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AC

AC is the name of a chemotherapy combination. It includes the drugs:

  • A – adriamycin (doxorubicin)
  • C – cyclophosphamide

It is a treatment for breast cancer. 

How it works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have it

You have AC into your bloodstream (intravenously).

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

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.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

An increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness  

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

An increased risk of bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechia).

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Inflammation of the bladder (cystitis)

You might feel that you have to pass urine more often than usual. And you may have a burning feeling when you do. Or you might feel that you can't wait when you need to go. This is called cystitis. 

It helps to drink plenty of fluids. Some people think that cranberry juice can help but others feel it makes the soreness worse. Research studies haven't found that it helps. 

You might find that some drinks increase the soreness, such as tea and coffee. You can experiment for yourself and see what works for you.

Don't take any over the counter medicines for cystitis as they could be harmful.

Tell your doctor or nurse if you have soreness. They can prescribe medicines to help.

You could also have very blood in your urine. Your healthcare team might do urine tests to keep a check in this.

A high temperature (fever)

You might get a high temperature (fever) for a few hours after having this treatment. Tell your doctor or nurse if you have a fever.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • loss of appetite
  • heart problems that can affect how well your heart works
  • feeling or being sick
  • sore mouth and mouth ulcers
  • diarrhoea
  • inflammation of the lining of your throat, stomach, gut (intestines) and bowel
  • changes to the way your liver works
  • chills and or shivering
  • feeling weak and having no energy

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • an allergic reaction
  • • a small chance of developing a second cancer including acute myeloid leukaemia (AML), bladder cancer, kidney cancer and myelodysplastic syndrome (MDS)
  • a change to the amounts of chemicals in your blood caused by the breakdown of the cancer cells this can affect how your heart and kidneys work. If you are at risk of this happening you might have extra fluids with your chemotherapy
  • sore, red, itchy eyes (conjunctivitis)
  • dry, red, itchy skin and or a rash
  • nail changes including colour, brittle nails and where the nails separate from the nail bed
  • dizziness
  • an excessive uncontrolled release of a hormone called antidiuretic hormone (ADH) causing feeling sick, loss of appetite, sore muscles and weakness
  • not enough fluid in the body (dehydration)
  • fit (seizure) causing sudden, violent and irregular movement of the body (convulsion)
  • changes to your eyesight including blurred vision
  • inflammation of the liver (hepatitis)
  • chest pain

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else should I know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with this drug. 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. Women may be able to store eggs or ovarian tissue but this is rare.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray. You should do so for 2 weeks following their vaccination if you have a severely weakened immune system.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help