AC-T Chemo Treatment: Adriamycin + Cytoxan + Taxol

If you’ve been diagnosed with early-stage breast cancer that’s growing quickly (high grade) is very large, or has spread to the lymph nodes under the arm, your doctor may recommend that you receive AC-T chemotherapy. 

AC-T chemo is a combination of three chemotherapy medicines given over several months. The AC-T chemo regimen consists of:

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  Adriamycin (chemical name: doxorubicin)

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  Cytoxan (chemical name: cyclophosphamide) 

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  Taxol (chemical name: paclitaxel)

Your recommended chemo regimen will be based on the type of breast cancer you have. The type and stage of cancer will also influence whether it will be given before or after surgery.

While some people with early-stage breast cancer receive Adriamycin and Cytoxan only (AC chemo regimen), studies show that adding Taxol can lead to better outcomes in people with higher-risk breast cancer.

However, Adriamycin can have a toxic effect on the heart. If you have pre-existing heart problems, your doctor will likely recommend another chemo regimen, like TC. 

The three medications in the AC-T regimen target cancer cells in different ways:  

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  Adriamycin is an anthracycline. Anthracyclines kill cancer cells by damaging the DNA of cancer cells and interfering with their reproduction.  

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  Cytoxan is an alkylating agent. Alkylating agents stop breast cancer cells from reproducing by damaging the DNA inside the cells.

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  Taxol, a taxane, interferes with the ability of cancer cells to divide. This leads the dividing cells to die.  (Doctors may decide to use Taxotere, another taxane, instead of Taxol. They can explain why they recommend one or the other for your unique case. )

AC-T chemo is typically given as four AC treatments, once every three weeks, followed by Taxol. You may receive four treatments of Taxol combined with granulocyte colony-stimulating factor (G-CSF) every two weeks or you may receive 12 weekly treatments of Taxol.

You and your doctor will discuss your options and decide which of the two schedules is best for you.

While on AC-T, you may experience any of the common side effects of Adriamycin, Cytoxan, or Taxol, including:

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  easy bruising and increased risk of bleeding

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  appetite changes

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  nail changes

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  hair loss

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  nausea

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  vomiting

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  diarrhea

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  mouth sores

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  hand-foot syndrome

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  reddish-orange urine

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  susceptibility to infection

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  allergic reactions

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  numbness in the fingers and toes (neuropathy)

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  weakness

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  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

Other severe side effects include:

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  pain, blisters, or sores at the injection site

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  fast heartbeat or shortness of breath

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  swelling in your ankles or feet

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  low white blood cell count

AC is not safe during early pregnancy, and the safety of Taxol during pregnancy is not well understood. Each medication has the potential to cause fetal harm. It’s also not recommended if you’re breastfeeding — the drugs can be passed through breast milk. 

Members of our community discuss their experiences with AC-T 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.

“I did AC-T chemo two years ago … It was tough, but not nearly as bad as I had feared. I was 48 at the time and kept working my desk job throughout treatment. I shaved my head around Day 17 after starting chemo when I found that my hair was starting to fall out. I found it easier to take control and honestly didn't mind being bald so much.”  —scaredme

“I did AC + T, and rocked an awesome wig while teaching at my university. My wig was way more attractive than my real hair. My department chair allowed me to get out of all committee work, and assigned a teaching assistant to my classes so someone could take over if I "went down." I never did. After Taxol, I did lose my eyelashes and eyebrows and they grew back sparsely.” —elainetherese

“I did AC&T and am a year and a half out from my last infusion. I did four AC and twelve Taxol. One of the most important things, I believe, is to rest and make sure you're drinking a lot of water. It was difficult for me because my taste buds were off and water did not taste good;  lemon helped me somewhat. I also found ginger ale and popsicles to work for me. The popsicles really helped soothe any mouth sores, for which the MO [medical oncologist] can recommend a mouthwash, should you get them.” —serendipity09

Read more in our AC-T discussion forum.

The cost of AC-T 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-T. 

If you have trouble paying for AC-T, 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.