Adjuvant chemotherapy with 6 cycles of 5-fluorouracil (5FU), doxorubicin (Adriamycin, A), and cyclophosphamide (Cytoxan, C). 


1) What is a cycle? It is a 3-week period. This is the basic plan of each cycle. 



2) The total plan of 6 cycles is planned to take 18 weeks to complete.


3) What side effects might be expected? This should be discussed with your doctor. It depends on your individual health and resistance to side effects, and what medicines you receive to prevent these side effects. On most days during therapy most people can do what they normally do, but side effects can on some days cause serious discomfort and even lead to hospitalization.  You should know that most side effects are temporary, but some can be permanent and rare ones can cause death.


The following table shows how many women out of 100 had side effects of different kinds (based on a study in which 480 women got this therapy). For example, for mouth sores, for 100 women getting this therapy, 72 women might expect to have none at all, 35 women might expect to have some days with mild or moderate mouth sores, and 3 women might expect to have severe or very severe mouth sores on some days. 




Low white cells do not cause any symptoms.  Because white blood cells purpose is defend you from infections, during periods of low blood counts you are at higher risk of infection.  Granulocytes are a special type of white blood cell that has the purpose of defending you from bacteria. During periods of low blood counts you are at higher risk of infection. During therapy no women out of 100 women developed serious infections while their white blood counts were low.  In a study that included 480 women who got this type of chemotherapy, no women died of infections or other treatment related side-effects. 


Although the adriamycin used in these treatments can cause a small amount of decrease in the strength of the heart in most patients, this amount cannot be sensed, and does not cause any physical limitations. 3 out of 480 women developed changes in heart function during treatment. None of these patients died of this. 


One possible severe side effect of this type of chemotherapy may be an increased risk of leukemia. In the 480 woman study, no woman was reported to have developed leukemia within 6 years of getting the therapy. 


A very similar side effect profile was seen in a second study in which 736 patients got this type of FAC chemotherapy. Differences were that there seemed to be much less (< half as much) severe nausea and vomiting which may reflect the fact that the BCIRG study was started more recently when better anti-nausea drugs were available. 2% of the patients in this second study developed signs of potentially serious infections while their blood counts were low. 1 patient in this study developed leukemia. 1 patient died of a heart problem that may have been caused by the treatment. 


More information about the side effects of this therapy can be found in an article detailing the use of this therapy in 480 patients (1) and the abstract about the 745 patient study (2):


(1) Martin M, Villar A, Sole-Calvo A et al.  Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil, and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: A study by the GEICAM group."  Annals of Oncology 14: 833-842. 


(2)  Martin M, Pienkowski T, Mackey J,  et al. TAC improves disease free survival and overall survival over FAC in node positive early breast cancer patients, BCIRG 001:  55 months follow-up. Breast Cancer Research and Treatment 82(s1): Presentation 43 at the San Antonio Breast Cancer Symposium, 2003


Added 12/03