Q. I’ve been diagnosed with node-positive breast cancer, and the doctor says I’ll be having chemotherapy: AàCMF, is how he wrote it down. What’s it all about?
A. AàCMF is an acronym for the drug doxorubicin (Adriamycin), followed by a three-drug “cocktail” of cyclophosphamide (Cytoxan); methotrexate (Amethopterin, Mexate, Folex); and fluorouracil (5FU). You don’t have to remember these chemical names! Just remember the initials “AàCMF,” and that’s sufficient for anyone who asks.
How do these drugs work in tandem to kill cancer? Basically, each attacks your cancer cells in a slightly different way. The “A” part of this AàCMF “chemo cocktail” both blocks DNA production in your cells, and also inhibits the enzymes responsible for repairing DNA. Cells can’t live without DNA; thus when they’re deprived of it, they die (in fact, some even kill themselves when their DNA is damaged).
The “A” chemo drug can’t distinguish between cancer cells and normal cells; but because cancer cells are dividing so rapidly, it has a greater negative effect on them than on your normal cells. “C” attaches itself to the cancer cell’s DNA, which then gets tangled up and is unable to replicate itself (sneaky!). “M” prevents cells from using folic acid, a vitamin that’s critical for their growth and development; without it, they die. And “F” is made up of molecules that look very much like the molecules in normal cells, but they’re structured slightly differently; this very small difference is enough to keep cells from functioning properly, once “F” makes its way into them. And when cells can’t function, they die.
Q. OK, what’s the schedule for AàCMF chemotherapy? How many times, and how often, will I get treatment?
A. AàCMF is usually given intravenously, via a drip into your hand or arm. You’ll probably receive “A” alone, once every three weeks for four cycles. After that, you’ll receive “CMF”, given on day 1 and again on day 8 of a four-week cycle, the cycle repeating a total of four to eight times. So the whole treatment should take about five to nine months, barring any complications that slow down the process.
Don’t worry if your AàCMF schedule is somewhat different than this. Researchers are always testing slightly different ways of delivering these drugs, and hopefully you’ll receive them on the most effective schedule currently known.
The AàCMF treatment itself will probably take between one to three hours, depending on whether you’re getting “A” or “CMF.” Add to that the ride to and from the hospital, the blood tests before (to make sure your white cells are up to the battle), and the inevitable waiting around, and you’re looking at half a day each time. Bring stuff to distract or amuse yourself: books, knitting, a friend or family member. You don’t want to just sit around and twiddle your thumbs the whole time.
Q. You mentioned complications…
A. Each time you begin AàCMF treatment, you’ll have blood drawn first. One of chemo’s side effects is lowering your white blood cell count; i.e., killing off some of the cells that help fight infection. If your doctor decides your white cell count isn’t high enough to keep you healthy, he or she will delay your next chemo until your white cells have built themselves back up to an acceptable level.