Or you might have pain in part of the body that hasn’t been injured. 

You might also have numbness or tingling in your fingers or toes. This is often temporary and can improve after you finish treatment. You might also have weakness in your arms and legs, but this is less common.

Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.

Pain

You may have pain as a result of this treatment. This might include pain in your muscles or joints. Less often, people may have pain around their chest, tummy or genitals. Let your healthcare team know so they can advise you on how to reduce it.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Lowered appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tiredness and weakness (fatigue) during and after treatment 

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Lung and breathing problems

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

You might also develop a cough or breathing problems. This could be due to infection, such as pneumonia. The cough could be dry, or you might have phlegm. You might also sweat, feel shivery, and have a fast heartbeat.

Rarely you might have fluid in or around your lungs causing difficulty breathing. Or lower oxygen levels in your body causing shortness of breath even when you are not exercising. Your breathing may become shallow, or you might have wheezing. 

Let your doctor or nurse know straight away if you suddenly become breathless or develop any of these symptoms.

Problems with bleeding 

This treatment can cause bleeding from anywhere in your body. This is usually mild but there is a risk of a serious bleed. This is due to a drop in the number of platelets in your blood. Signs of bleeding include bruising, blood in your urine or poo (stool), black poo, vomiting or coughing up blood, nosebleeds, bleeding gums, headaches, dizziness or feeling weak.

Less commonly you may have vaginal bleeding, or you might have bleeding that looks like small red or purple spots on the skin.

Contact your hospital advice line straight away if you have any signs of bleeding.

Rarely you might see some blood in your sick.

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Inflammation of the bladder 

Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine. 

You should drink 8 to 12 cups of fluid a day to try to prevent this.

High temperature or chills

High temperature (fever, shivering or chills) can happen with this treatment. This is because it can affect your body’s ability to control temperature. Having a fever with this drug doesn’t always mean you have an infection. But you should call your advice line, as an infection can be serious if not treated quickly.

Kidney problems 

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• blood pressure changes - you might feel faint, lightheaded or have headaches

• eyesight changes such as discharge from the eye, eye pain, excessive tears, swelling of the eyes, or bleeding in the eye. More rarely you might have dry eyes, excessive tears or double vision

• taste changes

• weight loss. More rarely you might put on weight

• indigestion or heartburn

• fluid build up in different parts of the body (oedema)

• difficulty sleeping (insomnia)

• changes in mood and much less commonly you may feel confused, anxious, imagine something that doesn’t exist (hallucinating), or unable to stay still

• lack of fluid in the body (dehydration)

• sore mouth, throat and ulcers

• changes to how your liver works. Rarely you might get yellowing of the skin or whites of the eyes (jaundice)

• nosebleeds

• cramps, twitching (spasms) or weakness in your muscles

• headaches that can be severe

• dizziness

• fainting (passing out)

• changes in levels of minerals and salts in your body - you will have regular blood tests to check for this

• tummy (abdominal) pain or bloating

• shingles - this might be all around the body and can also affect your eyes

• skin changes such as a rash or itching, dry skin and red inflamed skin or an infection, including fungal infections - some skin problems can be severe. Less often you might develop acne or colour changes to your skin

• changes in blood sugar levels

• the feeling of the room spinning or moving around you (vertigo)

• wind

• generally feeling unwell (malaise)

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• allergic reaction - this may happen during treatment, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Tell your nurse or doctor immediately if at any time you feel unwell
• heart problems such as a change in heart rhythm, changes to how well the heart works, fluid around the heart or enlargement of the heart
• changes of levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
• hiccups
• difficulty swallowing
• inflammation of the pancreas and obstruction of the bile duct  
• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• hearing changes that can cause pain and discomfort as well as hearing loss or ringing in your ears (tinnitus). This is usually temporary
• stroke
• swelling or stiffness in your joints
• posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible
• difficulty concentrating
• high or low levels of thyroid hormones
• pain, bleeding and inflammation at the injection site
• runny nose
• infections of the ear or teeth and gums 
• swollen lymph nodes   
• sudden reddening and warmth of the neck, upper chest and face (flushing)
• increased sweating, or night sweats
• difficulty getting an erection
• a second cancer some years after treatment has finished
• a blood disorder called haemolytic anaemia
• symptoms affecting the nervous system (this includes the brain, the spinal cord, and the nerves in the body). Including severe headaches, problems with speech, fits (seizures), memory loss and uncontrollable movements of your arms, legs face and chest, difficulty walking, pain in the area if you previously had singles, and memory loss
• inflammation of your blood vessels. Symptoms can vary depending on which blood vessels are affected. General symptoms include feeling very tired, loss of appetite, weight loss, a high temperature, and aches and pains (vasculitis)
• reactivation of a virus you’ve had in the past – this might cause symptoms such as shingles. You might take tablets to prevent this

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception 

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least a year afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility 

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding 

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.