AC-T: Adriamycin, cyclophosphamide, and Taxol

AC-T (doxorubicin and cyclophosphamide followed by or preceded by paclitaxel), also called AC-T and AC-Taxol, is a chemotherapy combination treatment used to treat early-stage breast cancer. It includes these medicines:

• Doxorubicin (Adriamycin) – a type of chemotherapy medicine called an anthracycline
• Cyclophosphamide (Cytoxan) – a type of chemotherapy medicine called an alkylating agent
• Paclitaxel (Taxol) – a type of chemotherapy medicine called a taxane

Sometimes this regimen is offered with docetaxel (Taxotere) instead of paclitaxel. It would still be called AC-T. Ask your healthcare team to explain why they recommend one taxane over another.

How AC-T works

Doxorubicin damages the DNA inside the cancer cells. The damage stops the cells from dividing, which causes them to die.

Cyclophosphamide attaches to and damages the DNA in cancer cells when they are in their resting phase (not dividing). After their DNA is damaged, the cells can’t keep dividing, and their growth slows or stops.

Paclitaxel works by damaging the structure or the “skeleton” that supports cancer cells. This stops the cancer cells from growing and dividing. Docetaxel (Taxotere) works in a similar way and is sometimes used instead of paclitaxel.

Who gets AC-T

AC-T is a standard regimen for early-stage breast cancers that require treatment with chemotherapy. This regimen is often recommended for:

• People diagnosed with higher grade, lymph node-positive breast cancer
• Younger people
• In some cases, people who have a breast cancer recurrence, depending on the medicines previously taken for early-stage disease

AC-T can be given after surgery as adjuvant therapy, or before surgery as neoadjuvant therapy.

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

How AC-T is given

Doxorubicin (A) is usually given through a port, which is a device that can be implanted under the skin near a major vein. C and T can be given by vein into your hand or arm.

AC-T can be given before (neoadjuvant) or after (adjuvant) surgery in different ways.

Here are some examples of AC-T regimen schedules:

• In eight treatments, once every 3 weeks:
  • The first four treatments are AC (one drug at a time during each treatment session), and the next four are paclitaxel (T).
  • Sometimes the paclitaxel is given weekly at a lower dose instead of every 3 weeks.
  • The whole course of AC-T treatment typically takes about 5 months.
• On a dose-dense schedule of AC (doxorubicin and cyclophosphamide) every 2 weeks for a total of four cycles, followed by:
  • Paclitaxel (T) once a week for a total of 12 weeks, or
  • Paclitaxel every 2 weeks for a total of four cycles
• On a dose-dense schedule that begins with paclitaxel and is followed by AC

Sometimes docetaxel is used instead of paclitaxel. In this case, the AC portion is given once every 3 weeks followed by docetaxel, which is given once every 3 weeks.

You and your doctor will decide the treatment combination and schedule that are right for your individual situation.

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.

Side effects of AC-T may include:

• Low red and white blood cell counts
• Infection
• Nausea and vomiting
• Loss of appetite
• Hair loss
• Neuropathy
• Mouth sores
• Nail and skin changes
• Bladder irritation
• Bone pain
• Diarrhea
• Increased risk of sunburn
• Menopausal symptoms
• Fatigue
• Heart damage
• Bruising or bleeding

Your doctor will check your blood before you start treatment. If your blood count is low then your treatment may be delayed.

Be sure to tell your doctor about any medicines you are taking, including vitamins, herbal supplements, and over-the counter-medicines, to make sure they will not interfere with your chemotherapy treatment.

Drinking a lot of fluids can help avoid kidney and bladder side effects. Ask your doctor how much and how often you should drink each day. You should also avoid getting too much sun. When you go outside, wear sunscreen and clothes that cover your skin. Contact your doctor right away if you develop a fever or other symptoms of an infection such as a sore throat, cough or diarrhea.

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