Patient treatment portal · Pembrolizumab 200 mg + carboplatin AUC 5 / paclitaxel → AC

Your complete treatment reference

Understand the plan. Find what you need.

Medicines, schedule, tests, side effects, daily life, with sources and practical actions.

Open complete patient reference → Explore your 21-day timeline →

Source reconciled; independent oncology, pharmacy and patient/PPI review pending · prepared 2026-10-20

Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks). Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle. After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

How your medicines work

Immunotherapy

Pembrolizumab

Releases an immune brake

Immune cell→Brake blocked→Cancer cell

PD-1 is a control switch on T cells, a type of immune cell. When it connects with PD-L1 or PD-L2, the T cell receives a signal to reduce its activity. Some cancers use this pathway to escape immune attack. Pembrolizumab is an antibody that blocks PD-1, helping T cells recognise and attack the cancer. It does not directly poison cancer cells like chemotherapy. Releasing this brake can also allow immune cells to attack healthy organs, which explains the different side-effect pattern and why symptoms can appear after treatment stops.

The immune system can also inflame healthy organs. New cough, diarrhoea, unusual weakness, severe headache, thirst or a spreading rash need prompt advice. Effects can start during treatment or after it finishes.

Platinum chemotherapy

Carboplatin

Damages DNA inside cells

Platinum enters cell→DNA links form→Copying is disrupted

Carboplatin creates links in DNA, making it harder for cells to copy and repair their genetic instructions. Its dose depends on kidney function as well as the intended regimen.

Keep blood-test appointments. Fever, unusual bleeding, repeated vomiting or infusion symptoms need prompt advice.

Taxane chemotherapy

Paclitaxel

Locks the cell division machinery

Microtubules form→Structures remain locked→Division is interrupted

Cells use tiny structures called microtubules to separate their chromosomes when dividing. Paclitaxel stabilises these structures so they cannot rearrange normally, interrupting cell division. It can also affect nerves and other healthy tissues.

Report tingling or numbness before the next weekly dose, especially if it affects walking or hand use. Tell the nurse immediately about flushing, chest or throat tightness, itching, dizziness or breathing changes during infusion.

Anthracycline chemotherapy

Doxorubicin

Interferes with DNA handling

DNA handling disrupted→Cell damage→Division reduced

Doxorubicin interferes with enzymes and DNA processes needed for cell division. It can also affect heart muscle, so the team considers previous exposure and cardiac risk.

Report pain or burning at the infusion site immediately. New breathlessness or chest symptoms need prompt review. Red urine for a short time can be a drug-colour effect; pain, clots or persistent bleeding still need advice.

Alkylating chemotherapy

Cyclophosphamide

Damages DNA needed for growth

Drug activated→DNA damage→Cell division affected

Cyclophosphamide is activated in the body and damages DNA. This helps stop dividing cancer cells but can also affect blood-cell production and reproductive tissues.

Use the prescribed anti-sickness and hydration plan. Report fever, painful urination or blood in the urine.

Baseline → treatment → follow-up

When checks happen

Relative sequence, not booked dates or equal time intervals. Baseline ECG is distinct from risk-based echo. No routine three-monthly CT or echo is implied. The team books and reviews results.

Check	Before starting	Phase 1 · weeks 1–12	Before / during AC	Surgery / postoperative	After treatment
Blood tests	FBC, renal and liver; verify GFR	Weekly before planned doses	Before each 21-day AC cycle	Before each pembrolizumab cycle	Symptoms or abnormalities determine follow-up
ECG / echo	ECG and cardiac risk review; echo if indicated	Symptoms prompt earlier assessment	Review before first doxorubicin; further echo by risk / symptoms	Review any cardiac symptoms or previous abnormalities	Risk-based cardiac follow-up
Cancer imaging	Breast/nodal imaging; staging as indicated	Clinical response review; image for concern	Assess response and plan surgery	Pathology review; agree next steps	Breast surveillance; no routine CT/markers when asymptomatic
Thyroid / hormones	Thyroid baseline	Thyroid every 3–6 weeks	Continue immune monitoring	Continue while on pembrolizumab	Delayed immune symptoms still require review
Surgery / radiation	Agree overall MDT pathway	Systemic treatment first	Complete neoadjuvant phase if appropriate	Surgery → pathology → radiation if indicated	Follow-up and late-effect support

