Components:
- A: Doxorubicin (Adriamycin) — an anthracycline antibiotic
- C: Cyclophosphamide — an alkylating agent
Indications:
- Commonly used as adjuvant or neoadjuvant chemotherapy for breast cancer (early and locally advanced)
- Also used in other solid tumors and some hematologic malignancies
Mechanism of Action:
- Doxorubicin: Intercalates DNA, inhibits topoisomerase II, and generates free radicals causing DNA damage and apoptosis.
- Cyclophosphamide: Alkylates DNA, leading to crosslinking and inhibition of DNA replication.
Administration:
- Typically given intravenously every 2–3 weeks, often followed by sequential taxane therapy (e.g., paclitaxel or docetaxel) in breast cancer.
Key Toxicities:
- Doxorubicin: Cardiotoxicity (cumulative dose-dependent), myelosuppression, mucositis, alopecia
- Cyclophosphamide: Myelosuppression, hemorrhagic cystitis (prevent with hydration and MESNA if high dose), nausea/vomiting
Pharmacist Considerations:
- Monitor cardiac function (LVEF) before and during therapy due to doxorubicin risk.
- Assess blood counts regularly to manage neutropenia and thrombocytopenia.
- Counsel on antiemetic use to prevent nausea/vomiting.
- Educate on risk of secondary malignancies and infertility.