TAC

TAC is the name of a combination of chemotherapy drugs used to treat early stage breast cancer after surgery. It is made up of the drugs

• T = Docetaxel (also called Taxotere)
• A = Doxorubicin (originally called Adriamycin)
• C = Cyclophosphamide

The links above take you to more information about the individual side effects of each drug.

The side effects of a combination of drugs are usually a mixture of those of each drug. You may get some or all of the side effects. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with TAC are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

You usually have TAC chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have between 4 and 6 cycles, taking 3 to 4 months in total.

You have TAC drugs into your bloodstream (intravenously). Docetaxel and cyclophosphamide are clear colourless fluids. Doxorubicin is a red fluid. You can have these drugs 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 just before your course of treatment starts and it stays in place as long as you need it.

For each cycle of treatment you have all 3 drugs (docetaxel, doxorubicin and cyclophosphamide) as drips or injections on the first day. Then you have a rest with no treatment for the next 20 days. This completes one cycle. You then begin another cycle by having the same drugs again followed by the rest period.

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 doctor if you have any of these  effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick is usually well controlled with anti sickness medicines
• Loss of appetite
• Complete head and body hair loss affects 8 out of 10 people (80%) but is temporary
• Fluid retention occurs in about 1 in 2 people (50%) having docetaxel – you will have steroids to help prevent this, but may have swelling of the hands and feet, breathlessness and weight gain
• A skin rash which may itch affects about 1 in 2 people (50%) treated with docetaxel
• A sore mouth and throat may happen about 5 days after each treatment and last for a couple of weeks – you may have mouth ulcers and red sore skin in your mouth
• Your urine may become a pink or red colour for 1 or 2 days after treatment with doxorubicin – this is due to the colour of the drug and is nothing to worry about
• Darkening in the creases of your skin
• Sensitivity to sunlight – it is important not to sit out in the sun, and to cover up or use sun block on exposed skin
• Women may stop having periods (amenorrhoea) – this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you
• TAC may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you could become pregnant

Between 1 and 10 in every 100 people have one or more of these.

• Inflammation of the bladder (cystitis) can happen with cyclophosphamide and may cause pain, and occasionally bleeding, when passing urine – drink plenty of fluids to reduce cystitis and contact your treatment centre straight away if you see blood in your urine
• Aching muscles and joints
• Fever and chills
• Numbness or tingling in fingers and toes can cause difficulty doing small things such as fastening buttons – this starts a few days or weeks after treatment and usually goes within a few months of finishing treatment
• Inflammation around the drip site when having docetaxel or doxorubicin – if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately
• Your nails may become darker and white lines may appear on them
• Diarrhoea – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• A mild allergic reaction affects about 3 out of 100 people (3%) who have doxorubicin and can cause a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins – it should clear up within a few days
• Skin in areas treated with radiotherapy in the past may get dry and flaky and may feel sore and hot
• Change in heart rhythm due to doxorubicin – your heart will be checked before and during treatment. In most people this goes back to normal when the treatment ends but some people may have permanent heart damage

Fewer than 1 in 100 people have these.

• There is a small risk that you may get a second cancer some years after TAC treatment
• Changes in lung tissue may lead to a cough or breathlessness – let your doctor or nurse know if you have these effects
• Sore eyes - your nurse can give you eye drops to help

Not everyone will get these side effects. You may have none or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much 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 they can help you manage them. You should have a contact number for your chemotherapy nurse, clinic or ward nurse. You can ring them 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, these 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.