The whole treatment journey

Pembrolizumab 200 mg + carboplatin AUC 5 / paclitaxel → AC: the whole pathway

Triple-negative breast cancer · neoadjuvant and adjuvant immunotherapy

Phase 1: four 21-day cycles; paclitaxel on Days 1, 8 and 15, carboplatin on Day 1. Phase 2: four AC cycles every 21 days. Pembrolizumab 200 mg every 21 days during chemotherapy; after surgery, nine 21-day doses or five 42-day doses (400 mg). See the whole-treatment map for monitoring and sequencing.

Read from left to right. Columns show stages, not equal lengths of time. This is a general plan: no dates or personal information are needed. Your team confirms which steps apply and arranges appointments.

On a small screen, swipe the map sideways. The checks below give the same timing in words.

Treatment, tests and reviews across the course
Care / check	Before starting	Phase 1 · weeks 1–12	Before / during AC	Surgery / postoperative	After treatment
Cancer medicinesNCCP 00857	Confirm diagnosis and suitability	Four 21-day cycles: weekly paclitaxel; carboplatin AUC 5 Day 1. Pembrolizumab each cycle Day 1.	Four AC cycles every 21 days. Pembrolizumab each cycle Day 1.	Surgery → pathology; pembrolizumab: 200 mg q21 days ×9 OR 400 mg q42 days ×5, if appropriate	Review late effects and follow-up
SurgeryEARLY · NEO	Discuss operation options	After systemic treatment	Plan after recovery	Lumpectomy or mastectomy as agreed	Surgical follow-up
RadiotherapyEARLY	Assess indication	Not a routine concurrent chemotherapy phase	Plan with surgery / radiation teams	After surgery if indicated; may overlap pembrolizumab if agreed	Late-effect review
Blood testsNCCP 00857	FBC, renal and liver; verify GFR	Weekly before planned doses	Before each 21-day AC cycle	Before each pembrolizumab cycle	Symptoms or abnormalities determine follow-up
ECG / echoNCCP 00857 · ESC	ECG and cardiac risk review; echo if indicated	Symptoms prompt earlier assessment	Review before first doxorubicin; further echo by risk / symptoms	Review any cardiac symptoms or previous abnormalities	Risk-based cardiac follow-up
Imaging / markersEARLY · NEO	Breast/nodal imaging; staging as indicated	Clinical response review; image for concern	Assess response and plan surgery	Pathology review; agree next steps	Breast surveillance; no routine CT/markers when asymptomatic
Thyroid / hormonesNCCP 00857	Thyroid baseline	Thyroid every 3–6 weeks	Continue immune monitoring	Continue while on pembrolizumab	Delayed immune symptoms still require review

What each check is for

1Blood testsFBC, renal and liver tests weekly during the carboplatin/paclitaxel phase, then before every AC cycle. Continue the required blood tests before each postoperative pembrolizumab cycle.

Check safety before the planned dose.

Ask / act: Agree the booking owner, result reviewer and plan if delayed.

Sources: NCCP 00857

2ECG / cardiac reviewBaseline ECG and cardiac history/risk assessment. NCCP lists baseline echo/MUGA for age over 65 or when clinically indicated. Recheck the cardiac assessment before starting doxorubicin; echo/MUGA during treatment is driven by symptoms, risk or the agreed cardio-oncology plan. There is no automatic three-monthly echo schedule for every person on this pathway.

Check risk before and during anthracycline exposure.

Ask / act: Agree the booking owner, result reviewer and plan if delayed.

