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Medical Oncology

Chemotherapy and Systemic Therapy
Chemotherapy is a systemic treatment using drugs to destroy cancer cells. The anti-cancer drugs interfere with metabolism and growth process of cancer cells, and cause them to die. The anti-cancer drugs are used in combination to improve effectiveness, but sometimes used as a single agent. Chemotherapy is used to shrink or eliminate the tumor, prevent it from spreading, destroy cancer cells that have spread to other parts in the body, or to relieve or prevent symptoms.

Side effects of chemotherapy depend on the type of drugs. Some transient side effects such as nausea, vomiting, loss of appetite and fatigue may occur. Other side effects can be more severe or long-lasting, but fortunately occur less frequently. Improvements in anti-nausea drugs and supportive care have made chemotherapy side effects more manageable than in the past.

Hepatocellular Carcinoma (Primary Liver Cancer)

  • Sorafenib (Nexavar) is an oral drug that belongs in a class of molecularly targeted therapy. Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development. The drug blocks the proteins inside cancer cells that are involved in signaling cancer cells to grow and divide, thus stopping the growth of cancer cells.
    • Common side effects may include itching, redness, pain, swelling, blisters of hand and foot, rash and tiredness.
    • Less common side effects may include itching, redness/pain/swelling/blisters of hand and foot, rash and tiredness.
    • Rare side effects may include heart attack.

Cholangiocarcinoma/Gallbladder Cancer

  • Gemcitabine (Gemzar) is given intravenously and works by interfering DNA synthesis, which causes cancer cell death.
    • Common side effects may include nausea/vomiting, low blood count, increased risk of infection, increased risk of bleeding, loss of appetite and tiredness.
    • Less common side effects may include diarrhea, rash, mouth sores, abnormal liver function and hair loss.
    • Rare side effects may include lung scarring, severe allergic reaction and sleepiness

Metastatic Colorectal Cancer
One or several chemotherapy drugs are used.

  • Leucovorin is given intravenously and is used with 5-Fluorouracil (5-FU) to increase the effects of 5-FU. It has no anti-cancer activity by itself.
  • 5-Fluorouracil (5-FU) is given intravenously during the course of either minutes or hours, or as a continuous infusion over days. It works by binding to an enzyme important for making DNA and thus keeps cells from making DNA that is vital to the growth of cancer cells.
    • Common side effects may include nausea, vomiting, decreased blood count, increased risk of infection, mouth sores, diarrhea, skin color changes, poor appetite and hair thinning.
    • Rare side effects may include confusion, difficulty walking, severe allergic reaction and numbness/tingling/reddening/swelling of hand and feet.
  • Capecitabine (Xeloda) is an oral drug that is an analog of 5-Fluorouracil.
    • Common side effects may include nausea, vomiting, tiredness, mouth sores, dry skin/irritation, and tingling/itching/redness of hands and feet.
    • Less common side effects may include sensation of pins and needles of hands and feet due to nerve injury and abnormal liver function.
  • Oxaliplatin (Eloxatin) is given intravenously and it binds to DNA to stop the growth of cancer cells, which causes the cells to die.
    • Common side effects may include nausea, vomiting, numbness and tingling of hands and/or feet and/or mouth due to nerve injury, abdominal pain, mouth sores and tiredness.
    • Less common side effects may include difficulty walking, hair thinning, decreased blood count, increased risk of infection, poor tolerance to cold temperature and abnormal liver function.
  • Irinotecan(Camptosar) is given intravenously and it blocks the enzyme called topoisomerase I. Blocking this enzyme results in DNA breaks, which leads to cancer cell death.
    • Common side effects may include nausea, vomiting, diarrhea, mouth sores, hair loss, decreased blood counts, loss of appetite and tiredness.
    • Less common side effects may include cholinergic syndrome (may include runny nose, increased saliva, sweating, tearing in the eyes, flushing, abdominal cramps, diarrhea), increased risk of infection and abnormal liver function.

Targeted Agents

  • Bevacizumab(Avastin) is given intravenously. It is a type of targeted therapy that targets angiogenesis (harmful blood vessel formation by cancer cells). It blocks a protein called Vascular Endothelial Growth Factor (VEGF). By blocking VEGF, the drug stops the tumor from being able to create new blood vessels, thus limiting its supply of nutrients and slowing or stopping the growth. The drug may also work by making tumor blood vessels less leaky, allowing chemotherapy to get into cancer cells more effectively.
    • Common side effects may include high blood pressure, headache, tiredness, and loss of appetite.
    • Less common side effects may include nosebleed, protein in the urine, nausea, vomiting, and blood clots.
    • Rare side effects may include stroke, heart attack, bowel perforation, slow healing of wounds, severe internal bleeding, confusion, and severe allergic reaction.
  • Cetuximab(Erbitux) is given intravenously. It is a type of targeted therapy that targets the epidermal growth factor receptor (EGFR) pathway. By blocking EGFR protein, the drug interferes with cellular signaling that tells cancer cell to grow.
    • Common side effects may include skin rash, tiredness, and low blood magnesium level.
    • Less common side effects may include infusion reaction (may include fever, headache, chills, itching, hives, nausea, shortness of breath), and diarrhea.
    • Rare side effects may include severe allergic reaction, and lung damage.
  • Panitumumab(Vectibix) is given intravenously and it also targets EGFR pathway similar to Cetuximab. Side effects are relatively similar to Cetuximab with exception of less frequent infusion reactions.

Metastatic Carcinoid Tumors
Chemotherapy alone has a limited role in this type of tumor.

  • Octreotide (Sandostatin) is given as an injection. It helps to relieve symptoms of carcinoid syndrome such as diarrhea and flushing by decreasing certain hormone production in the body.
    • Common side effects may include nausea, bloating, loose stools, constipation, headache, and pain/irritation at injection site.
    • Less common side effects include high or low blood sugar, gallbladder stones, and allergic reaction.