Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

AC followed by paclitaxel (dose-dense and weekly)

Doxorubicin and cyclophosphamide, then paclitaxel; adjuvant and neoadjuvant treatment of breast cancer

Updated: 28 October 20261 min read6 references

Summary for doctors

  • High-risk early breast cancer, adjuvant or neoadjuvant [1, 2].
  • Dose-dense (every 14 days) only with G-CSF; gave longer survival than every 3 weeks [1].
  • After 3-weekly AC, weekly paclitaxel was better than 3-weekly paclitaxel [2].
  • Cumulative doxorubicin dose 240 mg/m²; baseline echocardiogram [3].

Dose and schedule

Dose-dense AC then dose-dense paclitaxel

High-risk early breast cancer (HER2-negative; in HER2-positive disease with anti-HER2 drugs)

High-risk early breast cancer (HER2-negative; in HER2-positive disease with anti-HER2 drugs)

DrugDoseRouteSchedule
Phase 1: 4 cycles
Doxorubicin60 mg/m²IVDay 1
Cyclophosphamide600 mg/m²IVDay 1
Phase 2: 4 cycles
Paclitaxel175 mg/m²IV over 3 hoursDay 1
Cycle length
Every 14 days with G-CSF
Duration
4 cycles of AC, then 4 cycles of paclitaxel (16 weeks)

Doses as in CALGB 9741 [1].

Dose source: [4, 5].

AC then weekly paclitaxel

The same use; when dose-dense treatment is not suitable

The same use; when dose-dense treatment is not suitable

DrugDoseRouteSchedule
Phase 1: 4 cycles
Doxorubicin60 mg/m²IVDay 1 every 21 days
Cyclophosphamide600 mg/m²IVDay 1 every 21 days
Phase 2: 12 weeks
Paclitaxel80 mg/m²IV over 1 hourWeekly
Cycle length
AC every 21 days; weekly paclitaxel
Duration
4 cycles of AC, then 12 weeks of paclitaxel

Doses as in E1199 [2]. Epirubicin 90 mg/m² (EC) is a common alternative to doxorubicin.

Dose source: [6].

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • AC: highly emetogenic: NK1, 5-HT3, dexamethasone on day 1 and olanzapine (antiemetic tool).
  • G-CSF: mandatory with dose-dense treatment (pegfilgrastim on day 2 or filgrastim).
  • Paclitaxel: premedication with dexamethasone and H1 and H2 antihistamines (on the weekly schedule usually at a low dose, and can be reduced after several doses without a reaction).

Monitoring and dose adjustment

  • Baseline echocardiogram before the anthracycline [3] (cumulative dose).
  • Blood counts before each cycle; on the weekly paclitaxel schedule, ANC 1000 and platelets 75,000 to 100,000 are common thresholds.
  • Persistent grade 2 or grade 3 paclitaxel neuropathy: reduce the dose (for example to 65 to 70) or stop.

Main evidence

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CALGB 9741: the dose-dense schedule (every 2 weeks with G-CSF) improved disease-free and overall survival without increasing severe toxicity [1]. E1199: after AC, weekly paclitaxel improved disease-free and overall survival compared with 3-weekly paclitaxel [2].

Related cancer types

Breast cancer

Treatment regimens (physicians)

TC regimen (docetaxel and cyclophosphamide): dose and scheduleTCHP regimen: dose and schedule in HER2-positive breast cancerWeekly paclitaxel with trastuzumab (APT regimen)KEYNOTE-522 regimen: pembrolizumab and chemotherapy in triple-negative breast cancerTrastuzumab emtansine (T-DM1, Kadcyla): dose and scheduleTrastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringAdjuvant capecitabine after neoadjuvant treatment (CREATE-X)Sacituzumab govitecan (Trodelvy)Pembrolizumab with chemotherapy in metastatic triple-negative breast cancer (KEYNOTE-355)

Physician tools and lessons

Cumulative Anthracycline Dose and Doxorubicin Equivalents10 cheap steps that save patients' livesBone-modifying agents in cancer: bone metastases, adjuvant use and osteonecrosis of the jawGermline genetic testing in cancer: who, and which genes?Management of brain metastasesFertility preservation before cancer treatmentMalignant pleural effusion: drainage, pleurodesis or an indwelling catheterCancer during pregnancy: chemotherapy and decisions

References

6 references
Show all referencesClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741Citron ML, Berry DA, Cirrincione C, et al · J Clin Oncol · 2003;21:1431-9
    DOIPubMed Back to text: 1 2 3 4
  2. 2
    Weekly paclitaxel in the adjuvant treatment of breast cancerSparano JA, Wang M, Martino S, et al · N Engl J Med · 2008;358:1663-71
    DOIPubMed Back to text: 1 2 3 4
  3. 3
    Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice GuidelineArmenian SH, Lacchetti C, Barac A, et al · J Clin Oncol · 2017;35:893-911
    DOIPubMed Back to text: 1 2
  4. 4
    DOXORUBICIN HYDROCHLORIDE — Prescribing InformationActavis Pharma, Inc · FDA label · 2026
    Source Back to text
  5. 5
    PACLITAXEL — Prescribing InformationBluepoint Laboratories · FDA label · 2026
    Source Back to text
  6. 6
    HERCEPTIN (TRASTUZUMAB) — Prescribing InformationGenentech, Inc · FDA label · 2026
    Source Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/dose-dense-ac-paclitaxel/

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