This page tells you about the chemotherapy combination AC and its possible side effects. There is information about
AC is the name of a chemotherapy combination sometimes used to treat breast cancer. You are most likely to have this treatment to try to stop breast cancer from coming back after surgery and radiotherapy. This is known as adjuvant therapy. AC includes the drugs
- A – Adriamycin (doxorubicin)
- C – Cyclophosphamide
There are a number of drug combinations used for women with breast cancer. AC is just one type. Your doctor will decide which combination is best to treat the type of breast cancer and the stage of your breast cancer. You can read more about other combinations in our information about breast cancer chemotherapy.
You usually have AC chemotherapy as cycles of treatment. Each cycle lasts 3 weeks (21 days). A usual course of treatment consists of 4 to 6 cycles in total.
You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
The side effects associated with AC are detailed below. You can use the links to find out more about each side effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment ends
- Hair loss – almost everyone has complete, temporary, head and body hair loss. This usually begins 2 to 5 weeks after the treatment starts. Using a cold cap may help to prevent hair loss with this combination of drugs
- Your urine may become a pink or red colour for one or two days after treatment but this won't harm you
- Feeling or being sick can be quite severe but anti sickness injections or tablets usually control it. The sickness may start a few hours after each treatment and last for about a day. If your sickness is not controlled, tell your doctor or nurse. You may be able to have other anti sickness medicines that work better for you
- A sore mouth and throat can happen about 2 to 3 days after each treatment – you may have red sore skin in your mouth and mouth ulcers. This usually clears up within 3 weeks
- You may have black or brown discoloration in the creases of your skin – this is particularly common in children
- Watery eyes happen to about 1 in 4 people (25%) and may last for several days after each treatment – very rarely, you may get sore eyes
- Sensitivity to the sun – cover up and stay in the shade throughout your course of treatment. If you must go out in the sun, use a high factor sun cream
- Periods may stop during treatment (amenorrhea) but this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these.
- Nail changes – your nails may become ridged, darken, or become brittle and chip or break easily
- Inflammation of the bladder lining, which can cause pain and occasionally bleeding when you pass urine. If you see blood in your urine contact your doctor or nurse straight away
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
- 3 people in 100 (3%) have an allergic reaction to doxorubicin – you may get a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins. This should clear up within a few days
- AC can affect the skin in areas treated with radiotherapy in the past, making it dry, red, sore and flaky – this goes away on its own but keep affected areas out of the sun
- Damage to heart muscle, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
- Diarrhoea – if you get diarrhoea, drink plenty of fluids and tell your doctor or nurse if it becomes severe or lasts more than 3 or 4 days
Fewer than 1 in 100 people have these.
- There is a small risk of developing another cancer in the future after treatment with these drugs. If this is going to happen, it most often occurs 5 to 8 years after treatment
- Changes in lung tissue may lead to a cough or breathlessness developing in the future
- There is a small risk of developing permanent heart damage with these drugs – your doctor will check for this
You may have a few of the side effects mentioned. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may harm a baby developing in the womb. It is important not to become pregnant while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about the drugs used in AC look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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