Sources: NCCP 00857 · ESC

3Cancer imagingRecord baseline breast/nodal findings and stage with imaging appropriate to the presentation. Assess clinical response during neoadjuvant treatment and use the appropriate breast imaging before surgery or sooner for concern. There is no universal three-monthly CT schedule for this early-breast pathway. After local treatment, arrange the agreed breast surveillance; routine CT/PET and tumour markers are not asymptomatic recurrence screening.

Assess response and plan local treatment.

Ask / act: Agree the booking owner, result reviewer and plan if delayed.

Sources: EARLY · NEO

At the next review, ask

Which treatment phase am I in, and what happens next?
Which test is expected next, who arranges it, and who explains the result?
Who should I contact if an expected appointment has not arrived?

This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.

Open whole-treatment map Printable journey and checks

Phase 1 · four 21-day cycles

Day 1 → Day 21: a general pattern

This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.

Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks).

Day of cycle123456789101112131415161718192021

Carboplatin + paclitaxel · Day 1IV treatment

Paclitaxel · Day 8IV treatment

Paclitaxel · Day 15IV treatment

Pembrolizumab · each cycle Day 1Separate immune schedule

Blood counts / infectionFever or sudden illness: call

Nerves / nailsReport before each weekly visit

Immune symptomsCan occur on any day or after treatment

The first phase: Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks).

Changing to AC: Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle.

Surgery and afterwards: After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Why these bands stay broad: Treatment markers show the planned days. Symptom bands are broad possibilities, not measured risk curves; serious symptoms can occur at any time. Band length does not show likelihood or severity, and the chart cannot tell you whether it is safe to receive treatment. NCCP 00857 v3 · official regimen ↗

There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.

Phase 2 · four 21-day cycles

Day 1 → Day 21: a general pattern

This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.

Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle.

Day of cycle123456789101112131415161718192021

AC · Day 1IV treatment

Nausea / appetiteEarly or delayed effects

Blood counts / infectionFever or sudden illness: call

Pembrolizumab · each cycle Day 1Separate immune schedule

Immune symptomsCan occur on any day or after treatment

The first phase: Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks).

Changing to AC: Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle.

Surgery and afterwards: After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Why these bands stay broad: Treatment markers show the planned days. Symptom bands are broad possibilities, not measured risk curves; serious symptoms can occur at any time. Band length does not show likelihood or severity, and the chart cannot tell you whether it is safe to receive treatment. NCCP 00857 v3 · official regimen ↗

There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.

Postoperative · 21-day option

Day 1 → Day 21: a general pattern

This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.

After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Day of cycle123456789101112131415161718192021

Pembrolizumab · Day 1IV treatment

Immune symptomsReport during and after treatment

The first phase: Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks).

Changing to AC: Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle.

Surgery and afterwards: After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Why these bands stay broad: Treatment markers show the planned days. Symptom bands are broad possibilities, not measured risk curves; serious symptoms can occur at any time. Band length does not show likelihood or severity, and the chart cannot tell you whether it is safe to receive treatment. NCCP 00857 v3 · official regimen ↗

There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.

Postoperative · 42-day option

Day 1 → Day 42: a general pattern

This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.

After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Day of cycle123456789101112131415161718192021222324252627282930313233343536373839404142

Pembrolizumab · Day 1IV treatment

Immune symptomsReport during and after treatment

The first phase: Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks).

Changing to AC: Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle.

Surgery and afterwards: After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Why these bands stay broad: Treatment markers show the planned days. Symptom bands are broad possibilities, not measured risk curves; serious symptoms can occur at any time. Band length does not show likelihood or severity, and the chart cannot tell you whether it is safe to receive treatment. NCCP 00857 v3 · official regimen ↗

There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.

