Chemotherapy – cancer treatment and side effects

Archive for the ‘Treatment Options’ Category

The importance of Chemotherapy Dose

Chemotherapy refers to the treatment of cancer and other disease with chemicals that kill cells. Most chemotherapy drugs can’t differentiate between healthy and malignant cells. Because these drugs are toxic, it is very important to calculate each chemotherapy dose given to a patient carefully.

Further complicating giving a chemotherapy dose is complex delivery systems. In order to speed the chemicals into the patient’s body a pump is often used, which is connected either to an IV or port line. The chemotherapy dose is then calculated by how much of a drug is pumped into the patient’s system per minute. It’s very important this calculation is done properly since if too little of a drug is given the therapy will be ineffective, and too much can be seriously harmful to the patient.

According to an article in Bio-Medicine this was the case when a 43-year-old woman in Alberta Canada was given too high a dose via a miscalculated pump. The woman accidentally received a 4 day chemotherapy dose in the space of 4 hours through the incorrectly programmed drug-administering pump. Reference: (http://www.bio-medicine.org/medicine-news/Overdose-of-Chemotherapy-Drug-kills-a-woman-13776-1/)

She was given 5,000 mg of the chemotherapy drug 5-FU during too short a space of time. This chemotherapy dose was extremely high and this type of drug was so powerful that too many of her healthy cells were damaged in the process.

There is no antidote for this class of drug, and she passed away from organ failure within a few days of the mishap.
Of course, this isn’t the usual outcome of chemotherapy as it can prolong life and in many cases stop the recurrence of many different types of cancer for long periods of time. As stated earlier a chemotherapy dose is usually delivered intravenously. In some cases, isolated limb perfusion or isolated infusion chemotherapy is used.

The main purpose of isolating a limb or organ is to deliver a powerful chemotherapy dose to one specific area or tumor site thus avoiding overwhelming systemic damage to the rest of the patient’s body. Whatever the treatment plan or delivery system it’s very important that the chemotherapy dose be calculated by a trained medical professional.

FOLFOX is a term for a chemotherapy regimen that incorporates folinic acid (FOL) fluorouracil (F) and Oxalipatin (OX).  Chemotherapy is used to destroy rapidly dividing cells in the body.  FOLFOX chemotherapy treatments are used in treating cancer of the bowel.

Flourouracil or 5-FU belongs to a family of drugs called antimetabolities often used to treat cancer.  This drug has been around for over 40 years and has been very effective in cancer treatment.  Folinic acid is a derivative of tetrahydrofolic acid, and it is readily converted into other reduced folic acid derivatives.  Folinic acid is used as part of the FOLFOX formula since it enhances the effect of 5-FU.

FOLFOX is usually given intravenously through an IV drip into the arm, but it can also be delivered through a central line directly into a large vein in your chest.  The drawback with a central line is that it must be placed before treatment begins and remains there until all treatments are completed.

Like most chemotherapy FOLFOX is given in cycles.  Many factors go into how much treatment will be needed such as gender, weight, and the cancer’s response to the treatment.  Normally, up to 12 treatments may be given in 2 weeks long cycles.

On the first day of a FOLFOX treatment cycle, a patient is given an oxaliplatin and folinic acid drip for 2 hours followed by an injection of fluorouracil and then an infusion of 5-FU through another drip or pump.  This procedure may last up to over 20 hours.

The second day of treatment a folinic acid drip is given for 2 hours followed by an injection of fluorouracil then another fluorouracil infusion in a drip.  This procedure again takes up to 20 hours.  The benefit of a central line is that a patient can have the infusions of fluorouracil at home using a small pump rather than having to remain in a hospital or treatment center.

As with most chemotherapy the drop in white cell count means an increased risk of infection. Common side effects for FOLFOX are less drastic than for most cancer treatments.  Fatigue, numbness or tingling in the fingers or toes, and general malaise or most often reported.

What is Chemotherapy Port

A chemotherapy port is a relatively simple and painless way to deliver chemotherapy drugs into the body. Chemotherapy is a medical treatment for cancer, which can have many harsh side effects. A chemotherapy port can be a more comfortable way of administering chemotherapy and also prove safer for the patient’s overall health.

Chemotherapy is usually given in cycles of treatment that can last for a few days to several weeks. Several drugs are often involved in a course of this treatment often administered through the use of a drip or IV line. If no port is installed for a patient, this can mean multiple needle sticks not only for the drugs, but also to draw blood for tests.

