ACTH: Adriamycin and cyclophosphamide, followed by paclitaxel and trastuzumab

ACTH is a chemotherapy combination treatment used to treat HER2-positive breast cancer. It may also be called sequential AC/Taxol-Trastuzumab.

The medicines in this combination are:

• Doxorubicin (Adriamycin), an anthracycline, and cyclophosphamide (Cytoxan), an alkylating agent, followed by treatment with
• Paclitaxel (Taxol), a taxane chemotherapy, and trastuzumab (Herceptin)

Trastuzumab is a type of targeted therapy called a monoclonal antibody. It attaches to HER2 (human epidermal growth factor receptor 2) proteins and can kill HER2-positive cancer cells.

How ACTH works

Both doxorubicin and cyclophosphamide (AC) damage the DNA inside cancer cells so they can’t divide, which causes them to die. With doxorubicin, the damage stops the cancer cells from dividing and causes them to die. Cyclophosphamide stops cancer cells from reproducing.

Paclitaxel (T) is added to doxorubicin and cyclophosphamide (AC). It stops cancer cells from dividing into new cells.

Trastuzumab (H) attaches to HER2 proteins on the surface of HER2-positive cancer cells, and blocks the signals that cause the cancer cells to multiply.

Who gets ACTH

ACTH is often used as adjuvant therapy, after surgery, or as neoadjuvant therapy, before surgery, for early-stage breast cancers that are

• HER2-positive and have traveled to the lymph nodes
• HER2-positive and have not traveled to the lymph nodes (high-risk lymph node negative)

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

How ACTH is given

AC is usually given

• every 2-3 weeks for four cycles followed by
• T every 2-3 weeks for four cycles, plus weekly H

Then H is given alone weekly or every 3 weeks over a year to complete treatment.

Side effects & 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 ACTH may include:

• Low red and white blood cell counts
• Increased risk of bleeding
• Menopausal symptoms
• Nausea and vomiting
• Hair loss
• Risk of infection
• Mouth sores
• Fatigue
• Joint pain
• Nail and skin changes
• Neuropathy, numbness and tingling in the hands and feet
• Heart damage
• Higher risk of leukemia

Before starting ACTH, 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.

Trastuzumab can cause complications in pregnancy, so you should not become pregnant while taking it.

Be sure to 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.