CMF

CMF is the name of a chemotherapy combination used to treat breast cancer. Doctors most often use it to try to stop breast cancer from coming back after surgery and radiotherapy. This is called adjuvant therapy. CMF is

• C = Cyclophosphamide
• M = Methotrexate
• F = Fluorouracil (5FU)

You can click on the links to find out the side effects of each individual drug.

In the UK, it is most common to have treatment with injections and tablets. Each CMF treatment is given over 3 or 4 weeks. You take cyclophosphamide tablets every day for the first 2 weeks and have injections of methotrexate and 5FU on the 1st and 8th days of each 21 or 28 day cycle. Keep tablets in tightly closed containers and out of the reach of children. Return any unused tablets to the pharmacy.

As an alternative all the drugs may be given entirely by injection every 3 or 4 weeks. All 3 drugs are injected on the 1st and 8th day of each 21 or 28 day cycle.

However you have the treatment, it is most common to have 4 to 6 cycles of CMF. CMF is often given as E-CMF where you have 4 cycles of epirubicin and 4 cycles of CMF. 

The side effects of a combination of drugs are usually a mixture of the side effects of each individual drug. You may get some or all of the side effects. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity. The side effects associated with CMF are listed below. Use the links (underlined) to find out more about each side effect. Where there is no link please see our cancer drug side effects section, or use the search box at the top of the page.

With these drugs, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment - most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Feeling or being sick - this can be a problem for some people with cyclophosphamide tablets. Try taking anti-sickness tablets at least an hour before you take your cyclophosphamide.
• Loss of appetite
• Hair loss or thinning - some women only have mild thinning. Others have more. A few women have complete hair loss.
• Diarrhoea
• Sore mouth or mouth ulcers 
• Metallic taste or loss of taste - this may only be on the days when you are having your drugs and should get better when your treatment finishes
• Irritated eyes - they may feel as if they have grit in them. You can also have blurred vision or watery eyes.
• CMF may have a harmful effect on a developing baby. It is not advisable to become pregnant or father a child if you are having these drugs. You should talk about contraception with your doctor before having the treatment.
• Women may stop having periods (amenorrhoea) - this may only be temporary
• Loss of fertility - you may not be able to get pregnant after having this treatment. It is important to talk to your doctor about your fertility before starting treatment.

Some people have the following side effects

• Skin changes - your skin may darken. Or you may have an itchy rash. Your skin may become sensitive to sunlight - use a high factor sun cream and cover up when you go out.
• Nail changes - your nails may become ridged, or darken. They may become brittle and chip or break easily.
• Coughing or breathlessness
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your kidneys are working

A very small number of people have these side effects

• Allergic reaction when you are having methotrexate injection can cause an itchy rash, temperature and shivering, redness of the face, dizziness, headache or breathlessness - tell your chemotherapy nurse if you have any of these symptoms
• Burning, stinging or pain on passing urine (cystitis) - if you see blood in your urine contact your doctor straight away
• Heart problems - there is a very small risk of angina or heart attack
• Fluid retention
• Confusion or unsteadiness
• There is a small risk of developing another cancer years after finishing the treatment

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but very few people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.