Finding a vein from which to draw blood and then yet more usable veins for IV lines can be difficult even in a relatively healthy person. For a cancer patient, this can be even more problematic, since they might already be experiencing physical issues and side effects from the treatment as well as from the disease. Common side effects of chemotherapy are nausea and vomiting, weight loss, anemia, fatigue, and increased chance of infections.

The consequence of vomiting and weight loss is dehydration. Dehydration can make the skin overly sensitive and cause finding veins suitable for an IV line or blood draw difficult to locate. Anemia is the result of the low white blood cell count caused by chemotherapy treatments and other treatments the patient might be taking such as radiation therapy. This low white blood cell count is one of the causes of an increased risk of infection. Every needle stick then becomes a possible entry point for infection to such a patient.

It’s also natural that the more a patient is stuck with needles at a time when they are already feeling sick can cause apprehension and be emotionally draining. In short multiple injections, blood drawing, and IV jabs make a bad situation even worse.

A chemotherapy port or portacath is a medical appliance installed beneath the skin. A mild anesthesia is used on the site reducing the pain. A catheter then connects the chemotherapy port to a vein. Drugs can then be injected into or blood can be drawn through this port. This reduces the pain a patient will experience during chemotherapy and a single site is easier to keep free of infection.

5-FU is a medication used to treat various forms of cancer. The name comes from 5-fluoro-1H-pyrimidine-2,4 dione. Also known as Fluorouracil this chemotherapy agent had been used in the battle against cancer for more than 40 years. It acts in multiple ways, but its function is to slow down or inhibit rapid cell division thus curbing the growth of malignant cells.

5FU looks like a colorless fluid when used for injections or IVs. It is also sold as cream for the treatment of skin cancer. The drug was created by Robert Duschinsky in the late 1950’s. His idea was to develop a decoy molecule that would mimic the natural compound of normal cells.

The result is a drug which inhibits RNA replication enzymes halting the growth of cancerous cells. 5FU can be given as an injection, intravenously, as a drip, under the skin using a central line, or a cream applied directly to the skin. As a chemotherapy treatment, 5FU is normally arranged over several sessions or cycles and can last a few months.The course of treatment depends on the type of cancer and the cancer’s response to the drug.

There are some known side-effects to 5FU such as a sore mouth and ulcers, taste changes, diarrhea, ‘gritty eyes’, or blurred vision, skin changes, and lowered resistance to infection. Less common side effects for 5FU are vomiting, hair loss, changes to nails, rashes, or increased production of tears.

A more serious response is possible. A doctor should be contacted if a patient has a high fever, suddenly feels overall unwell, or experiences bruising or bleeding, anemia, or feeling extremely tired or weak.

5FU is most often given for the treatment of colorectal or bowel, breast, pancreatic, and stomach cancers. It is also sometimes used in the treatment of glaucoma a non cancerous condition of the eye. 5FU acts as an anti-scarring agent during the post op stage of treatment.

5FU has shown itself to be an effective chemotherapy. A study published in the Journal of Clinical Oncology in 2009 indicated that 5FU based chemotherapy for colon cancer showed a reduced risk of recurrence over a long period of time.

There are many types of chemotherapy drugs out there that work to combat against cancer.  Doctors have classified chemotherapy drugs into many different groups based on features like how they work in combination with one and another, their chemical makeup and how they treat cancer.

Alkylating agents

Alkylating agents are common type of chemotherapy drugs that target DNA in order to stop the cancer cells from multiplying.  This type of drugs is not a phase. These agents are used to treat chronic leukemia, lymphoma, Hodgkin disease, sarcoma, multiple myeloma, and even lung, breast, and ovary cancers.  However, the major downside of this chemotherapy drugs is when it targets your DNA, it also causes damage to your bone marrow.

Depending on the amount of dosage of this type of drugs there’s also a risk of leukemia involved. The risk gets lower if the dose is lower, but if the doses are higher, so are the risks.  The following are a few of the different types of alkylating agents. We’ll mention the most common type which is nitrogen mustards.

- nitrogen mustards: known as mechlorethamine (nitrogen mustard), chlorambucil, cyclophosphamide (Cytoxan), ifosfamide, and melphalan nitrosoureas: which include streptozocin, lomustine, and carmustine (BCNU)

Drugs like cisplatin, carboplatin, and oxalaplatin are sometimes combined with alkylating agents because they destroy cells in a similar way. These drugs are also less likely to cause leukemia than the alkylating agents.

Antimetabolites

Antimetabolites are considered another class of drugs that target DNA and RNA growth. They target cells only during the S phase. Most common antimetabolites are 5-FU or known as 5-fluorouracil. It’s commonly prescribed for leukemia, breast tumors, ovary, and the intestinal tract.

