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CCEP 248

CCEP 248

This leaflet provides information on a course of chemotherapy called CCEP.  The leaflet will explain what this is and when and how it is given.  It will also tell you about common side effects that you may experience.  Contact telephone numbers and details of how to obtain further information on CCEP are given at the end of the leaflet.

This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ folder.  If you haven’t received this folder please ask your nurse for a copy.

What is CCEP chemotherapy? 

This is a chemotherapy treatment which consists of four drugs.  There are three chemotherapy drugs which are given as tablets:

  • Lomustine
  • Cyclophosphamide
  • Etoposide 

The fourth drug is a steroid tablet called prednisolone.

It is usually called CCEP for short.  

Why am I having CCEP chemotherapy? 

Your doctor has prescribed this chemotherapy because it has been found to be effective in treating your type of cancer.

How often will I receive my treatment?

For this treatment to be most effective it is given at specific time intervals.  These are known as cycles.  It is usual to have a cycle of treatment every four weeks for four to six cycles.  Your doctor will discuss the exact number of cycles you will receive. 

In each four week cycle you will need to take the tablets as described below.  All the tablets start on the same day.   

The number of tablets you need to take will vary for each person.  The amount you need to take will be clearly marked on the boxes.  Remember to check each box to see how many tablets you need to take.

  • The lomustine capsules are taken for one day.
  • Cyclophosphamide tablets are taken once a day for up to 10 days.
  • Etoposide capsules are taken once or twice a day for up to 10 days. 
  • The prednisolone tablets are taken once a day for 5 days.

How often will I see the specialist team?

You will see the specialist team before each cycle.  You will have regular blood tests and we will check how you are feeling and discuss any problems you may have.  This is so we can check how the chemotherapy is affecting you.  If your blood results are satisfactory, your chemotherapy will be prescribed.

Can I bring relatives and friends with me? 

You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person.  Treatment areas are not suitable for young children.

How should I take my chemotherapy tablets?

The chemotherapy tablets should be swallowed whole with a glass of water.  They must not be chewed or crushed.  The amount you need to take will be clearly marked on the box.  It is important that you wash your hands thoroughly after taking your chemotherapy tablets.

Lomustine should be taken just before you go to bed, on an empty stomach (an hour after eating).  You should take the anti sickness tablet (ondansetron) and the sleeping tablet (temazepam) 30 minutes before taking the capsules.  This will reduce the risk of vomiting.  

Cyclophosphamide tablets are taken once a day.  You can choose what time of day you want to take them, but try to take the tablets at roughly the same time each day.  Some patients will need to take a different number of tablets on alternate days (for example 100 mg one day, 150 mg the next day).  We will explain this to you, and it will be clearly marked on the label. 

Etoposide capsules may be taken once or twice a day.  You should take the first dose in the morning.  If you need to take a second dose, this should be in the evening.  The capsules should be taken on an empty stomach, so an hour before or after eating.  

How should I take my prednisolone tablets?

The prednisolone tablets are taken for five days, starting on the same day as your chemotherapy.  You will need to take 12 tablets every day.  These should be taken in the morning after your breakfast.

What should I do if I forget to take my tablets?

  • If it’s within 2 hours of the normal time take them now.
  • If it’s more than 2 hours late please contact Velindre Cancer Centre for advice.

What if I take too many tablets?

Please contact Velindre Cancer Centre immediately for advice.  The telephone number is at the end of the leaflet.

How should I store my tablets?

You should store your tablets in their original packaging in a safe place away from children.  They should be kept in a cool dry place.  Any unused tablets should be returned to the hospital Pharmacy or your local chemist for safe disposal.  

What are the possible side effects?

There are a number of possible side effects which can occur with this chemotherapy.  The doctor, nurses and pharmacy team can give you advice or answer any questions you may have.

Hair loss

Unfortunately you will lose your hair with this chemotherapy.  This is only temporary.  Your hair will grow back when your treatment has finished.  

We have a leaflet that tells you more about coping with hair loss.  Please ask your nurse for a copy. 


Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective.  If you are sick more than once in 24 hours despite taking regular anti-sickness medicine when you are at home after your chemotherapy treatment, please contact Velindre Cancer Centre for advice.  The telephone number is at the end of the leaflet.


You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.  

If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening. 

Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or if your temperature is below 35.5°.  The telephone number is at the end of the leaflet.


Diarrhoea is not common with CCEP.  However, if you have four or more bowel movements in 24 hours above what is normal for you please contact Velindre Cancer Centre immediately.  The telephone number is at the end of the leaflet.

Tiredness and fatigue 

You may feel more tired than usual.  It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able.  Some people find it beneficial to take gentle exercise as well as taking rest.

Sore mouth

Your mouth may become sore or you may notice small ulcers.  Please follow the advice on caring for your mouth in the general chemotherapy leaflet.  Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.

Cystitis (bladder irritation)

Cyclophosphamide can sometimes irritate your bladder and cause cystitis.  This can be uncomfortable.  To try to avoid this we recommend that you drink at least 2 litres a day (12 cups) during and for the first few days after completing your treatment.  Symptoms of cystitis include: 

  • burning or pain when passing water
  • the need to pass water urgently or often
  • blood in your urine
  • lower back pain.

Please tell you doctor or nurse if you have any of these symptoms.  We can give you medication to help this.  We may ask you for a sample of your urine to make sure that you don’t have an infection.

Blood clots

A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further.  It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.  

Blood clots can be very serious.  However, most clots can usually be successfully treated with drugs to thin the blood.  Your doctor or nurse can give you more information

Other side effects

A small number of people may experience lung problems following lomustine treatment.  If you develop a dry cough or notice that you are slightly short of breath please tell us at your next hospital visit.  If you are very short of breath please contact Velindre Cancer Centre or seek immediate medical attention.

Women sometimes find that chemotherapy treatment affects their periods.  They could become heavier, lighter or even stop altogether.  

It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.  

Side effects of the prednisolone tablets 

When taking these tablets you may notice several different side effects. These include:

  • An increase in appetite
  • Indigestion
  • Mood swings, irritability and difficulty in sleeping
  • You may feel more thirsty and pass more urine than usual.  This may be a sign of an increase in blood sugar levels.  If you are diabetic this may be a particular problem, please discuss this with your doctor or nurse.

Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.

Manufacturer’s patient information leaflets

Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy

Contact telephone numbers

Velindre Cancer Centre 029 2061 5888

Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:

  • Are sick more than once in 24 hours
  • Have a temperature of 37.5°C or above or below 35.5°centigrade 
  • Have diarrhoea

Pharmacy department 029 2061 5888 ext 6223

Monday – Friday 9am – 5pm for queries about your medicines

Macmillan freephone Helpline 0808 808 0000


Tenovus freephone 0808 808 1010

cancer helpline 

7 days a week 8am – 8pm for general queries on cancer

This information is also available in Welsh

This leaflet was written by health professionals.  The information contained in this leaflet is evidence based.  It has been approved by doctors, nurses and patients.  It is reviewed and updated every 2 years.