AC-PACL(DD); AC-PACL(DD)+TRAS
AC-PACL(DD) Treatment
This handout gives general information about this cancer treatment.
You will learn:
who to contact for help
what the treatment is
how it is given
what to expect while on treatment
This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
My cancer health care provider is: _____________________________________________
During the day I should contact: _______________________________________________
Evenings, weekends and holidays: _____________________________________________
This page gives general information about this cancer treatment.
You will learn:
who to contact for help
what the treatment is
how it is given
what to expect while on treatment
This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
AC-PACL (DD) is the code name of your breast cancer treatment regimen.
A regimen is a combination of medications to treat cancer.
This regimen name is made up of one or more letters from the names of the 3 medications in your treatment. This regimen name also has letters that describe the dose or other information about how the medication is given.
Here are the names of the medications in this regimen and what the other letters mean:
AC = doxorubicin (also called Adriamycin®) and Cyclophosphamide
PACL = PACLitaxel (also called Taxol®)
DD = dose dense, meaning treatment is given every 2 weeks. Each 2-week period is called a cycle.
For most people, treatment lasts 16 weeks. The treatment is divided into 8 cycles. Each cycle is 2 weeks long.
Here is a picture of the schedule for AC-PACL (DD) treatment:
Cycle 1 AC (2 weeks)
Cycle 2 AC (2 weeks)
Cycle 3 AC (2 weeks)
Cycle 4 AC (2 weeks)
Cycle 5 PACL (2 weeks)
Cycle 6 PACL (2 weeks)
Cycle 7 PACL (2 weeks)
Cycle 8 PACL (2 weeks)
During each 2-week cycle, you will have AC or PACL treatment on day 1 at the hospital.
Each cycle looks like this:
Day 1
Treatment Day:
Go to the hospital for
AC or PACL treatment
2
No
AC or PACL Treatment
3
4
5
6
7
8
9
10
11
12
13
14
Remember To:
Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
The medications in your treatment are given through an IV (injected into a vein) at the hospital.
Your health care team may suggest that you get a PICC line or a Port-a-Cath.
These are special IV’s used to give medicines and fluids into larger veins.
A PICC or Port-a-Cath can be safer for some medications that can cause reactions
when given through an IV in your hand.If you have a PICC or Port-a-Cath you do not need an IV (needle) put into your arm
every time you come for treatment.
- Talk to your healthcare team about the benefits and risks of a PICC or a Port-a-Cath to see if one of these options is right for you.
You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.
To Prevent Nausea and Vomiting
You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), aprepitant (Emend®), olanzapine (Zyprexa®) or others.
To Prevent Allergic Reaction
Before paclitaxel (PACL), you may be given medications to help prevent allergic reactions before they start.
There are different types of medications to stop allergic reactions. They are called:
antihistamines (such as diphenhydramine or Benadryl®)
analgesics/antipyretics (such as acetaminophen or Tylenol®)
H2 blockers (such as ranitidine or famotidine)
corticosteroids (such as prednisone)
To Prevent Infection
You will also be given a medication after each treatment day to increase your white blood cell count (neutrophils). This helps to prevent infection and make sure it is safe for you to get your next treatment.
The medication may be called filgrastim (such as Neupogen®, Grastofil®, or others) or pegfilgrastim (such as Neulasta®, Lapelga®, or others).
DO tell your health care team about any other medical conditions that you have such as heart, liver or kidney problems, or any allergies.
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO drink plenty of fluids (unless told differently) and pee often for 2 or 3 days after your AC treatment to prevent bladder irritation. It is normal for your urine (pee) to be red for up to 2 days after your AC treatment. Tell your health care team if your pee stays red for more than 2 days.
DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.
DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
DO tell your health care team about any other medical conditions that you have such as heart, liver or kidney problems, or any allergies.
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO drink plenty of fluids (unless told differently) and pee often for 2 or 3 days after your AC treatment to prevent bladder irritation. It is normal for your urine (pee) to be red for up to 2 days after your AC treatment. Tell your health care team if your pee stays red for more than 2 days.
DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.
DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
Check with your health care team before starting or stopping any of them.
- Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®.
- Over-the-counter products such as dimenhydrinate (Gravol®)
- Natural health products such as St. John’s Wort
- Supplements such as vitamin C
- Grapefruit juice
- Alcoholic drinks
- Tobacco
- All other drugs, such as marijuana or cannabis (medical or recreational)
Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
Fever can be a sign of infection that may need treatment right away.