The next group of chemotherapy drugs is called anti-tumor antibiotics, and the first of these are anthracyclines.  These antibiotics work to get in the way of the enzymes that work with the DNA copying.  For this drug, all the phases of the cell cycle are involved.  And because of that fact, this drug is used for many different types of cancer.  However, one of the major side effects is that it can cause permanent damage to your heart if your dose is too high, and is why there is a lifetime limitation on the dosage.

• Some of these drugs include daunorubicin, epirubicin, doxorubicin (Adriamycin®), and idarubicin.
• Others include bleomycin, actinomycin-D, and mitomycin-C.

Another form of anti-tumor antibiotics is mitoxantrone which has the same effect as doxorubicin however it can also damage your heart.  What’s more, it also acts like one of the topoisomerase II inhibitor’s below and can cause leukemia.  This drug is often used for prostate cancer, breast cancer, leukemia, and lymphoma.

Topoisomerase inhibitors are drugs that get in the way of the enzymes called topoisomerases.  These enzymes work to separate the DNA strands to be copied.  These drugs are used to treat certain forms of leukemia, lung cancer, ovarian cancer, gastrointestinal cancer, and others.  And this drug has two groups; type I and type II.  However, some of the inhibitors can cause a secondary cancer called myelogenous leukemia, and this can be seen 2-3 years after the drug has been taken.

• Some topoisomerase I inhibitors are topotecan and irinotecan (CPT-11).
• Examples of  topoisomerase II inhibitors are etoposide (VP-16) and teniposide.

The next types of chemotherapy drugs are also inhibitors and are called mitotic inhibitors.  These however are from plant alkaloids.  What they do is help to stop mitosis or rather, get in the way of the enzymes as they try to produce the proteins that the cells need to make new.  Although this works primarily in the M phase of the cell cycle, it can also do so in all phases.

These drugs are used to treat a whole scope of cancers like breast cancer, lung cancer, myelomas, lymphomas, and even leukemia.  However, they are also known to sometimes cause damage to your nerves depending on the dose taken.  These drugs are also split into groups called the taxanes, epothilones, the vinca alkaloids, and estramustine.

The final types of chemotherapy drugs we will cover are called corticosteroids.  These drugs are made out of the natural steroids that we produce ourselves as well as synthetic hormones.  These steroids are very helpful in treating cancers like lymphoma, multiple myeloma, and some leukemia, as well as other illnesses you may have.  What they do is either kill or slow down the cancer cells and their growth. They are also used to help alleviate certain symptoms from other chemotherapy drugs like nausea and vomiting, and in these cases are referred to as anti-emetics.  What’s more, steroids are used to treat allergic reactions that some people have from chemotherapy.

• Some examples of these steroids are prednisone, dexamethasone, and methylprednisolone.

Disclaimer: Please do not treat this post as a professional advice. As always with any medication please consult your doctor.

NOTICE: Some of the above mentioned chemotherapy drugs are registered trademarks of their respective manufacturers.

Because there are many different types of drugs to treat cancer each type is grouped by what they are, what they may be combined with, and other grouping processes.  One such way to group some of these types of chemotherapy drugs is on how they work.

This is because many of them work in more than one way and must be grouped accordingly.  This is one of the reasons why it is very important to know exactly how a drug works.  The other reason why it is important is because it can help in predicting the side effects.  And in the end, an oncologist will be able to easier determine which drugs can be used and which ones work well together.

Furthermore, knowing which group a chemotherapy drug is in will help when the need to mix drugs arises. The doctors will have a better idea as to which drugs work well together and how to determine the dosage and cycles in which they are taken.  But what about the types of drugs used?

Sometimes popular drugs like cisplatin, carboplatin, and oxalaplatin are added to this group because they tend to kill the cells in much the same way.  However, these particular drugs are less likely to cause leukemia than alkylating agents.

The next types of chemotherapy drugs are called antimetabolites. Rather than destroying the DNA, these drugs get in the way of your DNA and RNA growth.  They are most often used to treat leukemia, tumors of the breasts and ovaries, as well as cancers of the intestinal tract.

• Some examples of these drugs are; 5-fluorouracil (5-FU), capecitabine (Xeloda), 6-mercaptopurine (6-MP), methotrexate, gemcitabine (Gemzar), cytarabine (Ara-C), fludarabine, and pemetrexed (Alimta)/

There are even some drugs out there and biological treatments that can treat cancer, but are not classified as ‘chemotherapy.”  While chemotherapy drugs fight against the cancer cells’ fast reproduction, these other drugs go after different characteristics that make cancer cells different than other cells.  What’s more, these drugs are often less aggressive in nature when it comes to side effects when compared to the other different types of chemotherapy drugs because they only target the cancer sell, not the healthy cells.

