AC

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

Click on the links to find out the side effects of each individual drug.

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 stage of your breast cancer. There is more information about these combinations in the section 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 usually have both drugs by injection through a thin, short tube (cannula) put into a vein in your arm on the day of each treatment. Or you may have it 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 just before your course of treatment starts and it stays in place as long as you need it.

The side effects of a combination of drugs are usually a mixture of the side effects of each drug. The combination of drugs may increase or decrease your chance of getting each side effect. Or the combination may change the severity. We have listed the side effects associated with AC below. 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.

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) 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, which 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 is not harmful
• Feeling or being sick can be quite severe but anti sickness injections or tablets usually control it – it 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 because 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, which 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 happens 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
• AC may have a harmful effect on a developing baby. It is not advisable to become pregnant or father a child if you are having this treatment. Talk about contraception with your doctor or nurse before having the treatment
• Periods may stop during treatment (amenorrhea) but this may be temporary
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with these drugs. It is important to talk to your doctor about your fertility 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, which 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

The side effects above may be mild or more severe. 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

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.