AC chemotherapy
Factsheet
This factsheet is about the
chemotherapy combination AC. It
explains when it may be used, how
it works and what side effects may
occur during and after having
treatment.
2 | Introduction
AC is a combination of two chemotherapy drugs:
doxorubicin and cyclophosphamide. Doxorubicin is
also known as Adriamycin (a brand name), and this
is why the combination is called AC. Doxorubicin
belongs to a group of chemotherapy drugs known as
anthracyclines. Cyclophosphamide is part of a group of
chemotherapy drugs known as alkylating agents.
There are several combinations of drugs used to treat breast
cancer; AC is one of these. AC may also be used in combination
with other chemotherapy drugs. Your specialist team will
decide which combination is best for your type and stage of
breast cancer.
It is a good idea to read this factsheet with our Chemotherapy
for breast cancer booklet, which describes chemotherapy
treatment in general, explains possible side effects and features
some frequently asked questions.
Who might be offered AC chemotherapy?
AC chemotherapy can be used to treat people with primary
breast cancer – breast cancer that has not spread beyond the
breast or the lymph nodes (glands) under the arm.
It may be given before surgery (this is called primary or
neo-adjuvant chemotherapy) to try and reduce the size of
the cancer or, more commonly, after surgery – known as
adjuvant therapy.
Whether or not you are offered chemotherapy for primary breast
cancer depends on your individual situation. Various factors are
taken into consideration, such as: the size of your breast cancer;
whether any lymph nodes are involved; the grade of your cancer;
and the oestrogen receptor (ER) and HER2 receptor status
(for more information on these see our Understanding your
pathology report booklet).
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AC chemotherapy | 3
AC may also be given to people with a local recurrence (breast
cancer which has come back in the chest/breast area, or in the
skin near the original site or scar) or regional recurrence (breast
cancer which has come back and has spread to the tissues and
lymph nodes around the chest, neck and under the breastbone).
It can also be given to people with secondary breast cancer
(when cancer cells from the breast have spread to other parts of
the body such as the bones, lungs, liver or brain).
If you have any concerns regarding your treatment and its side
effects, it’s important to discuss these with your specialist team
before treatment begins.
How does AC treatment work?
Healthy cells divide and grow in an orderly way which enables
growth and repair of body tissues, but cancer cells grow by
dividing in a disorderly and uncontrolled way. Chemotherapy
destroys cancer cells by interfering with their ability to divide
and grow.
Different chemotherapy drugs work in different ways and attack
the cancer cells at different stages of their growth. This is why a
combination of drugs is often used instead of one single drug.
How is AC chemotherapy given?
The two drugs are usually given directly into a vein (intravenously).
A small plastic tube called a cannula is inserted into the vein in the
back of the hand or lower arm. The drugs are given as an infusion
(also called a drip) and an injection directly through the cannula,
over a period of approximately one hour or more in total.
Sometimes another intravenous device is used, for example,
a skin-tunnelled catheter (a fine tube inserted into a large vein
through a small cut in the chest wall). Alternatively, you may have
a PICC (peripherally inserted central catheter) line inserted into a
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4 | What are the possible side effects of AC?
AC chemotherapy | 5
vein in your arm which extends into a large vein leading to your
heart. Both of these can stay in place until your chemotherapy
treatment is complete.
team. It’s also a good idea to talk to your specialist team if you
notice any side effects that are not listed here but you think may
be due to the chemotherapy drugs.
Your specialist will be able to explain whether a cannula or
another type of intravenous device is best for you.
Some people find complementary therapies helpful in trying to
manage some of the side effects. However, it is important to
talk to your specialist team about any complementary therapies,
supplements or herbal remedies you may wish to use before you
start using them as some may interfere with your treatment. For
more information see our Complementary therapies booklet.
With AC, both drugs are given intravenously into the cannula on
the same day. You will then have a three-week break. On the
first day of the fourth week both drugs will be given again. This
pattern, known as a ‘cycle’ or ‘course’, is generally repeated four
to six times.