If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
You have a fever if your temperature taken in your mouth (oral temperature) is:
38.3°C (100.9°F) or higher at any time
OR
38.0°C (100.4°F) or higher for at least one hour.
If you do have a fever:
Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Talk to your health care team about:
- How this treatment may affect your sexual health
- Changes to your menstrual cycle (periods), if this applies to you
- Symptoms of menopause such as hot flashes, vaginal dryness or changes in your mood, if this applies to you
- How this treatment may affect your fertility (ability to have a baby)
This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time while you are on treatment. Talk to your health care team about which birth control options are best for you, and how long you should use them after your last treatment dose.
- Do not use hormonal birth control (such as birth control pills), unless your health care team told you that they are safe. Talk to your health care team about the safest birth control for you.
- Do not breastfeed while on this treatment. Talk to your health care team about how long to wait before you start breastfeeding after your last treatment dose, if this applies to you.
The following table lists side effects that you may have when getting AC or PACL treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.
Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on AC-PACL (DD).
| Very Common Side Effects (50 or more out of 100 people) | |
| Side effects and what to do | When to contact health care team |
Hair thinning or loss What to look for?
What to do?
| Talk to your health care team if this bothers you |
Low neutrophils (white blood cells) in the blood (neutropenia) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for?
You have a fever if your temperature taken in your mouth (oral temperature) is:
What to do? If your health care team has told you that you have low neutrophils:
If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.
| If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.
|
Low platelets in the blood When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for?
What to do? If your health care team has told you that you have low platelets:
If you have signs of bleeding:
If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away. | Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency help right away. |
Nausea and vomiting (More likely with AC) What to look for?
What to do? To help prevent nausea:
| Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe |
Mild joint, muscle pain or cramps (More likely with PACL) What to look for?
What to do?
Ask your health care team for the Pain pamphlet for more information. | Talk to your health care team if it does not improve or if it is severe |
| Common Side Effects (25 to 49 out of 100 people) | |
| Side effects and what to do | When to contact health care team |
Allergic reaction; Reaction at the injection site (May be severe) What to look for?
If you have mild redness or discomfort at the site where the injection has been given during the AC treatments, you may need to apply ice/cold compresses. Talk to the health care team to find out what treatment is right for you. | Get emergency medical help right away for severe symptoms |
Diarrhea What to look for?
What to do? If you have diarrhea:
| Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day) |
Neuropathy (Tingling, numb toes or fingers) (More likely with PACL) What to look for?
What to do?
In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice. | Talk to your health care team, especially if you have trouble doing tasks like doing up buttons, writing, moving, or if you have severe pain or numbness |
| Less Common Side Effects (10 to 24 out of 100 people) | |
| Side effects and what to do | When to contact health care team |
Fatigue What to look for?
What to do?
Ask your health care team for the Fatigue pamphlet for more information. | Talk to your health care team if it does not improve or if it is severe |
Nail changes What to look for?
What to do?
| Talk to your health care team if it does not improve or if it is severe |
Pains or cramps in the belly What to look for?
What to do?
| Talk to your health care team if it does not improve or if it is severe |
Low appetite What to look for?
Ask your health care team for the Loss of Appetite pamphlet for more information. | Talk to your health care team if it does not improve or if it is severe |
Mild swelling What to look for?
What to do?
| Talk to your health care team if it does not improve or if it is severe |
Liver problems (More likely with PACL) Your health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms.
If you have any symptoms of liver problems, get emergency medical help right away. | Get emergency medical help right away |
Mouth sores What to look for?
To help prevent mouth sores:
Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information. | Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow |
Taste changes What to look for?
What to do?
| Talk to your health care team if it does not improve or if it is severe |
Dizziness What to look for?
| Talk to your health care team if it does not improve or if it is severe |
Bladder problems (With AC) What to look for?
| Talk to your health care team. Get emergency medical help right away for severe symptoms. |
Other rare, but serious side effects are possible with this treatment.
If you have any of the following, talk to your cancer health care team or get emergency medical help right away:
- irregular heartbeat, shortness of breath or chest pain
- sudden, severe pain in your belly or arm
- sudden confusion, trouble speaking or difficulty moving your arms or legs
- coughing up blood or trouble breathing
- pain and swelling of a vein in your arm or leg
- any changes in your vision
- severe bloating or feeling of fullness
- belly pain that extends to your back
- passing out (fainting) or seizure
- severe rash that causes your skin to blister or peel
For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.
January 2024 Formatting change only
For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.
The information set out in the medication information sheets, regimen information sheets, and symptom management information(for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.
A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.