Printed by Isobel Webster on 10/21/2021 2:53:19 PM. For personal use only. Not approved for distribution.

Copyright © 2021 National Comprehensive Cancer Network, Inc., All Rights Reserved.
Chemotherapy Order Template BRS13a
Page 1 of 2
Breast Cancer
Dose-Dense AC (DOXOrubicin/Cyclophosphamide) followed by PACLitaxel
Dose-Dense AC (DOXOrubicin/Cyclophosphamide) Course

INDICATION: REFERENCES: NCCN SUPPORTIVE CARE:

HER2 negative: Neoadjuvant or Adjuvant 1. NCCN Guidelines® for Breast Cancer 1. Emetic risk: Day 1 High
V.2.2021. 2. Febrile Neutropenia Risk: High
2. Citron ML, et al. J Clin Oncol.
2003;21(8):1431-9.a

CHEMOTHERAPY REGIMEN
14-day cycle for 4 cycles
DOXOrubicin 60 mg/m² IV push on Day 1
See Safety Parameters and Special Instructions for information on slow IV Push administration.
Cyclophosphamide 600 mg/m² IV over 30 minutes on Day 1
Oral hydration is strongly encouraged with cyclophosphamide; poorly hydrated patients may need supplemental IV hydration. Patients
should attain combined oral and IV hydration of 2,000 – 3,000 mL/day on day of chemotherapy.
See Other Supportive Therapy for example of IV hydration.
This course is 4 cycles of dose-dense AC (DOXOrubicin/Cyclophosphamide). PACLitaxel is initiated weekly or every 14 days following completion of this
course. Please see Order Template BRS13b for PACLitaxel Every 14 Days course or BRS13c for PACLitaxel Weekly Course.
SUPPORTIVE CARE
Antiemetic Therapy
Scheduled prophylactic antiemetic therapy should be given for prevention of acute and delayed nausea and vomiting based on the emetic risk of
the chemotherapy regimen. This may include antiemetic therapy given on the days following chemotherapy. For more information on emetic
prophylaxis, refer to the NCCN Guidelines for Antiemesis and Appendix D to the NCCN Chemotherapy Order Templates.
PRN for breakthrough: All patients should be provided with at least one medication for breakthrough emesis. Please consult the NCCN
Guidelines for Antiemesis for appropriate antiemetic therapy.
Myeloid Growth Factor Therapy
Filgrastim (or clinically appropriate G-CSF agent) 5 mcg/kg subcutaneously daily, recommended to start the day following or up to 3 – 4
days after completion of chemotherapy and to continue until post-nadir ANC recovery to normal or near-normal levels by laboratory
standards. Dose is rounded to the nearest vial size by institution-defined weight limits. Same-day administration is not recommended.
OR
Pegfilgrastim (or clinically appropriate biosimilar) 6 mg subcutaneously once, recommended to be given the day following or up to 3 – 4
days after completion of chemotherapy. There are insufficient data to support use of pegfilgrastim for cytotoxic chemotherapy regimens
administered less frequently than every 2 weeks. Same-day administration is not recommended.
For more information on prophylaxis of febrile neutropenia and a list of appropriate agents, refer to the Myeloid Growth Factors algorithms in
the NCCN Guidelines for Hematopoietic Growth Factors and Appendix C to the NCCN Templates.
Other Supportive Therapy
For cyclophosphamide: Example of recommended hydration: Sodium chloride 0.9% infused IV at a rate of 1.5 – 3 mL/kg/hour for a total of
500 mL on day of chemotherapy.
MONITORING AND HOLD PARAMETERS
CBC with differential should be monitored as clinically indicated for potential dose modification.
For DOXOrubicin:
This agent is an anthracycline. Cumulative anthracycline dosage should be monitored.
Ejection fraction should be monitored prior to initiation of treatment and as clinically indicated.
Liver function should be monitored prior to each cycle and as clinically indicated for potential dose modification or discontinuation.
For cyclophosphamide: Renal function should be monitored as clinically indicated for potential dose modification or discontinuation.

Template continued on page 2

NCCN Chemotherapy Order Templates (NCCN Templates®) are peer-reviewed statements of the consensus of its authors derived from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
regarding their views of currently accepted approaches to treatment. An NCCN Template does not constitute an order. Any clinician seeking to treat a patient using the NCCN Templates® is expected to use
independent medical judgment in the context of individual clinical circumstances of a specific patient's care or treatment. NCCN disclaims all warranties, express or implied including, without limitation, the
implied warranties of merchantability and fitness for a particular purpose. NCCN does not warrant the accuracy, currency, or completeness of the NCCN Templates or make any representation regarding the
use or the results of the use of the NCCN Templates in treatment. In no event shall NCCN or its members be liable for any damages including, without limitation, incidental, indirect, special, punitive, or
consequential damages arising out of or in connection with the use of the NCCN Templates including, without limitation, loss of life, loss of data, loss of income or profit, losses sustained as a result of any
injury to any person, or loss or damage to property or claims of third parties.
National Comprehensive Cancer Network, Inc. © 2021. All rights reserved. 03/18/2021
 Printed by Isobel Webster on 10/21/2021 2:53:19 PM. For personal use only. Not approved for distribution. Copyright © 2021 National Comprehensive Cancer Network, Inc., All Rights Reserved.
Chemotherapy Order Template BRS13a
Page 2 of 2
Breast Cancer
Dose-Dense AC (DOXOrubicin/Cyclophosphamide) followed by PACLitaxel
Dose-Dense AC (DOXOrubicin/Cyclophosphamide) Course

SAFETY PARAMETERS AND SPECIAL INSTRUCTIONS

For DOXOrubicin:
This agent is a vesicant.
This agent is administered IV push. The preferred IV push method for a vesicant is administration through the side port of a freely
flowing IV.
Central venous access is recommended for administration of this agent.
Secondary malignancies have been associated with this drug. Review drug package insert for additional information.
For cyclophosphamide: Secondary malignancies have been associated with this drug. Review drug package insert for additional information.

NCCN Chemotherapy Order Templates (NCCN Templates®) are peer-reviewed statements of the consensus of its authors derived from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
regarding their views of currently accepted approaches to treatment. An NCCN Template does not constitute an order. Any clinician seeking to treat a patient using the NCCN Templates® is expected to use
independent medical judgment in the context of individual clinical circumstances of a specific patient's care or treatment. NCCN disclaims all warranties, express or implied including, without limitation, the
implied warranties of merchantability and fitness for a particular purpose. NCCN does not warrant the accuracy, currency, or completeness of the NCCN Templates or make any representation regarding the
use or the results of the use of the NCCN Templates in treatment. In no event shall NCCN or its members be liable for any damages including, without limitation, incidental, indirect, special, punitive, or
consequential damages arising out of or in connection with the use of the NCCN Templates including, without limitation, loss of life, loss of data, loss of income or profit, losses sustained as a result of any
injury to any person, or loss or damage to property or claims of third parties.
National Comprehensive Cancer Network, Inc. © 2021. All rights reserved. 03/18/2021