From the Guidelines
The recommended take-home medications for dose-dense AC (Adriamycin/Cyclophosphamide) chemotherapy regimen are aprepitant, a 5-HT3 receptor antagonist, and dexamethasone, as outlined in the guidelines for moderately emetogenic chemotherapy regimens 1.
Medications for Nausea and Vomiting Prevention
- Aprepitant 80 mg orally on days 2 and 3 after chemotherapy, as part of the antiemetic regimen for moderately emetogenic chemotherapy 1
- A 5-HT3 receptor antagonist, such as ondansetron, on day 1, as part of the antiemetic regimen for moderately emetogenic chemotherapy 1
- Dexamethasone, with the optimal duration and dose in the delayed phase not defined, but typically used in combination with a 5-HT3 receptor antagonist and aprepitant for moderately emetogenic chemotherapy 1
Medications for Neutropenia Prevention
- Pegfilgrastim 6 mg subcutaneous injection, given 24 hours after chemotherapy, to stimulate white blood cell production and prevent neutropenia, as indicated for chemotherapy regimens with a risk of febrile neutropenia of >20% 1
Additional Medications
- Loperamide 2 mg orally as needed for diarrhea
- Acetaminophen 650 mg orally every 6 hours as needed for fever or pain
These medications help manage common side effects of dose-dense AC chemotherapy, including nausea, vomiting, neutropenia, diarrhea, and fever or pain. Patients should be instructed to take these medications as prescribed and to contact their healthcare provider if they experience severe side effects or have any concerns. It's crucial to emphasize the importance of adhering to the medication schedule, especially for the anti-nausea drugs and pegfilgrastim, to ensure optimal management of side effects and maintain the chemotherapy schedule. The use of aprepitant, a 5-HT3 receptor antagonist, and dexamethasone is supported by the guidelines for moderately emetogenic chemotherapy regimens, which include the AC combination 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Take-Home Medications for Dose-Dense AC
The take-home medications for dose-dense AC (Adriamycin (doxorubicin) and Cyclophosphamide (cyclophosphamide)) include:
- Pegfilgrastim, a long-acting hematopoietic growth factor, administered subcutaneously on day 2 of each cycle 2
- Darbepoetin alfa, an erythropoiesis-stimulating agent, initiated at 200 microg subcutaneously every 2 weeks for hemoglobin ≤ 12 g/dL 2
- Filgrastim, a short-acting myeloid growth factor, administered on days 3 through 10 of each cycle 3, 4
Rationale for Medication Use
The use of these medications is supported by studies demonstrating their efficacy in minimizing hematologic toxicity and facilitating dose-dense chemotherapy:
- Pegfilgrastim and darbepoetin alfa were shown to be effective in reducing the incidence of febrile neutropenia and red blood cell transfusions in patients receiving dose-dense AC followed by paclitaxel 2
- Filgrastim was used in the CALGB 9741 study to support dose-dense sequential chemotherapy with doxorubicin and cyclophosphamide (AC) followed by paclitaxel (P) 4
- Pegfilgrastim was also shown to be effective in supporting neoadjuvant dose-dense epirubicin and cyclophosphamide chemotherapy in breast cancer patients, with low incidences of chemotherapy delay and febrile neutropenia 5