Often cancer treatment involves chemotherapy as part of the multi-modality approach of cancer care. Some tumors are exquisitely sensitive to specialized drugs, which are designed to combat the cancer at its site of origin and possibly its roots of spread. In fact, in some specific cancers, it is the sole treatment, which can provide a curative result. In other cancers, chemotherapy is used to enhance the treatment with radiation or surgery or to make an unresectable tumor surgically approachable. This powerful tool has to be given often in a very precise and timely manner in conjunction with other prescribed modalities.
The physical proximity of chemotherapy and radiation treatment units can make all the difference in the world, not only for convenience and practicality of delivering treatments, but as a well orchestrated instrument against cancer.
Central Care Cancer Center Oncology Unit is staffed with professionals trained to meet the specific needs of each patient. Central Care participates in national treatment protocols. Both inpatient and outpatient chemotherapy services are available.
Alkylating agents work directly on DNA to prevent the cancer cell from reproducing. As a class of drugs, these agents are not phase-specific (in other words, they work in all phases of the cell cycle). These drugs are active against chronic leukemias, non-Hodgkin’s lymphoma, Hodgkin’s disease, multiple myeloma, and certain cancers of the lung, breast, and ovary.
Examples of alkylating agents include busulfan, cisplatin, carboplatin, chlorambucil, cyclophosphamide, ifosfamide, dacarbazine (DTIC), mechlorethamine (nitrogen mustard), and melphalan.
Antimetabolites are a class of drugs that interfere with DNA and RNA growth. These agents work during the S phase of the cell cycle (the phase where the cell makes duplicate of its DNA in order to divide) and are used to treat chronic leukemias as well as tumors of the breast, ovary, and the gastrointestinal tract.
Examples of antimetabolites include 5-fluorouracil, capecitabine, methotrexate, gemcitabine, cytarabine (ara -C), and fludarabine.
Antitumor antibiotics interfere with DNA by stopping enzymes and mitosis or altering the membranes that surround cells. (They are not the same as antibiotics used to treat infections.) These agents work in all phases of the cell cycle. Thus, they are widely used for a variety of cancers.
Examples of antitumor antibiotics include dactinomycin, daunorubicin, doxorubicin (Adriamycin), idarubicin, and mitoxantrone.
Mitotic inhibitors are plant alkaloids and other compounds derived from natural products. They can inhibit, or stop, mitosis or inhibit enzymes for making proteins needed for reproduction of the cell. These work during the M phase of the cell cycle (the phase during which the cell divides its copied DNA and cytoplasm to make two new cells).
Examples of mitotic inhibitors include paclitaxel, docetaxel, etoposide (VP-16), vinblastine, vincristine, and vinorelbine.
Nitrosoureas act in a similar way to alkylating agents. They interfere with enzymes that help repair DNA . These agents are able to travel to the brain so they are used to treat brain tumors as well as non-Hodgkin’s lymphomas, multiple myeloma, and malignant melanoma.
Examples of nitrosoureas include carmustine (BCNU) and lomustine (CCNU).
Non Chemotherapy Agents
Targeted therapy/Monoclonal Antibodies
Monoclonal antibodies and targeted therapies are a class of medication given either orally or intravenously. They are different from traditional chemotherapy. Chemotherapies kill rapidly dividing cells and are not very specific to cancer cells. Monoclonal antibodies and targeted therapies target specific molecules found either on the surface of, or inside the cells. With doing that, these medications try to exert their effect mostly on cancer cells while sparing normal cells. However, some of the normal body cells have similar targets that can be affected by these medications which cause some of their side effects. The side effects associated with monoclonal antibodies and targeted therapies are generally considered to be more manageable than side effects associated with chemotherapy and radiation. There is the potential although rare occurrence for allergic or anaphylactic reactions that can be severe or even life-threatening. These classes of agents are now available to treat variety of cancer types.
Steroids are natural hormones and hormone-like drugs that are useful in treating some types of cancer (lymphoma, leukemias, and multiple myeloma) as well as other illnesses. When these drugs are used to kill cancer cells or slow their growth, they are considered chemotherapy drugs. They are often combined with other types of chemotherapy drugs to increase their effectiveness.
Examples include prednisone and dexamethasone.
Hormonal therapies, or hormone-like drugs, alter the action or production of female or male hormones. They are used to slow the growth of breast, prostate, and endometrial (lining of the uterus) cancers, which normally grow in response to hormone levels in the body. These hormones do not work in the same ways as standard chemotherapy drugs.
Examples include anti-estrogens (tamoxifen, fulvestrant), aromatase inhibitors (anastrozole, letrozole), progestins (megestrol acetate), anti-androgens (bicalutamide, flutamide), and LHRH agonists (leuprolide, goserelin).
Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system. These drugs offer a unique method of treatment, and are often considered to be separate from “chemotherapy.”
Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.
You and your doctor will decide which drug or combination of drugs, dosages, route of administration, frequency and length of treatment are best for you. All of these decisions will depend on your specific type of cancer, the location, the extent of its growth, how it is affecting your normal body functions, and your overall general health.
Biophosphonates (Zometa, Aredia) slow the bone-destroying activity that occurs with bone metastases. They are used to help improve bone strength and reduce bone complications such as bone fracture. Biophosphonates are given to patients with solid tumors and multiple myeloma that have spread to the bones.
Supportive care is available for patients that experience side effects like neutropenia (low white count) and anemia (low hemoglobin).Growth factors are given to increase the white blood count and hemoglobin.