AC: doxorubicin and cyclophosphamide

AC (doxorubicin and cyclophosphamide) is a common chemotherapy regimen usually given for early-stage breast cancers.

AC is a combination of two chemotherapy medicines:

• Doxorubicin (Adriamycin)
• Cyclophosphamide (Cytoxan)

Doxorubicin is a type of chemotherapy medicine called an anthracycline. Cyclophosphamide is a type of chemotherapy medicine called an alkylating agent.

While the chemotherapy paclitaxel (Taxol) is usually given before or after AC (a regimen called AC-T), AC is sometimes given without paclitaxel.

How AC works

Both doxorubicin and cyclophosphamide damage the DNA inside cancer cells so they can’t divide, which causes them to die. Doxorubicin stops damaged cancer cells from continuing to grow, while cyclophosphamide stops cancer cells from reproducing.

The medicines attack the cancer cells at different stages of their growth:

• Doxorubicin works at any point in the cell cycle.
• Cyclophosphamide works when the cells are in their resting phase (not dividing)

Who gets AC

AC can be used to treat people diagnosed with early-stage breast cancer.

It is often, but not always, followed by paclitaxel (Taxol). This is called AC-Taxol (AC-T). The paclitaxel can also be given before AC is given.

AC is sometimes also recommended to treat local recurrence, or breast cancer that has returned at or near the original site. AC may also be used in some cases of metastatic breast cancer.

You and your doctor will discuss the best chemotherapy treatment for your situation.

How AC is given

AC can be given after surgery as an adjuvant therapy, or before surgery as a neoadjuvant therapy.

The medicines are usually given by vein one at a time on the same day. Doxorubicin (Adriamycin) is usually given first.

The first treatment session is followed by a rest period of 2 or 3 weeks. When the regimen is given every 2 weeks, your doctor may call this schedule dose-dense AC chemotherapy. This cycle is usually repeated four to six times over 3 to 5 months.

AC can be delivered into a vein through a needle with an intravenous (IV) line attached to it, or through a small, implantable device called a port. A port, usually implanted into the chest area for a limited time, can help you avoid repeated needle sticks.

Side effects and things to remember

Different medicines have different side effects. You may not have every side effect related to each medicine of the combination therapy. Common side effects of AC include:

• Low red and white blood cell counts
• Nausea and vomiting
• Hair loss
• Diarrhea or constipation
• Mouth sores
• Fatigue
• Bladder irritation
• Skin changes
• Menopausal symptoms

Less common side effects include:

• Heart problems
• Leukemia, a blood cancer, which can occur many years after receiving AC chemotherapy
• Nail changes

Before starting AC 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 chemotherapy treatment.

You should avoid becoming pregnant while you are receiving AC. Tell your doctor right away if you become pregnant while undergoing treatment.

Talk to your doctor, pharmacist, or nurse about all your side effects so that they can help you manage them. You can also go to our section on side effects for more information.