And with these other drugs and biological treatments have come other advancements in creating chemotherapy drugs that will target just the cancer cell.  And these new drugs as well as the biological treatments are often used side by side with more traditional chemotherapy options.

• Examples of these new drugs are; imatinib (Gleevec), gefitinib (Iressa), erlotinib (Tarceva), and bortezomib (Velcade).

Then we see differentiating agents that work to make cancer cells mature into normal healthy cells.

• These drugs would include; ATRA or Atralin and bexarotene (Targretin), and even at times you will see arsenic trioxide used.

And even hormone therapy has been used to help fight against cancer.  These drugs are hormone-like drugs that change the production of either the male or female hormones, and are used to slow down the growth of some cancers like breast, prostate, and uterine cancers.  The difference with these hormone-like drugs is that they keep the cancer cells from feeding off the hormones it needs to grow, or by preventing your body from producing hormones.

• Some of these drugs  would include; the anti-estrogens fulvestrant (Faslodex), tamoxifen, and toremifene aromatase inhibitors, such as anastrozole (Arimidex), exemestane (Aromasin), progestins – megestrol acetate (Megace), estrogens, anti-androgens – bicalutamide (Casodex), flutamide (Eulexin), and nilutamde (Nilandron)

The next rounds of drugs you will find used are immunotherapy drugs.  These are used to help stimulate a person’s natural immune system. The reason for this is because a healthy immune system would recognize these cancer cells and target them.  In comparison to other cancer treatments, this is a still fairly new technique.  What’s more, the different types of immunotherapy treatments range from active to passive.

An active immunotherapy works to stimulate your own immune system into fighting against the cancer.  On the other hand, a passive immunotherapy will work with antibodies instead to fight against the cancer cells.  There are even cancer vaccines that are being developed and tested to fight against cancer, but none have been approved by the FDA as of yet.

• Some of different types of immunotherapy drugs would include; monoclonal antibody therapy (passive immunotherapies) ,non-specific immunotherapies and adjuvants, these work to boost the immune system responses, immunomodulating drugs such as thalidomide and lenalidomide (Revlimid®)

Are you or someone you know living with cancer?  Although you feel like there is nothing you can do to help the situation at times, just getting informed about such things as treatments and medications can be a great help.  Here is a bit of information about chemotherapy drugs.

Each chemotherapy drug out there today has a specific range of dosage.  For over the counter medications, or rather, medications that you don’t need a prescription for, the therapeutic index is quite wide.  In other words, for different degrees of the issue a different amount of the same medication can be taken.  For example, where two doses of one medication may be needed for a big pain, half that dose can be taken for a milder problem.  However, the same cannot be said for many of your prescription medications like chemotherapy drugs.

These types of medications are very strong and have specific uses, and therefore their therapeutic index is very narrow.  With chemotherapy drugs and dose, too little will not treat the cancer, and too much can be life threatening.  Therefore, doctors have to be very precise in prescribing the right dose for the right person.

For example, the dose for children greatly differs from that of an adult, even if you use both ways of calculating dosages.  The reason for this is a child’s body process medications differently than that of an adult as well as their sensitivity to medication.  This is the same reason why dosages must be carefully measured out for people that; are elderly, have poor nutritional statuses, are obese, have low blood cell counts or liver or kidney diseases, or those people that are already on medications.

The next thing you need to look with chemotherapy drugs and dose is how often you have to take them, or rather, the cycle in which they are given.  For some chemotherapy cycles it may mean just one dose and then a few days or weeks without anything.  Because this type of medication is so severe, the time in between doses is used to help your normal cells recover.  On the other hand, some types of drugs will require doses over many days in a row and then a rest cycle. It all depends on the type of medication.

In the end, different types of chemotherapy drugs work with different cycles, and most often the cycle is determined by the type and stage of the cancer, or may even be flexible enough to take everything into account.  What also will affect this however is when more than one drug is being taken.  And with the majority of cases, these dosages, schedules, and drug interaction information have been founded during clinical trials.  And in the end, they have all been found to work best when a full course has been taken on schedule.

On the other hand, there are times when this is just not possible because of the side effects that each drug can have.  Some side effects are strong enough that doctors must adjust the dose or schedule to allow your body to recover, and even introduce other drugs that help combat these side effects.  Just remember that each case is different and it may take a few tries to get just the right one for you.