Treatments

What is cytotoxic chemotherapy?

Cytotoxic means the poisoning of cells.

Chemotherapy is the chemical or drug treatment of cancerous cells. It can be used on its own or in combination with other cancer treatments such as surgery, radiotherapy and immunotherapy.

A single agent or multiple (combination) chemotherapy drugs can be used to treat the specified cancer.

The definitions below are commonly used to define chemotherapy use in relation to treatment:

How does it works?

Chemotherapy kills cancer cells which stops them multiplying and spreading elsewhere in the body. There are many chemotherapy drugs used to treat many types of cancer. After each dose of chemotherapy some of the cancer cells will have been destroyed, but some healthy cells will also have been destroyed. To allow the body time to replenish the healthy cells, chemotherapy is not given as a single treatment but usually over a number of cycles to destroy as many of the cancer cells as possible while maintaining the body’s healthy cells.

How is chemotherapy given?

Different types of cancerous cells are sensitive to different chemotherapy drugs. The treatment decisions aremade based on the cancer type, stage of cancer and the individual patient’s body’s ability to tolerate and sustain treatment. The doses calculated for each individual are usually calculated using their height and weight, this can change during their treatment cycle.

Chemotherapy can be given in one of the following ways:

• Intravenous- The drugs are administered directly into the vein either using asmall needle (butterfly); through a plastic needle (cannula) or through a central line (PICC, Hickman, Portacath). Different drug treatments affect the body at different rates, some infusion may take only 5 or 10 minutes, some may need to be administered over several hours and there are those that might require several days and the individual may need to be admitted and regularly monitored.

• Tablet- This can be a single tablet given at regular intervals or one or more tablets taken a number of times a day for a specific period of time.
• Injection- It can be administered into the muscle (intramuscular), into the tissue between the skinand muscle (subcutaneous) or under the skin (intradermal).
• Lumbar Puncture (intrathecal)- This involves inserting a needle into the spine to enable the drugs to reach the cerebrospinal fluid surrounding the brain.
• Ointment- Applied directly to your skin.
• Intra-arterial- Chemotherapy administered into the artery supplying blood to the tumour.
• Intravesical- Chemotherapy given into the bladder using a urinary catheter.
• Intra-peritoneal- Chemotherapy directly administered into the abdominal cavity.
• Intra-pleural- Chemotherapy given into the pleural cavity (the space between the lung and the lining of the lung) .

What are the side effects of chemotherapy?

Side effects experienced from chemotherapy vary from treatment to treatment. This effects can also vary between two people receiving the same drug. Most side effects are temporary and gradually disappear after treatment is completed.

Common side effects:

• An increased risk of infection
• An increased risk of bleeding
• Anaemia

• Mucositis
• Loss of taste
• Familiar tastes change
• Nausea and vomiting
• Diarrhoea
• Constipation
• Hair loss (alopecia)
• Fatigue and tiredness
• Infertility, congenital abnormalities
• Tingling and numbness on fingers and toes
• Dry skin, photosensitivity (increased risk of sunburn)

Chemotherapy and Clinical Trials

Clinical trials remove bias in their results by allocating treatments randomly when comparing different drugs or techniques. It is a first step in the testing of new drugs or treatments for humans with an aim to find a more effective treatment for cancer.

The drugs used today will have been through the clinical trials (research) stage to prove their effectiveness before licensing.

What is radiotherapy?

Radiotherapy is a method of treatment that uses carefully calculated and measured doses of radiation. It is normally used to treat cancer (malignant disease), although very occasionally it is used to treat benign conditions.

How does radiotherapy work against cancer?

At high doses, radiotherapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.

Radiotherapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiotherapy ends.Radiotherapy treatment itself is painless, side effects can occur but are different dependant on which site is treated.

There are two types of radiotherapy treatments:

• External beam radiotherapy.This is when the radiation is delivered from a machine outside the body

• Internal radiotherapy.This is when a specialist machine (is used to deliver radiation into body cavities or tissues. This includes Brachytherapy and Papillon.

Radiotherapy can be used alone, or in combination with surgery and/or chemotherapy (drug treatment) and/or Immunotherapy.

Why are radiotherapy studies important?

A research study is a scientific way to improve or develop new methods of Radiotherapy. Also, research studies and clinical trials allow the development of drug protocols in combination with radiotherapy to benefit the treatment. Studies are important because they contribute to knowledge and progress on cancer treatment. It is a way to confirm treatments are effective, reliable and safe. Radiotherapy research studies are important to further understand how radiotherapy can benefit the patients. Research into newer technological advancements in radiotherapy is key, to justify their implementation within radiotherapy departments and adapt treatment protocols to benefit the patients outcomes.

What is immunotherapy?

Cancer immunotherapies are treatments that harness and enhance the innate powers of the immune system to fight cancer. This represents the most promising new cancer treatment approach since the development of the first chemotherapies in the 1940s.

Immunotherapy is an effective treatment for patients with certain types of cancer that have been resistant to chemotherapy and radiation treatment, and has also been approved as a first line of treatment in several cancers. It may be given alone or in combination with other cancer treatments.

Cancer immunotherapy offers the possibility for long-term control of cancer.

The Clatterbridge Cancer Centre has been a pioneer in advancing this new class of treatment. Immunotherapy has potential to treat all cancers.

How does it work?

Immunotherapy enables the immune system to recognize, target, and eliminate cancer cells, wherever they are in the body. These therapies can ‘train’ the immune system to remember cancer cells which is known as ‘immunomemory’. This may result in longer-lasting and potentially permanent protection against cancer recurrence. Immunotherapy harnesses the body’s natural strength to fight cancer.

Cancer immunotherapy offers the possibility for long-term control of cancer.

What are the side effects of immunotherapy?

Immunotherapy may not cause the same side effects as chemotherapy and radiation and may vary depending on which type is used. Cancer immunotherapy is focused on the immune system and is often more targeted than chemotherapy or radiation.

Both chemotherapy and radiation damage healthy cells, commonly leading to hair loss and nausea/vomiting, side effects that may be less likely with immunotherapy.

Immunotherapy side effects are usually related to stimulation of the immune system and can range from minor symptoms of inflammation to major conditions similar to autoimmune disorders.

Immunotherapy and Clinical Trials

Clinical studies on long-term overall survival have shown that the beneficial responses to cancer immunotherapy treatment can be maintained even after treatment is completed.