2. Chemotherapy Basics

3. What is Chemotherapy? Sometimes referred to simply as "chemo", chemotherapy is used most often to describe drugs that kill cancer cells directly. Sometimes referred to as "anti-cancer" drugs or "anti-neoplastics." Other chemo drugs such as biologic response modifiers, hormone therapy, and monoclonal antibodies, work in different ways to treat cancer, Today's therapy uses more than 100 drugs to treat cancer.

4. What is Chemotherapy Used For? To cure a specific cancer; To control tumor growth when cure is not possible; To shrink tumors before surgery or radiation therapy; To relieve symptoms (such as pain); and To destroy microscopic cancer cells that may be present after the known tumor is removed by surgery (called adjuvant therapy). Adjuvant therapy is given to prevent a possible cancer reoccurrence.

5. Chemotherapy Terms Adjuvant chemotherapy - Chemotherapy given to destroy left-over (microscopic) cells that may be present after the known tumor is removed by surgery. Adjuvant chemotherapy is given to prevent a possible cancer reoccurrence. Neoadjuvant chemotherapy - Chemotherapy given prior to the surgical procedure. Neoadjuvant chemotherapy may be given to attempt to shrink the cancer so that the surgical procedure may not need to be as extensive. Induction chemotherapy - Chemotherapy given to induce a remission. This term is commonly used in the treatment of acute leukemias. Consolidation chemotherapy - Chemotherapy given once a remission is achieved. The goal of this therapy is to sustain a remission. Consolidation chemotherapy may also be called intensification therapy. This term is commonly used in the treatment of acute leukemias. Maintenance chemotherapy - Chemotherapy given in lower doses to assist in prolonging a remission. Maintenance chemotherapy is used only for certain types of cancer, most commonly acute lymphocytic leukemias and acute promyelocytic leukemias.

6. Chemotherapy Terms cont’d. First line chemotherapy - Chemotherapy that has, through research studies and clinical trials, been determined to have the best probability of treating a given cancer. This may also be called standard therapy. Second line chemotherapy - Chemotherapy that is given if a disease has not responded or reoccurred after first line chemotherapy. Second line chemotherapy has, through research studies and clinical trials, been determined to be effective in treating a given cancer that has not responded or reoccurred after standard chemotherapy. In some cases, this may also be referred to as salvage therapy. Palliative chemotherapy - Palliative is a type of chemotherapy that is given specifically to address symptom management without expecting to significantly reduce the cancer.

7. Chemotherapy Protocols Normally, cells live, grow and die in a predictable way. Cancer occurs when certain cells in the body keep dividing and forming more cells without the ability to stop this process. Each type of tissue has a specific look and will tell where the primary tumor is arising from.

8. Cell Differentiation

9. Chemotherapy protocols involve destroying cancer cells by keeping the cells from further multiplying. Unfortunately, in the process of undergoing chemotherapy protocols, healthy cells can also be affected, especially those that naturally should divide quickly. Chemotherapy protocols strive to maximize the elimination of cancer cells while minimizing the negative effects that these protocols have on healthy cells. How Does Chemotherapy Work?

10. Chemotherapy at work…

11. How Is Chemotherapy Given? Oral chemo medications (taken by mouth) Subcutaneous injection of chemo treatments Intra-muscular chemo injections Intravenous chemo treatments - Short IV catheter - PICC, Port-a-cath or Hickman Intraventricular/Intrathecal chemo treatments Intraperitoneal chemo treatments Intra-arterial chemo treatments Intravesicular chemo treatments Intrapleural chemo treatments Implantable chemotherapy treatments Topical chemo treatments

12. How Do Doctors Decide Which Chemotherapy Drugs To Give? Research –Most types of cancer have standard protocols that help guide the doctors in selecting the right chemotherapy for each patient. Response rates –Refer to the number of people whose tumors will respond (shrink or disappear) to the drug or drugs given. The health of the patient –Chemotherapy has toxicities, some patients may not be able to tolerate certain chemotherapy protocols. –The potential risks versus benefits must be discussed before deciding which treatment will be of benefit There is usually no one correct choice in choosing chemotherapy, your physician and you will come to this through shared decision making discussions. * Each treatment protocol has advantages and disadvantages, and there may be more than one good option. In addition, treatment choices can change over time.

13. What are the Short and Long Term Side Effects of Chemotherapy? Side effects of chemotherapy are unwanted things that happen as a direct result of taking a drug. Chemotherapy damages cells that are dividing, so the parts of the body where normal cells divide frequently are likely to be affected by chemotherapy. Mouth, intestines, skin, hair, bone marrow (the spongy material that fills your bones and produces new blood cells) are commonly affected by chemotherapy. Hair is growing all the time. The skin is constantly renewing itself. So are the lining of the mouth and digestive system. To do this, the cells of all these body tissues must constantly divide to produce a steady supply of new cells. And when cells are dividing, chemotherapy drugs can attack them.

14. Nadir: What is Nadir? When discussing chemotherapy side effects often you will hear the word nadir, in reference to the blood counts, –Nadir basically means low point, however further explanation may clarify this term in connection with chemotherapy treatment. Nadir is usually about 10 days after treatment.

15. Blood Cell Types: What are They? White blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant.White blood cell (WBC) count White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. The differential classifies a person's white blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and basophils.White blood cell differential neutrophils lymphocytesmonocyteseosinophilsbasophils Neutrophils are the important infection fighting cells we need to remain healthy.eutrophils

16. Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.Red blood cell (RBC) count Hemoglobin measures the amount of oxygen-carrying protein in the blood.Hemoglobin Hematocrit measures the percentage of red blood cells in a given volume of whole blood.Hematocrit Platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting.latelet count Blood Cell Types cont’d.

17. Which Drugs Will You Receive? Handouts will be given on each individual medication you will receive and cover what side effects you MAY experience Additional medications will be given to keep you from experiencing the side effects of nausea Some medications are given to keep you from having a possible reaction to a medication that is known to increase the possibility of reactions

18. We are Here for You You should call the oncology office with any questions or concerns We will review this information at each visit you are not expected to memorize everything you are told. We can usually keep most side effects from happening or becoming worse so you must let us know about them.

19. Thank you! Cancer Center of Western Wisconsin Westfields Hospital 715-243-2800 / Radiation 715-243-2950 Gary R. Shapiro, MD, Medical Oncology Director Clayton Chen, MD, Radiation Oncology Director Steven McCormack, MD, Medical Oncology Gary R. Shapiro, MD, Medical Oncology Director Clayton Chen, MD, Radiation Oncology Director Steven McCormack, MD, Medical Oncology Amery Regional Medical Center 715-268-0294 Dan Anderson, MD, Medical Oncology Baldwin Area Medical Center 715-684-8683Dan Anderson, MD, Medical Oncology Randy Hurley, MD, Medical Oncology Hudson Hospital & Clinics 715-531-6700 Gretchen Ibele, MD, Medical Oncology Osceola Medical Center 715-294-5706Randy Hurley, MD, Medical Oncology Gretchen Ibele, MD, Medical Oncology Dan Anderson, MD, Medical Oncology St Croix Regional Medical Center 715-483-0326Dan Anderson, MD, Medical Oncology Daniel Schneider, MD, Medical Oncology Kurt Demel, MD, Medical Oncology

20. References www.chemocare.com Copyright 2005 by The Cleveland Clinic Foundation