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This information is about a chemotherapy treatment for breast cancer called AC. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
AC is named after the initials of the drugs used and involves the chemotherapy drugs:
AC treatment can usually be given to you as a day patient. Before you start your treatment, you will need to have a blood test - either on the same day, or a day or two beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
When you begin your treatment, the nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, central line or PICC line, which is connected to a drip (infusion), but some anti-sickness drugs can also be given as tablets.
The chemotherapy drugs are then given separately, which involves:
This will usually take an hour or more. Although the doxorubicin is often given first, the order in which the drugs are given will not alter their effectiveness.
If you are having treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness drugs to take with you. It is important to take these as directed even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
Your doctor may use the word 'regimen' (eg the AC regimen), when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are receiving.
You will be given doxorubicin and cyclophosphamide (as described above) on the first day of your treatment. After this you will have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of your treatment.
After the rest period the same drugs will be given again, which begins the next cycle of your treatment. Four to six cycles of treatment are usually given over a period of three to four months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having AC chemotherapy. We have outlined the most common ones, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed below, please let your nurse or doctor know.
Lowered resistance to infection AC can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising or bleeding AC can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with AC you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Hair loss This usually starts 3–4 weeks after the first cycle of treatment. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.
Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink as much fluid as you can (up to two litres) during the 24 hours after chemotherapy to help prevent this. Doxorubicin is red, so your urine may become a pink-red colour. This may last up to 24 hours after your treatment and is quite normal.
Diarrhoea If you have diarrhoea it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of liquid a day to replace the fluid you are losing.
Skin changes Your skin may become itchy and dry. Your doctor can prescribe treatment to help to reduce this. Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished.
During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes.
Sometimes areas of skin which have been treated with radiotherapy may become red and sore. Let your doctor know if this happens. The skin over the vein used for the injection may become discoloured.
Changes in nails Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once your treatment has finished.
Changes in the way your heart works This is very rare with usual doses of doxorubicin, but may occasionally happen when high doses are used. Tests to see how well your heart is working may be carried out before you start treatment.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue If doxorubicin leaks into the tissue around the vein, it can cause damage to the cells in that area. If you notice any stinging or burning around the vein while the drug is being given, tell the doctor or nurse immediately.
Fertility Your ability to become pregnant may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Discuss this with your doctor or nurse.
Loss of periods Due to the effect of chemotherapy on the ovaries, you may find that your periods become irregular and may eventually stop. In younger women this may be temporary but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our AC chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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