1. What is AC chemotherapy?
2. Who might be offered AC?
3. How does AC work?
4. How is AC given?
5. Common side effects
6. Less common side effects
7. Sex and contraception
8. Vaccinations

1. What is AC chemotherapy?

AC is a combination of two chemotherapy drugs.

It takes its name from the initials of these drugs:

  • doxorubicin (also known as Adriamycin)
  • cyclophosphamide.

Before you start your treatment, many hospitals will arrange a chemotherapy information session. At this appointment a nurse will discuss how and when your chemotherapy will be given and how side effects can be managed.

Contact numbers will also be given so you know who to phone if you have any questions or concerns.

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2. Who might be offered AC?

AC chemotherapy is used to treat primary breast cancer – breast cancer that hasn’t spread beyond the breast or the lymph nodes (glands) under the arm. It can be used in combination with other anti-cancer drugs.

AC may be given before surgery, known as neo-adjuvant therapy (sometimes called primary chemotherapy), or after surgery, known as adjuvant (additional) therapy.

It may also be given to people with secondary breast cancer.

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3. How does AC work? 

Chemotherapy drugs interfere with how cancer cells develop and grow, and different drugs do this in different ways.

AC works by stopping the cancer cells from dividing and multiplying, which blocks the growth of the cancer.

Different chemotherapy drugs attack the cancer cells at different phases of their growth. This is why a combination of drugs is often used instead of one single drug.

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4. How is AC given?

AC is given as a drip into a vein (intravenously) in the hand or arm. There are other ways of giving chemotherapy, depending on factors such as how easy it is to find suitable veins.

Read more information about how intravenous chemotherapy can be given

With AC, both drugs are given on the same day, as an outpatient, over a period of around one hour or more. This is usually followed by a 20-day rest period to allow your body to recover.

The interval between each cycle of treatment may vary. This will depend on whether the number of blood cells has returned to normal between each cycle (see Effects on the blood), and also how you are feeling. Most people will usually have 4-6 cycles of treatment.

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5. Common side effects of AC

Everyone reacts differently to drugs and some people have more side effects than others. These can usually be controlled and the side effects described here won’t affect everyone.

If you’re concerned about any side effects, regardless of whether they’re listed here, talk to your chemotherapy nurse or cancer specialist (oncologist).

Effects on the blood

AC can temporarily affect the number of healthy blood cells in the body.

You’ll have regular blood tests to check your blood count. If the number of blood cells is too low, your next course of treatment may be delayed or the dose of chemotherapy reduced.

Not having enough white blood cells can increase the risk of getting an infection.

If you feel unwell, develop a sore throat or shivering or have a temperature above 38°C at any time during your treatment, contact the hospital immediately, even if this happens at the weekend or during the night.

Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your specialist team know.

Chemotherapy can reduce the number of platelets. If your count is low you may also bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your specialist team if you have any of these symptoms.

Hair loss (alopecia)

AC causes hair loss. Most people will lose all their hair, including eyebrows, eyelashes and body hair. Hair loss should be temporary and in most cases your hair will begin to grow back a few weeks after your treatment has ended.

Many units offer scalp cooling, which is a way of preventing or minimising hair loss by wearing a ‘cold cap’ before, during and after treatment. It’s not available in all areas, so ask your specialist or chemotherapy nurse if this treatment would be suitable for you and if it is available.

Nausea and vomiting

You may experience nausea and vomiting, but many people will not actually be sick. You’ll be given anti-sickness medication before the chemotherapy is given, and you’ll be prescribed anti-sickness drugs to take home to reduce nausea or stop it happening.

Diarrhoea or constipation

You may have diarrhoea or constipation but your specialist or GP can prescribe medicine to help control it. Contact your specialist chemotherapy team if you have four or more episodes of diarrhoea within a 24-hour period.

Sore mouth and taste changes

You may be given mouthwash to try to reduce soreness of the mouth and gums and to try to stop mouth ulcers developing. Good mouth hygiene is very important during treatment. It’s advisable to see your dentist for a dental check-up before chemotherapy begins and try to avoid dental treatment during chemotherapy.

While you're having AC your taste can change and some food may taste different (for example more salty, bitter or metallic). It can be helpful to experiment with different types of food to find the ones you can eat.

Pain in the injection site

If AC leaks out of the vein it’s being given in (called extravasation), it can damage the surrounding soft tissue. Tell the nurse giving the chemotherapy immediately if you have pain, stinging or a burning sensation around the cannula (small plastic tube) while the drug is being given.

After treatment, pain can occur where the needle has been inserted or along the vein. After a few weeks you may notice tenderness, darkening and hardening around where the needle was inserted. This should improve in time.

Tiredness (fatigue)

It’s common to feel extremely tired during your treatment. For some people, fatigue can last for several weeks or even months after the treatment has finished, but your energy levels will gradually return.

There are different ways of coping with fatigue.

Change in the colour of urine

Doxorubicin is red. You may notice when you go to the toilet that your urine is red or pink. This is not blood but the doxorubicin passing through your kidneys and bladder. This can last for one to two days after treatment.

