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Taxotere, Adriamycin and Cyclophosphamide (“TAC”)
 
 

“Taxotere” is the trade name for docetaxel. Adriamycin in the trade name of doxorubicin. The three drugs together have been shown to be one of the most active regimes in breast cancer treatment.
TAC is an outpatient treatment given once every 3 weeks, usually for a total of 6 separate treatments. The three drugs are given by putting up an intravenous drip, then running the drugs in slowly over about 2 hours. Anti-nausea drugs are injected first, and it is necessary to take a steroid drug called dexamethasone starting the day before treatment. It comes as 4 mg tablets and you must take 2 tablets morning and night starting the morning of the day before your treatment, for five doses
Whilst TAC 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 drug Neulasta is always given the day after TAC to prevent a low white blood cell count and minimize the risk of infection.




Side Effects of TAC

Alopecia
(hair loss). TAC always causes dramatic hair loss, including the scalp, and often the eyebrows, eyelashes and other body hair. Hair loss occurs about 3-4 weeks after the first dose. After treatment with TACl has ended, normal hair growth should return.
Nausea.

Low white blood cells and infection.
Neulasta is used to minimize this, but you still need to take the precaution of reporting for medical care in the event of fever over 38 degrees centigrade.
Altered menstrual cycle and early menopause.

Allergic reactions. These may consist of fever or chills; flushing of the face; lower back or side pain accompanied by fever or chills; mild shortness of breath and occasional chest discomfort; skin rash or itching. Sometimes this occurs acutely during the infusion and often responds to a slowing down of the drip rate. We routinely give intravenous or oral dexamethasone before the docetaxel, and sometimes after it. Your chemotherapy nurse will supervise this.
Fluid retention
Some patients experience fluid retention, usually after at least two months of treatment. This can occur as mild swelling of the extremities ("oedema"), and occasionally may lead to fluid collecting in the sack around the heart ("pericardial effusion") or the linings of the lungs ("pleural effusion"). This usually causes breathlessness, and is usually readily treated by draining the fluid and ceasing the drug. It usually occurs gradually rather than suddenly, and your oncologist will be carefully monitoring for it. It is reduced by the regular use of dexamethasone as a pre-medication.
Skin and nail changes
TAC commonly produces redness, drying and cracking of the hands and feet, and often quite severe drying and cracking of the 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. These effects tend to occur gradually after several months of treatment. Thick glossy nail polish will help to prevent the nail changes. Tiredness and Fatigue ("Aesthenia")
This tends to occur gradually after several months of treatment.
Muscle pains ("Myalgia")
Pain in joints or muscles, especially in the back and legs may begins 2 to 3 days after treatment and may last up to 5 days. It feels like "’flu" pain, and may need strong pain killers like Panadeine Forte.
Loss of sensation ("sensory neuropathy")
Docetaxel causes reversible damage to the sensory nerves. This leads to "pins and needles" in the fingers and toes, and sometimes tenderness or odd burning sensations in the palms and soles, but especially the feet. It comes on after about two months of treatment, and may take as long as nine months to resolve after the treatment finishes. Not everyone gets this problem and some women seem much more sensitive to it than others.
Bad taste in the mouth ("dysgeusia").
Indigestion, heartburn .
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. In fact I have never seen a case. However, it is the reason that we always check your heart function before commencing Adriamycin. Heart function is measured using an Echo cardiogram, like an ultrasound test, or by 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.






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Copyright © 2014, Professor Richard Kefford AM MB BS PhD FRACP. All rights reserved.