For the Patient: ACT

Other names: BRAJACT

A Doxorubicin (ADRIAMYCIN®)
C Cyclophosphamide
T Paclitaxel (TAXOL ®)

Uses:

• BRAJACT is a drug treatment given after breast cancer surgery (called adjuvant chemotherapy) in
the hope of destroying breast cancer cells that may have spread to other parts of your body. This
treatment may reduce the chance of your breast cancer coming back and may improve your overall
survival or chance of a cure.

Treatment Plan:

• Your treatment plan consists of 8 chemotherapy cycles. Total time on drug treatment would be up
to about 6 months. A cycle length is 3 weeks. All the drugs are given intravenously at every visit.
For each cycle, you will need to have a blood test and see your oncologist before the treatment.
The dose and timing of your chemotherapy may be changed based on your blood counts and/or
other side effects.
• Doxorubicin and Cyclophosphamide (AC) are given for the first 4 cycles. Each treatment takes
about one hour. You will be given a prescription for anti-nausea drugs to take 30 minutes before
the treatment and again about 6-8 hours after, and will usually be on anti-nausea drugs the
following 2 days also.
• The next 4 cycles with Paclitaxel take about 4 hours in the chemotherapy room. You will be given
some intravenous medications before the Paclitaxel to prevent or lessen the chance of allergy.
• If needed, radiation therapy will start after your 8th chemotherapy cycle is finished and hormone
treatments may also be started, if your oncologist has recommended these for you.

Instructions:

• Bring your anti-nausea drugs with you to take before each AC treatment. You will also need to take
your anti-nausea drugs at home after therapy. It is easier to prevent nausea than treat it once it has
occurred, so follow directions closely.
• Drink lots of fluids for the first day or two after chemotherapy, especially while on AC (8 or more
cups a day).
• Check with your doctor or pharmacist before you start taking any new drugs. Other drugs such as
Phenytoin (DILANTIN®), Warfarin (COUMADIN®), Digoxin (LANOXIN®), and Thiazide diuretics
(“water pills”) may interact with BRAJACT.
• You may drink small amounts of alcohol, as it will not affect the safety or usefulness of your
treatment.
• Tell other doctors or dentists that you are being treated with BRAJACT before you receive any
treatment from them.
• If you are still having menstrual periods, BRAJACT may cause your ovaries to stop working,
resulting in menopausal symptoms (such as hot flushes) and infertility. Your periods may stop. This

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 may be permanent, especially if you are 40 years of age or older. Even if you have stopped
having periods after treatment, if you were fertile prior to chemotherapy, you may be able to
conceive a pregnancy. Use birth control (but not birth control pills) if you could become pregnant,
even if you have stopped menstruating because of chemotherapy. Do not breast feed during
treatment. Talk to your doctor if you have questions about fertility and birth control after treatment.

Serious Risks of Treatment:

Unexpected and unlikely side effects can occur with any drug treatment. The ones listed below are
particularly relevant to your treatment plan:
During treatment:
• Infection: The number of white blood cells that help fight infections will be lowered by the
chemotherapy drugs, usually starting after about day 7 of each of the 8 cycles. Your blood count is
expected to return to normal by day 1 of the next cycle, and will be normal after the 6 months of
chemotherapy drugs. If your white blood cell count becomes very low you could get a serious
infection. If you have a fever over 38°C or 100°F, call your cancer doctor immediately (24
hours a day) or go immediately to your nearest Hospital Emergency and tell the doctor you
are on chemotherapy.
• Increased risk of bleeding: The number of platelets (special blood cells that help your blood to
clot normally after injury) may be lowered by the treatment. They are expected to return to normal
by day 1 of next cycle. When the platelet count is low you may be more likely to bruise or bleed.
Notify your cancer doctor promptly if you develop large or numerous bruises, or unusual bleeding
(eg. nosebleed that won't stop, blood in stool, urine, or sputum). Try to avoid using ASA or
ibuprofen, if other pain medications could be used. Talk to your doctor if you feel you need to use
one of these medications while on chemotherapy. For patients receiving Warfarin, a modification of
the dose may be required based on blood test results.
• Tissue or vein injury: Doxorubicin and Paclitaxel can cause tissue injury if they leak out of the
vein while being given. Report any sensation of burning or pain to your nurse immediately.
Chemotherapy may cause some inflammation and/or scarring in the veins, which may make it
difficult to start an IV. Your nurse will help your doctor assess whether a special intravenous device
(PICC line or portacath) needs to be considered for your therapy. Pain or tenderness may occur
where the needle was placed in your vein. If so, apply cool compresses or soak in cool water for 15-
20 minutes several times a day

