AC-T: Adriamycin, cyclophosphamide, and Taxol

AC-T (doxorubicin and cyclophosphamide followed by paclitaxel), also called AC-T and AC-Taxol, is a chemotherapy combination treatment used to treat breast cancer. It contains 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. Docetaxol (taxotere) works in a similar way and is sometimes used instead of paclitaxel.

Who gets AC-T

AC-T is a standard regimen for breast cancers that require treatment with chemotherapy. Women with cancer of a higher grade and younger women often get this combination. It can also be used in people who have had a recurrence depending the medicines you received for early-stage disease.

AC-T can be given after surgery as adjuvant therapy, or before surgery as neoadjuvant therapy. Sometimes the AC portion is given before surgery and the taxane after, based on the cancer that remains in the breast after surgery.

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

How AC-T is given

AC-T is usually given in eight treatments, once every three weeks. The first four treatments are AC, and the next four are paclitaxel (T). Sometimes the paclitaxel is given weekly at a lower dose instead of every three weeks. The whole course of AC-T treatment takes about five months.

AC-T is more commonly given on a dose-dense schedule of AC every two weeks for a total of four cycles, followed by T every two weeks for a total of four cycles.

Adriamycin (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.

Sometimes docetaxel is used instead of paclitaxel. The AC portion is given once every three weeks followed by docetaxel, which is also given once every three weeks.

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 go to our section on side effects for more information.