Chemotherapy

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Overview

There are many chemotherapy drugs available, as well as medications such as interferon and interleukin (called biological therapies) and monoclonal antibodies (such as Herceptin and Rituxan) that are used to treat cancer.

Chemotherapy may cause short term (acute), long term (chronic), and permanent side effects, some of which may be severe. In many cases, side effects of chemotherapy can be prevented or controlled.

In some cases, chemotherapy drugs cause an allergic or hypersensitivity reaction. These reactions, which are triggered by an immune system response, may occur immediately (e.g., type I or type II reaction), or within hours or days of chemotherapy (e.g., type III or type IV reaction).

Anaphylaxis is a severe reaction that requires immediate treatment and may cause shock, low blood pressure, and death. Symptoms of an allergic reaction include the following:

• Breathing difficulty
• Flushing (redness of the face and neck)
• Hives (urticaria; raised, itchy blotches)
• Rash
• Swelling (e.g., of the lips, tongue, eyelids)
• Systemic reactions (e.g., liver and kidney disorders)

Chemotherapy Side Effects
General side effects from chemotherapy can affect the skin, the gastrointestinal tract, and the bone marrow. Constitutional symptoms include fever and general aches.

• Skin rashes and dry skin are common effects of chemotherapy. Temporary hair loss (alopecia) and hair thinning also can occur. Medications used to treat hereditary hair loss are not effective in preventing hair loss from chemotherapy.

• Gastrointestinal (GI) tract side effects include nausea and vomiting (also known as emesis or throwing up). Loss of appetite (anorexia) and weight loss also may occur. Alterations in colon function may lead to diarrhea or constipation. Additional side effects may include the development of mouth sores (stomatitis or mucositis) and inflammation of the esophagus (esophagitis). As with hair loss, these effects are temporary. In many cases, treatment is available to help prevent or substantially reduce the severity of these side effects. Below is a list of commonly used medications for the treatment of GI complications.

• Bone Marrow—The inside of bone is composed of a fine network of mesh-like bone, called marrow. Blood cells (e.g., white cells, red cells, platelets) are made and develop (mature) in the bone marrow prior to entering the blood stream. These cells are responsible for transporting oxygen (red cells), helping to control bleeding (platelets), and fighting infections (white cells). Because chemotherapy affects rapidly dividing cells, bone marrow cells are affected.

  During chemotherapy, blood cell production is suppressed, causing an increased risk for infections and bleeding, increased fatigue, and a lack of exercise capacity. Depending on the degree of suppression and cell count levels, one or more medications may be administered to reverse blood cell suppression and allow chemotherapy treatments to continue as scheduled, with no dose reduction. These medications are listed below.

• Constitutional symptoms include fever, body aches and pains, generalized feelings of ill health, and fatigue. Various medications can be used to treat these general side effects (e.g., acetominophen, ibuprofen, narcotic pain relievers). Other treatments options include physical therapy, counseling, and support groups.
  
  
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Treatment for GI Side Effects

• Aprepitant may be given by mouth to reduce nausea and vomiting by blocking certain neurotransmitters in the brain. This drug is one component of a three-drug therapy that includes a 5-HT3 antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone). It may cause constipation, diarrhea, fatigue, and headache.
• Zofran may be given either intravenously or by mouth (IV or orally) to control acute episodes of nausea and emesis occurring within 24–48 hours of chemotherapy administration. This drug is not as effective in controlling delayed nausea and emesis.
• Kytril is given either intravenously or by mouth (IV or orally) to help control acute episodes of nausea and emesis occurring within 24–48 hours of chemotherapy administration. It is not effective in controlling delayed nausea and emesis.
• Compazine is given either intravenously or by mouth (IV or orally) to help control delayed episodes of nausea and emesis occurring more than 48 hours after chemotherapy administration.
• Reglan is a medication that is usually administered in pill form. It is used to help reduce nausea and emesis by moving food through the stomach faster.
• Decadron is a steroid that has multiple actions and uses. It can be used alone, or in combination with Zofran or Kytril, to help control acute episodes of chemotherapy-induced nausea or vomiting. It also can be used alone to improve appetite and to improve the patient's general feeling of well-being. This drug can cause weight gain if used for prolonged periods of time.
• Megace is given orally, in either pill or liquid (most common) form. The medication is a progestational agent, which increases appetite and causes weight gain due to increased caloric intake. This drug may be used as second or third line therapy in patients who have breast cancer that has progressed on Tamoxifen.
• Marinol is a prescription medication that mimics the increased appetite side effect of marijuana, without the associated high.
• Lomotil is a prescription medication that is used to decrease transition time in the colon, allowing more water to be reabsorbed and decreasing the incidence of diarrhea.
• Immodium is an over-the-counter) medication that decreases colon transition time, reducing the frequency of diarrhea.
• Milk of Magnesia (MOM) is an over-the-counter medication that helps draw water into the large intestine, softening the stool for easier elimination. This medication may cause abdominal cramps.
• Magnesium citrate is an over-the-counter medication that draws water into the large intestine, softening the stool for easier elimination. As with Milk of Magnesia, this medication may cause abdominal cramps.
• Senokot is an over-the-counter medication that increases the bulk of the stool and can lead to more predictable elimination patterns.
• Benadryl/Nystatin/Viscous lidocaine solution is a prescription solution of three medications that helps to relieve the pain, inflammation and potential fungal infections associated with moderate to severe mucositis and esophagitis (inflammation and sores of the mouth and esophagus).
• Bax solution is a prescription medication that helps to relieve the pain and potential fungal infections associated with moderate to severe mucositis.
• Diflucan is a prescription antifungal medication used to treat fungal infections of the mouth and throat. Diflucan can be given either intravenously or by mouth (IV or orally).

Bone Marrow Treatment Options

• Neupogen (G-CSF) is a colony stimulating factor (CSF)that signals the bone marrow to increase the output of white cells (specifically neutrophils), which help to fight bacterial infections.
• Neulasta is a protein that stimulates the production of white blood cells.
• GM-CSF is a colony stimulating factor (CSF) that signals the bone marrow to increase the output of white cells. It differs from neupogen in that it also increases the production of macrophages, as well as neutrophils. This drug may cause more side effects than neupogen.
• Epogen is a growth factor that stimulates the bone marrow to increase the production of red blood cells.
• Neumega is a growth factor that stimulates the bone marrow to increase production of platelets.

Biological Therapy

Interferon and interleukin-2 are commonly used biological agents. Interferon has been shown to improve survival in non-Hodgkins lymphoma patients, as well as in melanoma patients and renal cell cancer patients. It is also used in patients with hepatitis C. Interleukin-2 can be used to treat patients with renal cell cancer and patients with melanoma. During treatment, these agents, which are naturally made by the body, are delivered in higher doses than the body is capable of producing.

The major side effects associated with biological agents are constitutional, particularly fever and flu-like symptoms with associated body and muscle aches (arthralgias and myalgias). Other side effects include water retention and water leakage (often seen with interleukin), shortness of breath, cardiac arrhythmias (irregular heart rates), and skin rashes. In some cases, neurological changes (e.g., memory loss, depression, suicidal ideation ) may occur. As with side effects of chemotherapy, these effects are temporary and reverse with discontinuation of the medication.

Monoclonal Antibodies
Most side effects of this treatment are constitutional, such as fever, chills, muscle aches, and lack of energy.

Chemotherapy, Overview reprinted with permission from oncologychannel.com
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