Practical treatment guide

Your practical treatment plan

Four 21-day cycles: paclitaxel on Days 1, 8 and 15; carboplatin AUC 5 on Day 1. Pembrolizumab 200 mg on Day 1 of each cycle (every three weeks). Four further cycles (cycles 5–8): doxorubicin and cyclophosphamide on Day 1 every 21 days. Pembrolizumab 200 mg on Day 1 of each AC cycle. After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

STEP 1

Before the first visit

Blood tests, ECG and cardiac review, medicines review, fertility discussion where relevant and the consent conversation come first. Include the prescribed immune baseline checks.

STEP 2

Plan venous access

A cannula, PICC or implanted port may be used. If a port is chosen, a trained team inserts it in a separate procedure with local anaesthetic and sometimes sedation; the team explains fasting, blood-thinner and wound instructions.

STEP 3

Infusion day

Trained staff check and access the line, give the prescribed premedicines and infusions, and monitor for reactions. Tell the nurse immediately about pain, burning, rash or breathlessness.

STEP 4

Home and next review

This regimen does not routinely need a take-home infusion pump. Staff disconnect the infusion; a port is de-accessed when appropriate. Keep line-care and next-visit instructions.

Port insertion and removal

The line team explains placement, dressing care and when normal activities can resume. A port is accessed with a special needle during treatment. Removal of the implanted device is a separate planned procedure when no longer needed; do not remove or adjust it yourself.

PICC care and urgent line symptoms

A PICC usually needs regular dressing and flushing appointments even between treatments. Fever, redness, swelling, pain, leakage or damage requires prompt advice. Your hospital supplies the exact care instructions.

Visit time and transport

Visits include assessment, pharmacy preparation, premedicines, infusions and observation. The first visit and a change in phase can take longer. Ask about transport and any escort needed after sedation or line insertion.

Open practical treatment guide · Printable practical guide

Sources: NCCP 00857 v3 · official regimen · eviQ · PICC patient information · eviQ · implanted port patient information. Source reconciled; independent oncology, pharmacy and patient/PPI review pending.

Regimen-specific symptoms

Recognise symptoms and act early.

This printed map shows phase 1. See the next page for all medicines and the online phase-specific maps. Report persistent effects after a phase ends.

Phase 1 · carboplatin / paclitaxel with pembrolizumab

A picture of side effects

Numbered symptom boxes connect to the anatomical illustration. The medicine responsible may be uncertain; report the symptom.

1Hair / scalp

Paclitaxel

Hair loss is common; ask about support and scalp cooling where suitable.

3Blood / infection

Carboplatin and paclitaxel

Fever, shivers, unusual bleeding or sudden illness: call immediately.

5Breathing

Pembrolizumab

New cough or breathlessness needs prompt assessment.

7Hormone glands / energy

Pembrolizumab

Report marked weakness, dizziness, headache or unusual thirst.

Full-body anatomical illustration with numbered symptom locations

12345678

2Nerves / nails

Paclitaxel

Report numbness, tingling or painful nails before the next dose.

4Infusion reaction

Carboplatin or paclitaxel

Tell staff immediately about flushing, chest tightness or breathing difficulty.

6Bowel

Pembrolizumab

Report diarrhoea early, especially with pain, bleeding or poor intake.

8Skin / liver symptoms

Pembrolizumab

A severe rash, blistering or jaundice needs prompt advice.

Selected effects, not every possible effect or a prediction. Blood-count, skin and line markers are schematic. Number and text carry meaning; colour is decorative.

Phase 2 · AC with pembrolizumab

A picture of side effects

Numbered symptom boxes connect to the anatomical illustration. The medicine responsible may be uncertain; report the symptom.

1Heart / breathing

Doxorubicin

Report breathlessness, swelling or chest symptoms promptly.

3Blood / infection

AC chemotherapy

Fever, shivers or sudden illness need urgent advice.

5Breathing

Pembrolizumab

New cough or breathlessness needs prompt assessment.

7Hormone glands / energy

Pembrolizumab

Report marked weakness, dizziness, headache or unusual thirst.

