CAF: Cyclophosphamide, Adriamycin, and fluorouracil

CAF (Cyclophosphamide, Adriamycin, and Fluorouracil) is a chemotherapy regimen given for localized breast cancers with a relatively high risk for recurrence.

It is a combination of three chemotherapy medicines:

• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin)
• Fluorouracil (5-FU)

Cyclophosphamide is a type of chemotherapy medicine called an alkylating agent. Doxorubicin is a type of chemotherapy medicine called an anthracycline. Fluorouracil (5-FU) is an antimetabolite chemotherapy medicine.

CAF uses the same medicines as the combination FAC, but has different doses and schedules.

How CAF works

Each medicine attacks the cancer cells in a different way:

• Cyclophosphamide stops cancer cells from reproducing.
• Doxorubicin stops cancer cells from making DNA and interferes with the enzymes that repair the DNA in the cells.
• Fluorouracil stops cells from making and repairing DNA. This causes the cells to die when they try to divide.

Who gets CAF

Past clinical trials showed CAF to be effective for both node-negative disease (which hasn’t traveled to lymph nodes) and node-positive disease (which has traveled to lymph nodes). It was often used in the past as adjuvant therapy, after and in addition to surgery, for people with locally advanced or inflammatory breast cancer.

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

How CAF is given

CAF can be given two ways:

• All three medicines together, by vein, on the first day of treatment, followed by fluorouracil alone one week later and then a 3-week rest period. This 4-week cycle is usually repeated four to six times over 3 to 4 months.
• Cyclophosphamide by mouth as a daily pill for 14 days, with doxorubicin and fluorouracil together, by vein, on days 1 and 8 of that 2-week period. This is followed by a 2-week rest period off chemotherapy. This cycle is usually repeated 4 to 6 times every 4 weeks for 4 to 5 months.

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 CAF include:

• Risk of infection
• Low blood counts (including white blood cells, red blood cells, and platelets)
• Menopausal symptoms
• Nausea and vomiting
• Hair loss
• Mouth sores
• Fatigue
• Eye problems
• Heartburn
• Diarrhea or constipation
• Bladder irritation
• Nail changes
• Joint pain

Less common side effects include:

• Heart damage
• Leukemia, a blood cancer
• Skin changes
• Increased risk of sunburn

Before starting CAF, 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 will have a blood test before you start treatment. Your providers may suggest you drink a lot of fluids during treatment to avoid kidney and bladder side effects. Ask your doctor how much you and how often you should drink each day.

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

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.