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This information is about a chemotherapy treatment for breast cancer called TAC. It describes the drugs, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
TAC is named after the initials of the chemotherapy drugs used:
TAC treatment can usually be given to you as a day patient. You will need to have a blood test before you start treatment – either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All this may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it should not take long. Some people have their chemotherapy given through a thin plastic tube which is inserted under the skin into a vein near the collarbone (central line) or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, central line or PICC line, which is connected to a drip (infusion). Some anti-sickness medicines may be given as tablets.
The chemotherapy drugs are then given separately:
If you are having your treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness drugs to take with you. It is important to take these as directed, even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
Your doctor may use the word regimen (eg the TAC regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are having. The following is a description of a commonly used schedule for giving TAC.
On the first day of your treatment you will be given all three drugs (Taxotere, doxorubicin and cyclophosphamide) by drip and injections. After this you will have a rest period with no chemotherapy for the next three weeks. This completes a cycle of your treatment.
Following the rest period, three weeks after you started, the same drugs will be given to you again, beginning the next cycle of your treatment. Usually 4–6 cycles of treatment are given over 3–4 months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having TAC chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed in this information, please let your nurse or doctor know.
Lowered resistance to infection TAC can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
You may be given injections of a drug called G-CSF (granulocyte-colony stimulating factor), which is a protein that can help boost the number of white blood cells that your bone marrow produces. It is given as an injection under the skin (subcutaneously).
Bruising or bleeding TAC can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with TAC you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Feeling sick (nausea) and being sick (vomiting) There are very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor. They can prescribe other anti-sickness drugs, which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss TAC chemotherapy often causes people's hair to fall out. This usually starts about 2–3 weeks after you first have chemotherapy. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once treatment is finished.
Scalp cooling is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it is available at your hospital.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
Taste changes You may notice that your food tastes different. Normal taste will return when treatment ends.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink as much fluid as you can (up to 2 litres) on the days when you have cyclophosphamide, to help to prevent this. Tell your doctor if you have any discomfort when you pass urine.
You may notice that your urine becomes a pink-red colour. This is caused by the red colour of the doxorubicin and may last up to 24 hours after your treatment. It is quite normal.
Skin changes You may develop an itchy rash. Your doctor can prescribe medicine to help with this. Rarely, your skin may darken. If it does it usually goes back to normal a few months after treatment is finished.
Sensitivity to the sun During treatment, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily. You can still go out in the sun, but always wear a high-protection-factor sun cream and cover up with clothes.
Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, a headache, breathlessness, anxiety and a need to pass urine. You will be monitored for signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms.
Fluid retention You may notice that you gain weight and/or your ankles and legs swell. This decreases slowly once your treatment has finished. To help reduce the chance of fluid retention you will be given steroid tablets (usually dexamethasone) to take for three days beginning the day before treatment. It is important to take the steroids as you are instructed. The dexamethasone may also help to reduce the chance of an allergic reaction.
Changes to nails Your nails may become brittle, chipped and ridged. These changes grow out slowly over a few months once the treatment has ended.
Pain in the joints or muscles It is important to tell your doctor or nurse about this, so that appropriate painkillers can be prescribed.
Numbness or tingling in the hands and feet This is due to the effects of the docetaxel on the nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons, or other fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly in the few months after the treatment ends.
Diarrhoea If you have diarrhoea it can usually be easily controlled with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of liquid a day to replace the fluid you are losing.
Change in the way your heart works This is very uncommon with the usual doses of TAC chemotherapy, but may occasionally happen if higher doses are used. You may have tests to see how well your heart is working before you start treatment.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If this happens while doxorubicin is being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given, tell your doctor or nurse immediately.
Fertility Your ability to become pregnant may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In younger women this may be temporary, but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our TAC chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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