Chemotherapy for Lung Cancer
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How Chemotherapy Works
Chemotherapy uses drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body in order to kill cancer cells. The side effects come from the fact that it destroys normal cells as well as cancer cells. Chemotherapy may be given either alone or along with radiation therapy . When given alone, it is given in a higher dose designed to kill off cancer cells. When given along with radiation therapy, it is delivered at a lower dose and is designed to make the cancer more sensitive to the radiation.
How Many Cycles Are Needed
Chemotherapy is usually given by vein, but some forms can be given by mouth. Your medical oncologist will tell you how many cycles or courses of chemotherapy are best for you. Usually there are between 4-6 cycles of chemotherapy given when the chemotherapy is delivered on its own, and up to 10 cycles of chemotherapy when the drugs are given along with radiation therapy. The side effects and amount of time required in the doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you get and how often.
What Kinds of Agents Are Used
Chemotherapy agents used in treating lung cancer include:
- Cisplatin (Platinol-AQ, Platinol)
- Etoposide (Toposar, VePesid)
- Carboplatin (Paraplatin, Paraplat)
- Paclitaxel (Taxol)
- Docetaxel (Taxotere)
- Vinorelbine (Navelbine)
- Doxorubicin (Adriamycin, Rubex)
- Vincristine (Oncovin, Vincasar PFS)
- Ifosfamide (Ifex, Isophosphamide)
- Gemcitabine hydrochloride (Gemzar)
- Erlotinib (Tarceva)
- Pemetrexed disodium (Alimta)
- Bevacizumab (Avastin)
Most treatment regimens will combine two or more of these drugs. The types, dosages, and duration of treatment will depend on the stage and type of your tumor and how well it responds to treatment.
What Side Effects Commonly Occur
While undergoing chemotherapy, most patients suffer from:
- Fatigue and weakness
- Loss of appetite
- Nausea and vomiting
- Hair loss
- Fuzziness in thinking, memory problems (called “chemo brain”)
Other side effects of chemotherapy agents include:
- Risk of infection
- Skin irritation, cracked nails
- Rash
- Allergic reactions
- Mouth sores
- Diarrhea
- Constipation
- Tendency to bleed and bruise easily
- Fluid retention
- Bladder problems
- Numbness in limbs
- Infertility
- Fever or chills—If your fever is over 100.3°F (37.9°C), call the doctor right away.
- Low blood cell counts (eg, anemia )—If you have low blood cell counts combined with fever, this is a serious side effect that requires emergency care.
The cancer itself or the chemotherapy can cause anemia. This occurs when you have a low number of red blood cells, which carry oxygen throughout your body. Your doctor may treat this condition with a blood transfusion or with medication, such as pegfilgrastim (Neulasta) or epoetin alfa (Epogen, Procrit). These treatments may be necessary to maintain an adequate blood count, particularly if you get high dose chemotherapy. In general, your doctor will draw blood every week to check your counts.
To manage other side effects, you may need to make diet and lifestyle changes and take medication. For example, your doctor may recommend that you eat several small meals throughout the day and avoid alcohol. Light exercise (eg, walking for 30 minutes) may help to fight fatigue.
Some of these side effects go away soon after chemotherapy has ended, while others linger after treatment.
When to Contact Your Doctor
Contact your doctor if you develop:
- Signs of infection, including fever (100.3°F [37.9°C]) and chills
- Nosebleeds
- Sores in your mouth or throat
- Black and blue marks on your skin
- Nausea, vomiting, loose or runny bowel movements
- Pain that you can't control with the medications you've been given
- Cough, shortness of breath, or chest pain
- Joint pain, fatigue, stiffness, rash, or other new symptoms
- Tingling in your fingers, toes or ringing in your ears
- Weight gain or loss of 10 lbs. or more
References:
Calvagna M. Chemotherapy for cancer treatment. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated June 2007. Accessed November 28, 2008.
Caring for the patient with cancer at home: a guide for patients and families. American Cancer Society website. Available at: http://www.cancer.org/docroot/MBC/MBC_2x_OtherEffects.asp?sitearea=MBC . Accessed November 28, 2008.
Chemotherapy principles. American Cancer Society website. Available at: http://www.cancer.org/docroot/ETO/eto_1_3_Chemotherapy_Principles.asp . Accessed November 28, 2008.
Cisplatin. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/druginfo/cisplatin . Accessed November 28, 2008.
Etoposide (oral route, intravenous route). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR600643 . Updated July 2008. Accessed November 28, 2008.
Facts about lung cancer. American Lung Association website. Available at: http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=4294229&ct=3052307 . Accessed November 28, 2008.
How long do side effects last? American Cancer Society website. Available at: http://www.cancer.org/docroot/MBC/content/MBC_2_2X_How_Long_Do_Side_Effects_Last.asp?sitearea=MBC . Accessed November 28, 2008.
Ifosfamide. American Cancer Society website. Available at: http://www.cancer.org/docroot/CDG/content/CDG_ifosfamide.asp . Accessed November 28, 2008.
Keller B. Discharge instructions for chemotherapy. EBSCO Publishing Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=1034 . Updated April 2008. Accessed November 28, 2008.
McCarthy A. Anemia of chronic disease. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated January 2008. Accessed November 28, 2008.
Understanding chemotherapy. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/chemo-side-effects/understandingchemo . Updated November 2008. Accessed November 28, 2008.
Vincristine (intravenous route). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR601433 . Updated June 2008. Accessed November 28, 2008.
Vinorelbine (Navelbine). Cancer Quest website. Available at: http://www.cancerquest.org/index.cfm?page=525 . Updated November 2008. Accessed November 28, 2008.
Last reviewed December 2008 by Igor Puzanov, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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