AC Chemo for Breast Cancer: Adriamycin + Cytoxan
If you have breast cancer that hasn’t spread to your lymph nodes or other areas of the body, your doctor may recommend that you receive AC chemotherapy.
The AC chemo regimen consists of:
Adriamycin (chemical name: doxorubicin)
Cytoxan (chemical name: cyclophosphamide)
There are other chemo regimens that can be used to treat early-stage breast cancer, such as CMF, TC, and AC-T. Your doctor will consider the type of breast cancer that you have before recommending AC. The type and stage of cancer will also influence whether it will be given before or after surgery.
How AC chemo works
Cytoxan and Adriamycin work in similar ways, but they’re different types of drugs.
Cytoxan is an alkylating agent chemotherapy drug. Alkylating agents stop breast cancer cells from reproducing by damaging the DNA inside the cells.
Adriamycin is an anthracycline, which kills cancer cells by damaging the DNA of cancer cells and interfering with their reproduction.
How AC chemo is given
AC treatment cycles last 21 days (3 weeks), meaning you’ll receive both drugs as an injection or infusion through an IV or port on Day 1, followed by 20 days of rest. Typically, AC chemo is given for four to six cycles.
AC chemo side effects
While on AC chemo, you may experience any of the common side effects of Adriamycin or Cytoxan, including:
increased risk of infection
reddish-orange urine
bladder irritation
irregular periods — this can include temporary cessation (usually resume after medication is completed) or permanent cessation of menstrual periods depending on your age and other factors
Less commonly, you may experience:
unusual thirst
yellowing of the eyes or skin
Other severe side effects include:
fast heartbeat or shortness of breath
swelling in your ankles or feet
AC chemo is not safe during early pregnancy, as each medication has the potential to cause fetal harm. You also shouldn’t get pregnant for at least a year after treatment. It’s also not recommended if you’re breastfeeding — the drugs can be passed through breast milk.
You may not be able to get pregnant after taking these medications, so talk to your doctor if your fertility is a concern.
Real patient reviews
Members of our community discuss their experiences with AC chemo in the community forum. Here are some of their comments. Remember, it's very important to talk to your doctor about any side effects you're having and ask about ways to manage them.
“First infusion was on Friday. I’m doing neoadjuvent AC first. It wasn’t as bad as I thought but it still kicked my butt. Feeling fatigued and nauseous. Taking the anti-nausea meds on schedule and was able to deal with the constipation today. Focusing on resting, walking when I can, and staying hydrated.” — purpletiger
“I had my first AC chemo session Monday. They have me [taking] so many nausea meds I barely got a twinge of that. I have been incredibly lethargic and my brain has been so fuzzy. I feel as though today is the first day I have emerged from a ‘chemo coma.’” — jmfws10
“On AC, the first few days were hardest, but by week 2 I felt pretty normal. A local friend was also on AC when I was. … She took her treatments on Friday afternoon, and by Monday she was fine to go back to work.” — GingerChi
Read more in our AC chemo discussion forum.
Paying for AC chemo
The cost of AC chemo may vary. The price you’ll pay depends on your health insurance provider and plan, where you live, and the pharmacy you use.
Note: Your insurance company may require you to get prior authorization before covering AC.
If you have trouble paying for AC, ask your pharmacist or care team about financial assistance programs that may be able to help.
Learn more about financial assistance and medicine cost-lowering tips.
— Last updated on March 29, 2025 at 4:49 PM