This information is about a chemotherapy treatment for breast cancer called TAC.
The drugs that are used
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TAC is named after the initials of the chemotherapy drugs used, which are:
How treatment is given
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TAC can usually be given to you as a day patient. Before you start treatment you will need to have a blood test – 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 shouldn't take long. Some people have their chemotherapy given through a thin, plastic tube which is inserted under the skin into a vein near their collarbone (central line) or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
Before the chemotherapy 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 are connected to a drip (infusion). Some anti-sickness medicines may be given as tablets.
You may be given a short course of steroid tablets to start taking the day before your chemotherapy and for two days after. These help to prevent an allergic reaction to docetaxel and to reduce some other side effects (sickness and fluid retention). It's very important to take these tablets. If for some reason you haven't taken them, let your doctor or nurse know before you start your chemotherapy.
The chemotherapy drugs are then given separately:
doxorubicin (a red fluid) is given either as an injection into your cannula or line, along with a drip (infusion) of salt water (saline)
docetaxel (a colourless fluid) is given as an infusion
cyclophosphamide (a colourless fluid) is given as an infusion or as an injection along with a drip of saline.
If you are having your treatment as a day patient you can then go home. The cannula will be removed before you go. If you have a central or PICC line, it will usually stay in place ready for your next cycle of chemotherapy. You will be shown how to look after the line.
You will be given a supply of anti-sickness drugs to take with you. It's important to take these as directed, even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
How often treatment is given
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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 you are having.
On the first day of your treatment you will be given all three drugs – docetaxel, 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 here won't affect everyone who has TAC chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
TAC can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
You may be given injections of G-CSF to help prevent the number of white blood cells getting too low. G-CSF is a type of protein that can stimulate the bone marrow to produce white blood cells. G-CSF is given as an injection under the skin (subcutaneously).
Bruising and bleeding
TAC can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
TAC can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 2–3 weeks after the first dose of docetaxel, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is usually temporary and your hair will almost always start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before treatment. Your nurse can give you advice about coping with hair loss.
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's available at your hospital.
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. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Cyclophosphamide may irritate your bladder. It’s important to drink as much fluid as you can (at least two litres) during the 24 hours following chemotherapy to help prevent this.
Doxorubicin is red and, as a result, your urine may become a pink-red colour. This is normal and can last up to 48 hours after your treatment. Let your doctor know if you have any discomfort when you pass urine, or if you notice any blood in it.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished.
During treatment and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
Some people can have an allergic reaction to docetaxel while it’s being given. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness.
Usually you will be given steroid tablets to take at home the day before treatment to reduce the chance of this happening. It’s important to take the steroid tablets as you have been directed. Instead of steroid tablets, you may be given a steroid by injection into a vein (intravenously) 30–60 minutes before the docetaxel. Other drugs such as antihistamines may also be injected into a vein before your treatment to prevent an allergic reaction.
You'll be closely monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms. If you do have a reaction, it can be treated quickly.
You may notice that you gain weight and/or that 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.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished. Some people have pain in the nail bed at the base of the nail but this is rare.
Less common side effects
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Pain in joints or muscles
This may be caused by docetaxel. It is important to tell your doctor about this so that they can prescribe painkillers to help.
Numbness or tingling in hands or feet
This is due to the effect of docetaxel on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
TAC can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Changes in the way your heart works
This is very rare with standard doses of TAC but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and sometimes before each treatment.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and 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’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Leakage into the tissue around the vein (extravasation)
If this happens when doxorubicin is being given, the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having TAC, as it may harm the developing baby. It’s important to use effective contraception while having TAC, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop.
In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
There is a potential risk that chemotherapy drugs may be present in breast milk so women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our TAC chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.