How does AC (Adriamycin and Cytoxan [cyclophosphamide]) work for Breast Cancer?
Medically reviewed by Carmen Fookes, BPharm. Last updated on April 21, 2020.
- AC is a common, effective, combination chemotherapy treatment commonly used to treat early-stage localized breast cancer
- AC contains two chemotherapy agents Adriamycin (doxorubicin) and cyclophosphamide which are usually given together or sequentially with weekly paclitaxel (Taxol) or docetaxel (Taxotere), to create a combination called AC-T or ACT
- Adriamycin works by damaging DNA at any point in the cell cycle whereas cyclophosphamide damages DNA during the resting phase of the cell cycle. Both prevent cell replication
- Sequential Adriamycin-cyclophosphamide therapy with paclitaxel or docetaxel (AC-T) was declared by a 2015 review to likely be the most effective treatment regimen of early-stage breast cancer regardless of hormone status.
The combination of Adriamycin and cyclophosphamide is considered a “tried-and-true”, common, regimen to treat localized breast cancer. It is often referred to as simply “AC”. Cytoxan, the branded version of cyclophosphamide has been discontinued in the United States. Generic versions of cyclophosphamide are still available.
How does Adriamycin and cyclophosphamide work?
Adriamycin (doxorubicin) belongs to a class of cancer medicines called anthracycline antibiotics. It works by damaging the DNA inside cancer cells so they cannot replicate. It works at any point in the cell cycle.
Cyclophosphamide belongs to a class of cancer medicines called alkylating agents. Cyclophosphamide prevents cancer cells from dividing by cross-linking DNA strands and decreasing DNA synthesis. It works during the resting phase of the cancer cell cycle.
When would Adriamycin and cyclophosphamide be used?
The combination of Adriamycin and cyclophosphamide may be used to treat early-stage localized breast cancer that may or may not have spread to the lymph nodes. It is usually followed by weekly paclitaxel (Taxol) or docetaxel (Taxotere), to create a combination regimen referred to as AC-T (when given sequentially) or ACT (when given concurrently).
Adriamycin and cyclophosphamide may also be given when breast cancer has returned, or for breast cancer that has spread to distant areas of the body, such as the bones, liver, lungs or brain.
How is AC for breast cancer given?
The combination of Adriamycin and cyclophosphamide are usually given as separate infusions on the same day, followed by a rest period of 2 or 3 weeks. The cycle is usually repeated 4 to 6 times over 3 to 5 months.
How effective is AC or AC-T for breast cancer?
A review in 2015 reported that sequential Adriamycin-cyclophosphamide therapy followed by paclitaxel or docetaxel appears to be the most effective treatment regimen of early-stage breast cancer regardless of hormone status.
What are the side effects of AC for breast cancer?
Common side effects of combination Adriamycin and cyclophosphamide treatment include:
- Bladder irritation, pink or red urine
- Diarrhea or constipation
- Hair loss
- Low blood cell counts
- Menopausal symptoms
- Mouth sores
- Nail changes
- Nausea and vomiting
- Skin changes.
What are the long-term side effects of AC for breast cancer?
Long-term side effects of Adriamycin may include:
- Secondary cancers
- Amenorrhea in women older than 40
- Gastrointestinal problems
- Neurological problems.
- Adriamycin (doxorubicin) for injection. FDA https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/062921s022lbl.pdf
- Doxorubicin (Rx) Medscape.com https://reference.medscape.com/drug/doxorubicin-342120
- Rahman AM, Yusuf SW, Ewer MS. Anthracycline-induced cardiotoxicity and the cardiac-sparing effect of liposomal formulation. Int J Nanomedicine. 2007;2(4):567–583.
- Rheingold SR, Neugut AI, Meadows AT. Therapy-Related Secondary Cancers. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13999/
- Doxorubicin. Drugs.com Oct 7, 2019. https://www.drugs.com/dosage/doxorubicin.html
- Cyclophosphamide. Drugs.com Oct 20, 2019, https://www.drugs.com/ppa/cyclophosphamide.html
- Hortobagyi GN, Buzdar AU, Marcus CE, Smith TL. Immediate and long-term toxicity of adjuvant chemotherapy regimens containing doxorubicin in trials at M.D. Anderson Hospital and Tumor Institute. NCI Monogr. 1986;(1):105-9.
- Fujii T, Le Du F, Xiao L, et al. Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer: A Systematic Review and Network Meta-analysis. JAMA Oncol. 2015;1(9):1311–1318. doi:10.1001/jamaoncol.2015.3062
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