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Systemic Anti-Cancer Therapy Regimen Library

Home > BR Neoadjuvant/Adjuvant - AC [DOXOrubicin and CYCLOPHOSPHamide] Q3W followed by PACLItaxel Q1W

BR Neoadjuvant/Adjuvant - AC [DOXOrubicin and CYCLOPHOSPHamide] Q3W followed by PACLItaxel Q1W

Treatment Overview

This regimen consists of two parts: AC [DOXOrubicin and CYCLOPHOSPHamide] Q3W followed by PACLItaxel Q1W.

Cycles 1 to 4 - 21 days - AC [DOXOrubicin and CYCLOPHOSPHamide] Q3W

Cycle length:
21

Cycle 5 - 7 days - PACLItaxel Q1W (all hypersensitivity pre-medications)

Cycle length:
7

Cycle 6 - 7 days - PACLItaxel Q1W (tapering hypersensitivity pre-medications)

Cycle length:
7

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycle 7 - 7 days - PACLItaxel Q1W (tapering hypersensitivity pre-medications)

Cycle length:
7

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycles 8 to 16 - 7 days - PACLItaxel Q1W (no hypersensitivity pre-medications)

Cycle length:
7

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycle details

Cycles 1 to 4 - 21 days - AC [DOXOrubicin and CYCLOPHOSPHamide] Q3W

Medication Dose Route Days Max Duration
olanzapine * 2.5 mg oral administration 1 to 4
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
ondansetron 8 mg oral administration 1
DOXOrubicin 60 mg/m² intravenous 1 15 minutes
CYCLOPHOSPHamide 600 mg/m² intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
cyclIZINE 50 mg Three times daily oral administration 1

Cycle 5 - 7 days - PACLItaxel Q1W (all hypersensitivity pre-medications)

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1
loratadine * 10 mg oral administration 1
PACLItaxel * 80 mg/m² intravenous 1 60 minutes
domperidone 10 mg Three times daily oral administration 1

Cycle 6 - 7 days - PACLItaxel Q1W (tapering hypersensitivity pre-medications)

Medication Dose Route Days Max Duration
dexamethasone * 4 mg oral administration 1
loratadine * 10 mg oral administration 1
PACLItaxel * 80 mg/m² intravenous 1 60 minutes
domperidone 10 mg Three times daily oral administration 1

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycle 7 - 7 days - PACLItaxel Q1W (tapering hypersensitivity pre-medications)

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1
loratadine * 10 mg oral administration 1
PACLItaxel * 80 mg/m² intravenous 1 60 minutes
domperidone 10 mg Three times daily oral administration 1

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycles 8 to 16 - 7 days - PACLItaxel Q1W (no hypersensitivity pre-medications)

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1
PACLItaxel * 80 mg/m² intravenous 1 60 minutes
domperidone 10 mg Three times daily oral administration 1

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Full details

Cycles 1 to 4 - 21 days - AC [DOXOrubicin and CYCLOPHOSPHamide] Q3W

Day: 1

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 12 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
DOXOrubicin 60 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
CYCLOPHOSPHamide 600 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Cycle 5 - 7 days - PACLItaxel Q1W (all hypersensitivity pre-medications)

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONE hour prior to the paclitaxel infusion with food.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Cycle 6 - 7 days - PACLItaxel Q1W (tapering hypersensitivity pre-medications)

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 4 mg oral administration
Instructions:

ONE hour prior to paclitaxel with food.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Cycle 7 - 7 days - PACLItaxel Q1W (tapering hypersensitivity pre-medications)

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • Alternative is dexamethasone 4 mg.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Cycles 8 to 16 - 7 days - PACLItaxel Q1W (no hypersensitivity pre-medications)

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hypersensitivity / Infusion related reaction risk: Variable

Emetogenicity:

  • HIGH cycles 1 to 4.
  • LOW cycles 5 to 16.

Hypersensitivity / Infusion related reaction risk: HIGH – routine premedication recommended with paclitaxel.

References

Sparano, J. A., M. Wang, S. Martino, et al. 2008. "Weekly PACLItaxel in the adjuvant treatment of breast cancer." N.Engl.J Med. 358(16):1663-1671, PMID: 18420499

Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020)

Fisher, B., A. M. Brown, N. V. Dimitrov, et al. 1990. "Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15." J.Clin Oncol. 8(9):1483-1496, PMID: 2202791

Early Breast Cancer Trialists' Collaborative Group (1998). "Polychemotherapy for early breast cancer: an overview of the randomised trials." Lancet 352(9132): 930-42, PMID: 9752815

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641., PMID: 25089112

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.