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Adriamycin and Cyclophosphamide ("AC")
This is one of the mainstays of breast cancer chemotherapy, utilizing two anti-cancer drugs that have seen over 25 years of careful testing, doxorubicin ("Adriamycin") and cyclophosphamide.
AC is an outpatient treatment give once every 3 weeks. The drugs are given by putting up an intravenous drip, then running the drugs in slowly over about 45 minutes. Anti-nausea drugs are injected first.
Side-Effects of "AC"
Whilst AC chemotherapy certainly isn’t easy, most of my patients are able to live their lives pretty normally throughout treatment, working, looking after their families and having a fairly normal social routine. In fact, I strongly encourage you to make a big effort to do just that. It is common to have 2-3 days out of each three-week cycle when you do feel seedy, with low-grade nausea, loss of appetite and little energy. However, if it is any worse that then I want to know about it because I can probably make some changes to subsequent cycles to make it easier.
The main side-effects are considered in detail elsewhere – just follow the links to find out more about each one and to read some tips on how to manage and minimize the symptoms.
They include:
- Alopecia
(hair loss). AC always causes dramatic hair loss and it is usually nearly complete on the scalp, but tends to spare the eyebrows and eyelashes. Loss of other body hair is variable. Hair loss occurs about 3-4 weeks after the first dose.
- Nausea
- Low white blood cells and infection
- Altered menstrual cycle and early menopause
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- Infertility.
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- Mouth soreness and ulceration ("mucositis")
- Changes to finger-nails. Black discolouration of the nail beds is a common effect after several treatments. Sometimes white bands appear, "ring-barking" the nail corresponding with each treatment. The nails may become brittle and may sometimes fall off. They always grow back normally.
- Changes to mental function. ("Cognitive dysfunction")
- Bladder irritation ("cystitis"). Sometimes the cyclophosphamide can irritate the lining of the bladder as it is excreted. Occasionally this may cause bleeding in the urine ("haemorrhagic cystitis"). This is very rare with the doses used in AC. However, it is the main reason that we encourage you to keep your fluids up for the first 24 hrs after chemotherapy. Try to take 1.5-2 litres in the day, but don’t panic if you can’t cope with that volume, or if it is making you nauseated. One litre is usually quite sufficient.
- Heart muscle alteration ("cardiomyopathy"). This is caused by the Adriamycin and is extremely rare at the doses usually employed in the treatment of early breast cancer, for which we generally employ only four cycles of treatment. However, it is the reason that we always check your heart function before commencing Adriamycin. In women with advanced breast cancer we may sometime wish to use up to 8 or 9 cycles of treatment. If this is the case, heart function is monitored carefully at the higher doses. Heart function is measured using a special nuclear medicine scan called a Gated Heart Pool Scan. A radionucleide is injected into an arm vein and pictures taken of the contracting heart with a gamma camera. This enables the contractile force of the heart muscle to be measured.
There is some evidence that those who received an anthracycline drug, like Adriamycin, may have measurable impairment of heart muscle function many years after receiving the drug. This late effect of the chemotherapy is rarely clinically significant, but continues to be carefully monitored in long-term follow-up studies.This risk is tiny compared to the benefits in marked reduction in risk of breast cancer recurrence.
- Fatigue.
- Bad taste in the mouth ("dysgeusia").
- Indigestion, heartburn.
- Bad smells
- Possible very slight increase in the long term risk of certain disorders of the blood, including leukaemia. This risk is tiny compared to the benefits in marked reduction in risk of breast cancer recurrence.
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