Objective: To observe the adverse reactions and quality of life (QOL) in early breast cancer patients undergoing adjuvant chemotherapy with AX regimen (pirarubicin/capecitabine). Methods: The adverse reactions in the early breast cancer patients that included 60 cases undergoing AX regimen and another 60 cases undergoing AC regimen (pirarubicin/cyclophosphamide) were recorded, and QOL surveys were conducted using the breast cancer-specific QOL scale. The results between the patients of the two regimens were compared. Results: The incidence of vomiting and severe vomiting (grade III/IV) in the AX regimen patients were significantly lower than those in the AC regimen patients (53.3% vs. 75.0%, P=0.013; 10.0% vs. 25.0%, P=0.031). The incidence of hand-foot syndrome in the AX regimen patients was significantly higher than that in the AC regimen patients (45.0% vs. 11.7%, P=0.001), but no significant difference was noted between the two regimen groups in incidence of severe hand-foot syndrome (3.3% vs. 0, P=0.154). There were no significant differences between the two regimen groups in the incidence of bone marrow suppression, nausea, diarrhea, hair loss or heart discomfort. The QOL questionnaire survey of functioning domains demonstrated that the patients with AX regimen had significant higher scores in the domain of personal and social functioning than those with AC regimen (78.40 vs. 70.92, P=0.042; 81.00 vs. 75.33, P=0.035), but there were no significant differences between the two regimen groups in the domain of physical, emotional and cognitive functioning (all P>0.05). Conclusion: Compared with the traditional AC regimen, AX regimen is easy to administer and shows less incidence of vomiting and severe vomiting as well as better overall QOL for patients.