AC-PACL; AC-PACL+TRAS

• Since these medications may harm your baby if used during pregnancy, women who have not yet reached menopause should use effective forms of birth control while on treatment. Do not use birth control pills. Please discuss this with your oncologist.
• If you become pregnant, tell your oncologist right away.
• Do not breastfeed while undergoing treatment.
• Also, if you plan to have children in the future, discuss this with your oncologist before starting your first treatment, as chemotherapy may affect your fertility and your chances of having a baby in the future.

• Your treatment plan consists of a total of 8 chemotherapy cycles. Each cycle lasts 3 weeks (21 days).
• For the first 4 cycles, you will receive two drugs (Doxorubicin, Cyclophosphamide) through a vein in your arm (IV) on first day (Day 1) of each cycle.
• For the next 4 cycles, Paclitaxel will be infused through a vein in your arm over 3 hours on Day 1 of each cycle.
• Days 2 to 21 are rest days for all 8 cycles.
• You will have a blood test before each treatment to check if your blood counts are high enough for you to receive the next cycle of chemotherapy.

        With AC Regimen:

• Doxorubicin can cause damage to surrounding tissues if it leaks out of the vein and into the surrounding area. The nurses are extremely careful when they give you the medication, but tell them immediately if you experience burning or pain with the injection.
• Doxorubicin can have an effect on the function of the heart, which in some patients might cause shortness of breath, palpitation, fatigue and leg swelling. Your oncologist may order special heart tests, usually before you start your very first treatment. Tell your oncologist if you have had any heart problems in the past and if you experience any of these symptoms.
• Cyclophosphamide can irritate your bladder. Starting the day before treatment, for a total of 2-3 days, drink plenty of fluids (at least 8 glasses per day) during the day and empty your bladder (pass urine) frequently.  Tell your oncologist or nurse if you experience pain on urination, see blood in your urine, or need to urinate small amounts frequently.

With Paclitaxel Regimen:

• Allergic reactions can occur during the infusion of paclitaxel. Symptoms of an allergic reaction include: lower back pain, flushing, shortness of breath, swelling, chest pain, dizziness, itching and rash. Your nurse will watch you closely, especially at the beginning of each treatment, when the paclitaxel will be given at a slower rate. Tell your nurse if you are experiencing any type of discomfort as soon as they occur. You may experience these symptoms even after you leave the cancer centre. Please contact your oncologist if these symptoms occur. Please go to the nearest emergency department if you experience signs of an allergic reaction after you have been discharged.

With both regimens:

• All patients will experience some or total hair loss. This generally starts 2 to 3 weeks after the first injection. Your scalp may feel tender. It’s a good idea to consider a wig or other head covering before starting treatment. Hair loss on your face (e.g. eyebrows, eyelashes) and body can also occur. Your hair will usually start to grow back once your treatment is over, but hair loss may be permanent in some cases. The colour and texture of your new hair may be different.
• Medications in this regimen may make your periods heavier or lighter. Your periods may even stop completely. This may be permanent. You may develop symptoms of menopause such as hot flashes, vaginal dryness, mood swings and changes in sexual desire. Please discuss any concerns you might have with your nurse or oncologist.
• Tell your oncologist, nurse, and pharmacist about other prescription and non-prescription medications you are currently taking. Check with your oncologist, nurse or pharmacist before you start taking any new drugs, including herbal or alternative treatments. Also tell other healthcare professionals you are seeing that you are having chemotherapy treatment.
• Due to increased risk of developing infections, check with your oncologist before having any vaccinations. Also check with your oncologist before any surgery or dental work.
• If you are taking ASA (Aspirin®, acetylsalicylic acid), please discuss this with your oncologist as this may interfere with your chemotherapy treatment. For headache, fever, or occasional aches and pains, use acetaminophen (Tylenol ®) instead of ASA.

The table below contains some common or important side effects with this treatment.  You may not have all of the side effects.  Other side effects may occur.  If you have any unusual or bothersome symptoms, discuss with your doctor.