Effects of administering AC
The dose of chemotherapy is calculated for each individual
based on weight and height. The total length of your treatment
is usually three to five months. The break between each
course of treatment gives your body time to recover from any
short-term side effects that might occur. The intervals between
the treatments may vary depending on how well your cells
recover between cycles. See the ‘Common side effects’ section
opposite for more information.
If doxorubicin leaks out of the vein into which it’s being given, it
can damage the surrounding soft tissue. Because of this, it is
important to tell the nurse giving the chemotherapy immediately
if you experience pain, stinging or a burning sensation near the
cannula while the drug is being given.
You will normally be given your treatment as an outpatient so
you will be able to go home the same day. Each time you have
chemotherapy, you should expect to be at the hospital for most
of the day to allow for waiting time, blood tests, the drugs to be
prepared and treatment to be given.
While the drug cyclophosphamide is being given, you may feel
hot or flushed and slightly dizzy, and have an itchy nose or a
metallic taste in your mouth. These feelings usually go when the
treatment has finished, but tell your nurse if you experience any of
them. Being given the drug more slowly can sometimes help.
What are the possible side effects of AC?
Common side effects
Like any treatment, AC chemotherapy can cause side effects.
Everyone reacts differently to drugs and some people have
more side effects than others. These side effects can usually be
controlled. Some people find it helpful to keep a diary of how they
are feeling during their chemotherapy so they can discuss this
with their chemotherapy nurse or specialist team.
Bone marrow suppression
If you are concerned about any side effects, it may be helpful to
talk to your chemotherapy nurse or someone in your specialist
Visit www.breastcancercare.org.uk
Some people experience flushing of the face while doxorubicin
is given.
Chemotherapy drugs can affect blood cells within the body and
in bone marrow (the spongy material found in the hollow part of
bones) where blood cells are made. Blood cells (white blood cells,
red blood cells and platelets) are released by the bone marrow
to replace those which are naturally used up within the body.
Chemotherapy reduces the ability of the bone marrow to make
these cells.
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6 | Common side effects
A low white cell count can increase the risk of getting an infection.
Your resistance to infection is at its weakest around 7–14 days
after the AC has been given.
If you feel unwell, develop a sore throat, cough, shivering or a
temperature above 38°C during your treatment, you need to
contact the hospital immediately, even if this happens at the
weekend or during the night. You may need to be treated with
antibiotics. Your specialist team will give you details of who to
contact at any time during your treatment.
Before each cycle of chemotherapy begins (and sometimes
during a cycle) you will have a blood test to see if your blood
cell count is within safe limits to have the treatment, and that the
blood cells have recovered from the previous cycle. If the number
of blood cells is too low, it may be necessary to delay the next
course of treatment or to reduce the dose of chemotherapy
you are given. In some circumstances your specialist team may
recommend injections of drugs that stimulate the production of
white blood cells to reduce your risk of infection. Your specialist
team will explain more about these injections if you are going to
have them.
Sometimes people having chemotherapy develop anaemia
because of a low red cell count. If you feel particularly tired,
breathless or dizzy you should let your specialist team know.
Although these symptoms can also be due to other causes, it is
important to report them. Occasionally a blood transfusion may
be necessary at some point during your treatment.
Because AC can reduce the number of platelets (which help the
blood to clot), you may find during your treatment you bruise more
easily, have nosebleeds or notice that your gums bleed when
you brush your teeth. You need to tell your specialist team if you
experience any of these symptoms. A platelet transfusion can
be given, although this is rarely needed, as platelet levels usually
correct themselves over time.
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AC chemotherapy | 7
Nausea and vomiting
You may experience nausea (feeling sick), which can start
immediately after chemotherapy or several hours later. It may last
for several hours or may even persist for several days. However,
it can usually be controlled or reduced with anti-sickness drugs.
It is important to contact your hospital if your symptoms
don’t improve.
Anti-sickness drugs are routinely prescribed with chemotherapy
to help prevent nausea. If these don’t work other drugs can
be prescribed.
Hair loss
AC causes total hair loss in most people. For many this can be a
particularly distressing side effect of chemotherapy, but you may
find it easier to deal with if you know in advance that this
will happen.
