Chemotherapy

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. They may be administered orally or intravenously and singly or in combination.

  • Chemotherapy may be combined with radiation (chemoradiation) to treat locally invasive inoperable tumors of the pancreas.
  • Chemoradiation may also be tried after surgery to reduce the risk of recurrence.
  • In patients with inoperable and advanced metastatic disease, chemotherapy may be used alone or in combination with targeted drug therapy.

Chemotherapy is an anticancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way chemotherapy is given depends on the stage of the disease. Combination chemotherapy provides treatment using two or more anticancer drugs. Steroid drugs may be added to kill the lymphoma cells as well. Side effects of chemotherapy depend on the drugs you’re given. Common side effects are nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.

At  HEMATOLOGY & ONCOLOGY CARE we customize your breast cancer care so you can receive the most-advanced, least invasive treatment with a few with side effects. Planning of the treatment involves an interdisciplinary team of medical professionals. This usually implies a meeting of different specialists, called a multidisciplinary opinion. In this meeting, the planning of chemotherapy  treatment will be discussed based on the relevant information summarized above.

  • Effective on cancer cells all over the body with systemic therapy such as chemotherapy, hormone therapy and/or HER2-directed therapy.
  • Immunotherapy
  • Targeted therapy or personalized chemotherapy

The extent of the treatment will depend on the characteristics of the tumor cells, molecular markets, and on the stage of the cancer, as well as on the age, the menopausal status and the co-morbidity of the patient. It is recommended to ask an oncologist about the expected benefits and risks of every treatment in order to be informed of the consequences of the treatment. For some treatments, several options are available. The choice should be discussed according to the balance between benefits and risks.

Some of the treatment approaches include but are not limited to:

Neoadjuvant therapy: is therapy given before surgery or radiotherapy.  Contrary, to adjuvant therapy that he is given after surgery or radiotherapy.  Neoadjuvant chemotherapy for breast cancer is a new multidisciplinary strategy that was introduced with the aim of reducing tumor size before surgery. The main rationale behind this type of treatment is to reduce the tumor size, make an inoperable tumor operable and of course, which is a new tendency allowing more conservative surgery and is now widely used, particularly for large tumors.  One of the advantages seen with neoadjuvant chemotherapy is the opportunity to observe tumors diminished in size or shrink both palpably and on imaging, and having a clinical oncologist can have a rapid assessment of clinical response.  This could help tests the progressive responses in vivo of the tumor to new drugs regimens, which could then could be used as adjuvant therapies. Neoadjuvant chemotherapy can shrink a larger tumor enough so that lumpectomy plus radiation therapy becomes an option to mastectomy

Adjuvant therapy: is a therapy given in addition to surgery. For some patients with  cancer, possible adjuvant therapies are radiotherapy, chemotherapy, hormone therapy and targeted therapy. In this setting, radiotherapy is a local treatment whereas chemotherapy, hormone therapy and targeted therapy can reach cancer cells that may have spread to other parts of the body.

Hormone therapy: This therapy consists of one or possibly a combination of two of the following treatments:

∙ A drug called tamoxifen which counteracts the action of estrogens on the breast and is active in both premenopausal and in postmenopausal patients

∙ A drug from the aromatase inhibitor family like anastrozole, exemestane or letrozole which inhibit the production of estrogens in post-menopausal women

∙ A drug from the gonadotropin-releasing hormone analogues family that lower the level of estrogens in pre-menopausal women

∙ Ovariectomy – the removal of the ovaries in premenopausal women The choice of hormone therapy is based on the menopausal status of the patient.

 

Chemotherapy:

Chemotherapy, for example,  for early-stage breast cancer consists of combining two or three anti-cancer drugs, which are given according to a precise protocol. For breast cancer, the treatment is generally given for 4 to 8 cycles, a cycle being a time period of 2 to 4 weeks with a precise dosage, duration, and sequence of drugs including a resting period before a new cycle is started. It is not clear which combination of drugs is best, but it is recommended that it contains doxorubicin or epirubicin, which are anti-cancer drugs from the anthracycline family. Assessment of heart function is important before therapy with anthracyclines. However, regimens without any anthracycline have been shown to be as effective, for instance, the combination of docetaxel and cyclophosphamide. Treatments are often named with acronyms using the initial letter of each drug name (e.g. FEC, stands for the combination of Fluorouracil, Epirubicin and Cyclophosphamide). For frail or elderly patients the CMF (Cyclophosphamide, Methotrexate, and Fluorouracil) regimen may still be appropriate. Another option, especially for women in whom tumor cells have spread to the lymph nodes, is to combine an anthracycline (doxorubicin* or epirubicin) with a taxane drug (paclitaxel), preferably given in sequence rather than in combined fashion.

 

Targeted Therapy: Targeted therapies are drug treatments that help the body’s immune system fight cancer. Herceptin® is a type of biologic therapy that targets cells that produce too much of a protein called HER2. This protein is present in some breast cancer patients. Herceptin binds to the cells, shutting off HER2 production.

HER2-directed therapy is used for HER2 positive cancers. Trastuzumab is a drug effective in patients with HER2 positive tumors, regardless of the size of the tumor and of its hormonal status. In the studies performed to evaluate its efficacy as an adjuvant therapy, trastuzumab was always given in combination with chemotherapy. It is not clear, whether the adjuvant use of trastuzumab without chemotherapy has a positive effect. The standard recommended duration of adjuvant treatment with trastuzumab is 1 year. Results from studies comparing this standard duration to shorter or to longer durations are pending. Trastuzumab can be given together with paclitaxel or carboplatin but should not be given together with doxorubicin* or epirubicin. The latter two drugs and trastuzumab are both toxic to the heart. Trastuzumab cannot be given to patients whose heart function is abnormal. If there is doubt about the heart function, it should be assessed before trastuzumab treatment.a

 

Immunotherapy is a type of treatment that either boosts the patients own immune system or uses man-made drugs called monoclonal antibodies that attack a specific target on the surface of lymphocytes (cells in which lymphoma starts). The monoclonal antibody rituximab is a drug used to treat Hodgkin’s lymphoma and administered by infusion into veins.

 

Role of Clinical Trials

Clinical trials test out new unproven drugs, new forms of therapy such as gene therapy, or new approaches to existing treatment. They do not guarantee a cure and may have unexpected side effects also.

However cancer clinical trials are closely monitored to ensure safety. Patients are offered access to treatment that is otherwise unavailable.

The patient and the family may weigh their options and decide to accept or reject the offer of a clinical trial.

 

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center

 

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