Chemotherapy

Kiran Turaga, MD, MPH, Medical College of Wisconsin surgical oncologist, explains why it is important to time chemotherapy and surgery.

Chemotherapy refers to a large variety of powerful drugs used to treat patients with cancer. Chemotherapy can be given directly into the body through:

a vein or artery (intravenous or intra-arterial)
by mouth with pills or liquids (orally)
by injections into the skin, the muscle or directly into the tumor (subcutaneous, intramuscular or intratumoral)

Goals

The goals of chemotherapy (also referred to as systemic therapy, meaning the drugs travel throughout the body) are:

to prevent a cancer from returning after surgery (adjuvant treatment)
reduce the amount of tumor by killing cancer cells;
to slow down the growth of the tumor,
to relieve symptoms related to the cancer
to use drugs prior to surgery (neoadjuvant therapy) in an attempt to shrink the tumor to facilitate surgical resection.
to use chemotherapy in combination with radiation. In this case, the drugs serve as radiosensitizers to make radiation work better.
to increase a patient’s survival time.

Chemotherapy may involve the use of one drug or a combination of drugs depending on the type of cancer. Side effects of chemotherapy depend on many things, including the type of cancer and the specific drugs being used.

A variety of therapies to help prevent and/or lessen the side effects that a patient may experience while receiving chemotherapy treatment are now available. It is very important that patients have a thorough discussion with their doctor regarding recommendations for specific chemotherapy drugs.

Novel or "Targeted" Therapy

Targeted therapy refers to drugs that are designed to attack cancers based on the specific changes present in cancer cells. The most exciting development for the treatment of advanced HCC is the approval of a multi-targeted drug, sorafenib (nexavar). This oral anti-cancer drug targets several pathways critical for tumor growth including angiogenesis (new growth of tumor blood vessels) and proliferation (rapid growth of tumor cells).

Based on a large randomized placebo-controlled phase III study (300 patients in each arm), patients who took sorafenib lived longer (average 10.7 months) and had longer time before their tumor grew (time to progression) compared to those who received placebo (8 months).

Sorafenib has become the standard treatment in patients with advanced HCC. This drug has several side effects including dry skin, calluses, diarrhea, fatigue, and loss of appetite, skin rash, and changes in liver function tests. Patients need to be monitored closely by an experienced oncologist while taking sorafenib so that the dosage can be adjusted or interrupted depending on the side effects.

Many other targeted drugs are under various stages of clinical development. Early evidence of antitumor activity has been seen in small phase II studies for bevacizumab (Avastin®) and erlotinib (Tarceva®), Brivanib tosylate, and ABT689. These drugs are being studied in large, randomized clinical trials to compare their benefits and side effects to those of sorafenib.

Possible Risks of a Trial

New drugs or procedures under study may not be better than the standard care
New treatments may have side effects or risks that doctors do not expect
In randomized trials, patients are not able to choose the therapy that they receive
More visits to the doctor maybe required under protocol treatment
Health insurance may not cover all of the costs of a study

Last Updated on 2/15/2012 9:35:36 AM