Hair loss usually happens gradually and begins within two to three
weeks of starting treatment. Occasionally it may be much more
sudden. You may lose some or all of your body hair, eyebrows
and eyelashes. However, your hair will grow back after treatment
has been completed. Your chemotherapy nurse or breast care
nurse should be able to advise you on where you can obtain
a wig if you wish to have one and this can often be organised
before your chemotherapy starts.
The hospital will be able to either supply you with a wig or refer
you to other suppliers. Breast Cancer Care also offers a support
service called HeadStrong which offers practical tips on hair and
scalp care during cancer treatments and information on hats,
scarves and hairpieces and where to get them. The service also
provides an opportunity to try on different types of headwear,
providing an alternative to wearing a wig. You can find out if there
is a HeadStrong service in your area by contacting your nearest
Breast Cancer Care centre or calling our Helpline.
Call our Helpline on 0808 800 6000
8 | Common side effects
For some people scalp cooling may be appropriate to try to
minimise hair loss. This involves wearing a ‘cold cap’ while you
are receiving your chemotherapy. In general the cap is worn on
the head for 15 minutes before, during the treatment session and
for some time afterwards. It‘s so cold that it reduces the blood
flow to the hair follicles, which can reduce the amount of drugs
reaching these follicles. Your specialist or chemotherapy nurse will
be able to advise if scalp cooling would be suitable for you, and if
it is available in your hospital.
For more information, see our booklet Breast cancer and
hair loss.
Change in bowel habit (diarrhoea or constipation)
You may experience some change in bowel habit during your
chemotherapy treatment. If your bowel habit changes, let your
specialist team know, as medication can be prescribed to help
control this. It’s also important to drink plenty of water.
Sore mouth
AC chemotherapy | 9
Each person’s experience of fatigue is different. Although many
people find they can manage their daily tasks as usual and
continue to go to work, others will find this very difficult. Fatigue
can continue for quite some time after treatment has finished.
Research has shown regular exercise such as walking can
help with feelings of fatigue. Walking 20 minutes each day may
improve your fatigue and your fitness levels. Although this may be
difficult at first, if built up gradually, it may become easier
with time.
Your energy levels may also be improved by drinking plenty of
fluids and eating small amounts regularly, particularly when your
appetite is good.
If you become anaemic (have low red blood cells) you may be
more prone to fatigue but it can occur even if your blood levels
are normal.
Bladder irritation
You may develop a sore mouth or gums, or mouth ulcers. Tell
your specialist team if this occurs as they can prescribe special
mouthwashes and medicines to help. Good oral hygiene is
particularly important during treatment. If you already have a
dental problem such as cavities or gum disease, see your dentist
so it can be treated before chemotherapy starts.
It is important to drink plenty of water when you have your
treatment as chemotherapy drugs (cyclophosphamide
particularly) can irritate the lining of the bladder. Tell your specialist
if you notice any irritation, a burning sensation or pain when
passing urine. The drug doxorubicin can cause your urine to
become red for a short while. This is expected, and is not a cause
for concern.
Fatigue (extreme tiredness)
Skin changes
Tiredness or exhaustion that doesn’t go away with rest or sleep
is referred to as fatigue. This is a very common side effect of
cancer treatment and may start quite soon after you begin your
chemotherapy. Your level of fatigue may vary throughout your
treatment and it may affect what you feel able to do.
You will be more likely to get sunburn if you have had
chemotherapy as your skin will be more sensitive, so it’s
important to wear high factor sun cream if you are in the sun.
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Call our Helpline on 0808 800 6000
10 | Less common side effects
AC chemotherapy | 11
Infertility (temporary or permanent)
Changes to your nails
Chemotherapy can affect the function of the ovaries resulting in
fewer or no eggs being produced, which can affect fertility.
While some women are unaffected, others may find that their
periods become irregular or stop temporarily or completely,
which may mean permanent infertility. Although they may return,
women aged around 40 and over are less likely to get their
periods back after completing chemotherapy than younger
women. If your periods stop, this may result in menopausal
symptoms such as hot flushes and vaginal dryness. You may
find our Menopausal symptoms and breast cancer
factsheet helpful if you are experiencing symptoms.