Bladder irritation

It’s important to drink plenty of fluids around the time you have your treatment because chemotherapy drugs (particularly cyclophosphamide) can irritate the lining of the bladder. Try to empty your bladder regularly, as soon as you feel the urge. Tell your specialist if you notice any irritation or a burning/stinging sensation when passing urine.

Effects on your concentration

Your ability to concentrate or think clearly can also be affected, which can be very frustrating. This is called cognitive impairment but you may hear it referred to as ‘chemo-brain’ or ‘chemo-fog’ and usually improves over time after treatment has finished.

Effects on fertility

AC chemotherapy causes changes in the ovaries, which may lead to infertility in women who haven’t been through the menopause. The likelihood of you becoming infertile may also depend on whether you have had chemotherapy in the past and your age.

If you’re concerned about your fertility, it’s important to talk to your specialist team before treatment begins to discuss options for preserving fertility.

Menopausal symptoms

Sometimes AC can cause women who haven’t been through the menopause (pre-menopausal) to experience menopausal symptoms. This is because it affects their ovaries, which produce oestrogen.

Common symptoms include:

  • hot flushes and night sweats
  • mood changes
  • joint aches and pains
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6. Less common side effects of AC

Sore eyes and runny nose

AC chemotherapy can cause a runny nose. It can also cause soreness and a gritty feeling in your eyes, or your eyes may water. Eye drops can be prescribed to relieve the soreness.

Skin reactions

You may develop a rash anywhere on your body, which can be itchy. You may also develop soreness or redness on the palms of your hands and soles of your feet (called palmar-plantar or hand-foot syndrome). Your doctor may prescribe drugs as gels or creams to apply to the affected areas such as steroids, anti-inflammatories, anaesthetics and pain relief. Creams containing 10% Urea may be recommended to help prevent loss of moisture from the skin.

Your skin can become dry and flaky or peel – particularly on your hands and feet – but this will improve after treatment finishes. Using moisturising cream may help.

Mention any skin reactions to your specialist team so they can monitor the symptoms.

During treatment with AC and for several months afterwards, your skin will be more sensitive. You’ll be more likely to get sunburnt, so wear sunscreen with a high sun protection factor (SPF) if you’re out in the sun.

Nail changes

Your fingernails and toenails may become darker and ridges may form. However, this is uncommon and will grow out over the months following the end of your treatment.

For some people, doxorubicin can cause the nail to separate from the finger and fall off, but this is rare.

Heart changes

Doxorubicin may cause heart changes by weakening the heart muscle. This is usually temporary but for a small number of people it may be permanent.

Heart problems as a result of doxorubicin are not common. Before you start chemotherapy your specialist may arrange a heart (cardiac) function test. This could be an electrocardiogram (ECG), which takes an electrical recording of your heart, or an echocardiogram (echo) to make sure your heart is working normally.

You may also be offered a multiple-gated acquisition (MUGA) scan to check how well the heart is pumping.

Your heart function may also be monitored during treatment.

Allergic reaction

If you have an allergic reaction to AC, it will probably happen within the first few minutes of your treatment and is most likely the first or second time you have the drug. Reactions can vary from mild to severe, but severe reactions are uncommon.

You’ll be monitored closely so that any reaction can be dealt with immediately.

Symptoms of an allergic reaction include:

  • flushing
  • skin rash
  • itching
  • back pain
  • shortness of breath
  • faintness
  • fever or chills

If you have a severe reaction, treatment will be stopped immediately.

If you have a reaction, medication can be given before future treatments to reduce the risk of further reactions.

Blood clots

Chemotherapy can increase your risk of blood clots. Tell your doctor straight away if you have any swelling, pain or redness in your leg, shortness of breath or chest pains.

Liver or kidney changes

AC can cause irritation to the kidneys or liver. You’ll have regular blood tests to monitor your liver and kidneys throughout your chemotherapy. Any irritation is usually mild and gets better by itself. 

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7. Sex and contraception

You’re advised not to become pregnant while having treatment because AC may have a harmful effect on a developing baby. However, if you are already pregnant when breast cancer is diagnosed, AC may be considered after the first twelve weeks of pregnancy.

If you haven’t been through the menopause, talk to your team about the most suitable method of birth control for you.

You can still have sex during treatment. It’s not known if chemotherapy drugs can pass into vaginal fluids (or semen). Most hospital specialists advise using barrier methods of contraception, such as condoms, for a few days after chemotherapy is given.

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8. Vaccinations

Travel vaccinations

Vaccines may be less effective if given during treatment, and live vaccines can cause serious infections.

You shouldn’t have any live vaccines while having chemotherapy as they could be harmful. These include vaccines that protect against measles, rubella, yellow fever and typhoid.

It’s usually safe to have these vaccinations six months after your treatment finishes.

If you’re planning a trip and need vaccinations, discuss this with your specialist team.

Flu vaccination

Anyone with a reduced immunity to infection should have a flu vaccine. This includes people having or due to have chemotherapy.

The flu vaccine is not a live vaccine, which means there are no active viruses in it.

It’s best to have the vaccination at least two weeks before your chemotherapy starts. If you’re already having chemotherapy, talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab to ensure you gain the greatest possible effect from the vaccine. This will usually be at a point in your chemotherapy cycle when your white blood cell count is recovering.

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Last reviewed: August 2016
Next planned review begins 2018

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