During or after treatment:

• Heart Failure: Rarely, Doxorubicin can have a serious effect on the heart, causing failure of the
heart’s pumping action, which results in shortness of breath, fatigue and leg swelling. This can
sometimes develop years after treatment. Your treatment may be stopped, and a heart function
test done, if there are concerns about your heart function during therapy.
• Leukemia: After chemotherapy, there is an increase in the risk of leukemia, a cancer of the white
blood cells. The risk is about 1% or less after this type of chemotherapy.
• Neuropathy: Paclitaxel can cause you to develop damage to the peripheral nerve endings (the
nerves to the hands and feet, and rarely, the face). This can result in feelings of numbness and
tingling, or sometimes painful burning sensations. You will need to be careful when handling things
that are sharp, hot, or very cold. The majority of the time, these feelings develop after a number of
treatments, are not severe, and will resolve fully over a period of months once treatment stops.
Infrequently (<5%), these feelings might occur early, might be severe, or might not entirely resolve.

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Common chemotherapy side effects and management:

SIDE EFFECT MANAGEMENT

Nausea and vomiting can occur with AC You will be given a prescription for anti-nausea drugs
and you will need to take anti-nausea drugs to take before your IV treatment and afterwards at
at the time of the injections and on days 2 home.
and 3 while at home. You will not usually • It is easier to prevent nausea than treat it once it
need antinausea drugs for paclitaxel. has occurred, so follow directions closely.
• Refer to the following pamphlets: For the Patient:
Managing Nausea; Chemotherapy & You; Food
choices to help control nausea*.
• Dexamethasone is used to help prevent allergic
Allergic reactions often occur after the
administration of Paclitaxel. Signs of an reactions. You will be given dexamethasone
allergic reaction are flushing, rash, itching, either as a single injection at the time of your
dizziness, swelling or breathing problems, or treatment.
sudden chest or back pain. • Your nurse will check your heart rate (pulse) and
blood pressure if needed.
• Tell your nurse or doctor immediately if you have
any sign of an allergic reaction
Hair loss. Your hair will fall out 2-4 weeks
after AC treatment begins. Your scalp may • Avoid hair spray, bleaches, dyes and perms.
feel tender. You may lose hair on your face • Apply mineral oil to your scalp to reduce itching.
and body. Your hair will grow back once your • If you lose your eyelashes and eyebrows, protect
chemotherapy treatments are over and your eyes from dust and grit with a broad-rimmed
sometimes between treatments. The colour hat and glasses.
and texture of the new hair growth may be • Ask your nurse about information on wigs and
different. head coverings.
Fatigue is common especially in the first • Your energy level will improve with time after
week after your treatment. As the number of treatment is completed.
chemotherapy cycles increases, fatigue may • You may obtain a suggestion pamphlet for
get worse or last longer. handling fatigue from nursing staff in your facility
Mouth sores may occur a few days after • Brush your teeth gently after eating and at
chemotherapy treatment and may last days bedtime with a very soft toothbrush. If your gums
or weeks. Mouth sores can occur on the bleed, use gauze instead of a brush. Use baking
tongue, gums, and the sides of the mouth or soda instead of toothpaste.
in the throat. • Try baking soda mouth rinses (using 1/4 tsp
baking soda in 1 cup warm water) and rinse
several times a day. Try ideas in Easy to chew,
easy to swallow food ideas*.
• Tell your doctor about a sore mouth, as your
chemotherapy doses may need to be decreased if
mouth sores are severe. Call your doctor if you
are having difficulty eating or drinking due to pain.

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 SIDE EFFECT MANAGEMENT
Diarrhea may occur between treatments. To help diarrhea:
• Drink plenty of liquids.

• Eat and drink often in small amounts.

Avoid high fiber foods as outlined in Food ideas to

help with diarrhea during chemotherapy.

Burning on urination. AC can cause an • Drink more fluids to keep the urine dilute and
irritation of the bladder that result in burning empty your bladder often.
on urination and/or frequency of urination.
Urine color may be red after AC for a short
while.
Pain affecting joints or muscles may occur • Take ibuprofen (e.g., ADVIL®) or acetaminophen
for a few days after paclitaxel. After you stop (e.g. TYLENOL®) for mild to moderate pain.
chemotherapy altogether, you may also feel Contact your cancer doctor if your pain is severe.
increased joint aching or stiffness for a few • Your family doctor can help you to manage
months. symptoms of joint pain after chemotherapy.
*available through your nurse or nutritionist
** available through your nurse

If you experience symptoms or changes in your body that have not been described
above but worry you, or if any symptoms are severe, contact

_______________________________ at telephone number ___________________

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