12345678

2Mouth / appetite

AC chemotherapy

Painful ulcers or inability to drink need advice.

4Bladder / fertility

Cyclophosphamide

Report painful urination or blood in urine; discuss fertility before treatment.

6Bowel

Pembrolizumab

Report diarrhoea early, especially with pain, bleeding or poor intake.

8Skin / liver symptoms

Pembrolizumab

A severe rash, blistering or jaundice needs prompt advice.

Selected effects, not every possible effect or a prediction. Blood-count, skin and line markers are schematic. Number and text carry meaning; colour is decorative.

After surgery · pembrolizumab alone

A picture of side effects

Numbered symptom boxes connect to the anatomical illustration. The medicine responsible may be uncertain; report the symptom.

1Breathing

Pembrolizumab

New cough or breathlessness needs prompt assessment.

3Hormone glands / energy

Pembrolizumab

Report marked weakness, dizziness, headache or unusual thirst.

1234

2Bowel

Pembrolizumab

Report diarrhoea early, especially with pain, bleeding or poor intake.

4Skin / liver symptoms

Pembrolizumab

A severe rash, blistering or jaundice needs prompt advice.

Selected effects, not every possible effect or a prediction. Blood-count, skin and line markers are schematic. Number and text carry meaning; colour is decorative.

Pembrolizumab

Immune inflammation of bowel, lungs, liver, kidneys or skin
Hormone-gland problems, sometimes permanent
Rare serious heart or neurological inflammation
Infusion reaction
Effects can first appear after treatment ends

Carboplatin

Low blood counts, infection and bleeding
Nausea, vomiting and fatigue
Allergic reaction, sometimes after previous exposure
Kidney or electrolyte changes

Paclitaxel

Low blood counts and infection
Numbness / tingling, sometimes lasting
Hair loss, muscle or joint pain
Infusion reaction
Mouth, bowel, skin and nail effects

Doxorubicin

Low counts, infection and mouth ulcers
Nausea, hair loss and fatigue
Heart damage, sometimes delayed
Severe tissue injury if the infusion leaks
Rare later blood cancers

Cyclophosphamide

Low counts and infection
Nausea, vomiting and hair loss
Bladder irritation / bleeding
Fertility effects and menopause
Rare later blood cancers

Support around treatment

Separate anti-sickness plans

The platinum/taxane phase and AC need separate prescriptions. Carboplatin Day 1 uses a high-risk plan; paclitaxel-only Days 8 and 15 use a separate low-risk plan. AC uses its own high-risk plan.

Growth-factor support

The team decides whether growth-factor support is needed for this three-weekly AC regimen.

Checks before the next dose

FBC, renal and liver tests weekly during the carboplatin/paclitaxel phase, then before every AC cycle. Continue the required blood tests before each postoperative pembrolizumab cycle. Keep the thyroid and other immune-monitoring appointments.

After chemotherapy

After surgery: pembrolizumab 200 mg every 21 days for nine doses OR 400 mg every 42 days for five doses. These are alternative schedules, not consecutive courses. Progression preventing definitive surgery or unacceptable pembrolizumab toxicity changes this plan; postoperative treatment is not automatic.

Do not wait for the next appointment

Emergency: 112 / 999. Severe breathing difficulty, collapse, seizure or severe chest pain needs emergency help.

Contact oncology immediately for temperature ≥37.5°C or ≤36°C, shivering or suddenly feeling unwell, even with a normal temperature. Follow your own hospital’s instructions. If you cannot reach the team, seek urgent medical assessment.

Your oncology team · daytimeInsert numbers here

Acute Oncology Service

Your oncology team · out of hoursInsert numbers here

Ask for medical oncology

Evenings / overnightYour out-of-hours pathway / nearest ED

Other hospitals: use the numbers your team provides.

Report new breathlessness, chest symptoms, severe diarrhoea, inability to drink, jaundice, a painful swollen leg or a severe rash promptly. You do not need to identify which medicine caused the symptom.