It’s fairly uncommon, but you may find that your fingernails or
toenails become darker or more ridged. If this occurs, these
effects are likely to grow out over the months following completion
of treatment.
If you are concerned about your fertility, it is important to talk to
your specialist team before treatment begins. See our Fertility
issues and breast cancer treatment factsheet for more
information.
Heart changes
Doxorubicin may not be suitable for people with existing heart
conditions. Heart problems as a result of doxorubicin are not
common. However, because of the potential risk, before you start
chemotherapy treatment your specialist may arrange a heart
(cardiac) function test. This could be an ECG (electrocardiogram),
an ECHO (echocardiogram) or a MUGA (multi-gated acquisition
scan) to make sure your heart is working normally.
Other issues
Less common side effects
Contraception
Other skin changes
Having AC when pregnant may have a harmful effect on a
developing baby during the first trimester. Some women can
still become pregnant even if their periods are irregular or have
stopped, so effective barrier contraception such as a condom
should be used.
Doxorubicin may cause the area of skin that has been previously
treated with radiotherapy to become red and sore. This is called
‘radiation recall’. Let your specialist team know if this occurs. You
may experience discolouration of the skin over the vein used for
the injection. Your skin may also become dry and itchy. Some
people also find that their skin becomes darker. This should return
to normal once the treatment is finished.
Sore eyes and runny nose
AC chemotherapy can cause a runny nose and make your eyes
feel sore and ‘gritty’ or you may notice that your eyes water.
Sometimes eye drops can be prescribed to relieve the soreness.
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Cognitive dysfunction (‘chemo brain’)
Some people also find chemotherapy affects their ability to
concentrate and makes them more forgetful. This is sometimes
referred to as ‘chemo brain’ or ‘chemo fog’ and usually improves
over time after treatment has finished.
There is not a great deal of research evidence to support the best
way to treat ‘chemo brain’ but some of the tips to help reduce
cancer-related fatigue may also be beneficial (physical exercise
and eating a healthy, varied diet) as well as relaxation techniques
to reduce stress.
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12 | Further support
Can I take other medicines, drugs and treatments?
It is important to tell your specialist about any other drugs you are
taking or additional drugs you would like to take. This includes
vitamin and mineral supplements that you buy over the counter.
You should also talk to your specialist before taking any herbal
remedies to check that they will be suitable for you and will not
interfere with your chemotherapy treatment.
For more information on the side effects of chemotherapy see our
Chemotherapy for breast cancer booklet.
Further support
Breast Cancer Care
From diagnosis, throughout treatment and beyond, our services
are here every step of the way. Here is an overview of all the
services we offer to people living with and beyond breast cancer.
Our free, confidential Helpline is here for anyone who has
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in a similar situation
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AC chemotherapy | 13
We host weekly Live Chat sessions on our website offering you
a private space to discuss your concerns with others – getting
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Our map of breast cancer services is an interactive tool,
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Our One-to-One Support service can put you in touch with
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We run Moving Forward Information Sessions and Courses
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Our HeadStrong service can help you prepare for the possibility
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We offer specific, tailored support for younger women through
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14 | Further support
Other organisations
Macmillan Cancer Support
89 Albert Embankment
London SE1 7UQ
General enquiries: 020 7840 7840
Helpline: 0808 808 0000
Website: www.macmillan.org.uk
Textphone: 0808 808 0121 or Text Relay
Macmillan Cancer Support provides practical, medical, emotional
and financial support to people living with cancer and their
carers and families. It also funds expert health and social care
professionals such as nurses, doctors and benefits advisers.
This factsheet can be downloaded from our website,
www.breastcancercare.org.uk It is also available
in large print, Braille, audio CD or DAISY format on
request by phoning 0845 092 0808.
This factsheet has been produced by Breast Cancer Care’s
clinical specialists and reviewed by healthcare professionals
and people affected by breast cancer.
If you would like a list of the sources we used to research this
publication, email [email protected] or
call 0845 092 0808.
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