What Kinds of Drugs, Timetables and Possible Side Effects Can be Expected with Commonly Used Protocols for Chemotherapy?

— -- Question: What kinds of drugs, timetables and possible side effects can be expected with the following commonly used protocols (schedules) for chemotherapy?

A) AC: Adriamycin and Cytoxin
B) CEF: Cytoxan, Epirubicin and Fluorouracil
C) AC/T: Adriamycin, Cytoxan and paclitaxel (Taxol)
D) TAC: Docetaxel, Adriamycin (doxorubicin) and Cytoxan
E) TC: Taxotere and Cytoxan

Answer:Certainly. When we give chemotherapy to help prevent breast cancer from coming back, we have a lot of choices. Typically we give multiple drugs, not just one, and the 'alphabet soup' (as people call it) of these regimens, include regimens such as AC, CEF AC/T, TAC, TC; all of these are different drug regimens and the letters stand for the chemotherapy drugs that are combined together.

Now there are certain characteristics and side effects of chemotherapy that are common across all of them. For example, hair loss and impact on the bone marrow, such that the particular things that can happen is low red cells (or anemia), which can make people feel tired; low white cells, which are the bacteria-fighting cells in the blood, which can make people prone to infection. These are both side effects that we can help prevent with some of our modern growth factor drugs. Nausea, which we also prevent very effectively with many of our modern drugs.

There are other side effects that are not common, but can go along with certain types of drugs. There's one class of drugs called 'anthracyclines' -- which were the 'A's and 'E's in those earlier regimens -- and rarely that can cause heart damage so we're careful not to give those drugs to patients who have pre-existing heart trouble. There are 'taxane'-type drugs -- which were the 'T's in those earlier regimens -- can cause nerve damage, so we're careful not to give those to people who have pre-existing nerve damage. I can tell you that the risk of serious side effects with any of these regimens is much less than 1 percent, and the drugs are generally well-tolerated and are given over about three-and-a-half to six months, at which point they're finished, and the patient can move on to the rest of her therapy. 

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