Chemo Regimen FAQs: AC + Taxol/Taxotere chemotherapy (ACT, TAC)

Q. I've just found out I have to have chemotherapy. The doctor said it's AC and Taxol [or Taxotere]. What does that mean, exactly?

A. AC is one of the five most common types of chemotherapy given to women with breast cancer. It includes two drugs: doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). Paclitaxel (Taxol) or docetaxel (Taxotere) is added to AC for women with node-positive cancer, or in women who've had a recurrence; it's delivered after you've finished the AC. But you don't have to remember the names; just the initials, because anyone who needs to know will recognize what the letters stand for.

The "A" part of this "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). "A" 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. The "C" part of this chemo combo stops cancer cells from replicating. As for "T," it slows or stops cell division, or keeps enzymes from making the proteins cells need in order to grow. So between all of these, you have some pretty powerful agents working to destroy those cancer cells.


Q. How long will it take to get it?

A. Delivery methods and schedules vary, as the pharmacology is constantly changing. That said, you'll probably have eight treatments, one every three weeks, so the whole thing will take about 5 months, barring any complications that slow down the process. Each treatment is given by IV into your hand or arm. The first four treatments are AC, and should last about 2 hours each. The next four will be Taxol (or Taxotere), and will last about 3 1/2 hours each. Taxol/taxotere takes longer, because there's a bigger risk of an allergic reaction; this risk is lessened by delivering the drug very slowly. In addition, you'll probably get a Benadryl injection first, again to lessen the chance of a bad reaction.

Note that you MAY receive both the AC and taxol/taxotere on an accelerated schedule. This is called "dose dense" chemo, and is thought to be a more aggressive way to deliver the drugs, when aggressive measures are necessary.


Q. You mentioned complications...

A. Each time you begin 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.


Q. OK, give me the bad news: what side effects can I expect from AC + Taxol?

A. Well, the "good news" is that the worst of the side effects will come from the AC, so you can get them over with first. Here's what you can expect from AC: