Purpose of the AC (Adriamycin and Cyclophosphamide) Regimen

• Breast cancer: Particularly in early stages or locally advanced cancers, and sometimes in metastatic cases.

• Non-Hodgkin’s lymphoma: Used less frequently but can be part of treatment protocols.

• Other cancers: AC may occasionally be used for other cancers as part of a research trial or unique treatment plan.

Key Components

• Class: Anthracycline antibiotic

• Mechanism: Interferes with DNA synthesis by inserting itself between DNA base pairs, causing breaks in DNA strands and inhibiting the enzyme topoisomerase II, which is crucial for DNA replication.

• Administration: Intravenously, typically over a few minutes. It is a red fluid, often referred to as “red devil” for its color and potent side effects.

• Class: Alkylating agent

• Mechanism: Forms cross-links in DNA, preventing cell division and leading to cell death.

• Administration: Can be given orally or intravenously, depending on the specific cancer protocol.

Clinical Pearls

• Cardiotoxicity Monitoring: Doxorubicin is known for its potential to cause cardiotoxicity. Regular monitoring of heart function via echocardiogram or MUGA scan is crucial before and during treatment.

• Infection Risk: Both drugs are immunosuppressive. Monitor patients for signs of infection and counsel on avoiding exposure to contagious diseases.

• Hepatic and Renal Function: Adjust dosages based on liver and kidney function tests to avoid excessive toxicity.

• Nausea and Vomiting Management: Prophylactic antiemetics should be administered before each dose as both drugs can cause significant nausea.

• Infusion Reactions and Extravasation: Special care should be taken during infusion to prevent extravasation, particularly with doxorubicin, which can cause severe local tissue damage if leaked into surrounding tissue.

Patient Management Tips

• Education on Side Effects: Patients should be thoroughly briefed about potential side effects like alopecia, mucositis, fatigue, and myelosuppression, and provided with strategies to manage them.

• Hydration and Nutrition: Encourage adequate hydration and provide guidance on maintaining a nutritious diet to help manage potential gastrointestinal side effects and general well-being.

• Emotional and Psychological Support: Chemotherapy can be challenging; provide resources for emotional and psychological support, including referrals to support groups or mental health professionals.

• Close Monitoring and Regular Assessments: Schedule regular follow-up appointments to monitor the patient’s response to treatment, manage side effects, and adjust treatment as necessary.

• Drug Interactions: Be vigilant about any other medications the patient is taking to avoid interactions, particularly with other cytotoxic agents, live vaccines, and drugs affecting cardiac function.