Cancer Treatment: Chemotherapy

What is chemotherapy?

Chemotherapy is a type of treatment that kills cells that grow very quickly. Many cancers grow and divide quickly and abnormally, making them good targets for chemotherapy. Unfortunately normal cells, such as skin, hair, blood cells and the cells that line the intestinal tract also grow rapidly, and chemotherapy can damage these too. This can lead to many of the side effects that people on chemotherapy experience. 

Doctors can choose from many different chemotherapy drugs and combinations. A chemotherapy drug may be used with another chemotherapy or with other types of treatments, including radiation, immunotherapy or targeted therapy. Each chemotherapy drug has different uses and side effects. The choice of chemotherapy may depend on the following:

• Your cancer type: Some types of cancer, such as ovarian and pancreatic cancer, are almost always treated with chemotherapy. Other cancers, such as breast cancer, may use chemotherapy for certain subtypes or stages of cancer. 
• Your cancer stage and grade: Because of its many side effects, chemotherapy is often used on hard-to-treat or aggressive cancers that are likely to spread or have already spread to other parts of the body. 
• For cancer that has spread, the location or site of cancer spread: Certain chemotherapy drugs may work better in different organs. For example, the blood-brain barrier protects your brain by filtering out drugs. If cancer has spread to your brain, your oncologist may treat you with chemotherapy that is able to cross the blood-brain barrier.  
• Your general health and other medical conditions: Chemotherapy can cause many side effects. Some drugs can affect the heart, liver, kidneys or other cells. Oncologists may choose specific chemotherapy agents for people with certain medical conditions, such as heart or kidney disease, to avoid further damage to these organs. 

How is chemotherapy given?

Chemotherapy is a type of treatment that kills cells that grow very quickly. Many cancers grow and divide quickly and abnormally, making them good targets for chemotherapy. Unfortunately normal cells, such as skin, hair, blood cells and the cells that line the intestinal tract also grow rapidly, and chemotherapy can damage these too. This can lead to many of the side effects that people on chemotherapy experience. 

Doctors can choose from many different chemotherapy drugs and combinations. A chemotherapy drug may be used with another chemotherapy or with other types of treatments, including radiation, immunotherapy or targeted therapy. Each chemotherapy drug has different uses and side effects. The choice of chemotherapy may depend on the following:

• Your cancer type: Some types of cancer, such as ovarian and pancreatic cancer, are almost always treated with chemotherapy. Other cancers, such as breast cancer, may use chemotherapy for certain subtypes or stages of cancer. 
• Your cancer stage and grade: Because of its many side effects, chemotherapy is often used on hard-to-treat or aggressive cancers that are likely to spread or have already spread to other parts of the body. 
• For cancer that has spread, the location or site of cancer spread: Certain chemotherapy drugs may work better in different organs. For example, the blood-brain barrier protects your brain by filtering out drugs. If cancer has spread to your brain, your oncologist may treat you with chemotherapy that is able to cross the blood-brain barrier.  
• Your general health and other medical conditions: Chemotherapy can cause many side effects. Some drugs can affect the heart, liver, kidneys or other cells. Oncologists may choose specific chemotherapy agents for people with certain medical conditions, such as heart or kidney disease, to avoid further damage to these organs. 

Chemotherapy is most often given as systemic therapy by injection into the veins or as a pill. This exposes the entire body to the drugs. In some cases, the medication may be given directly at the site of the cancer.

• Intraperitoneal (IP) chemotherapy means the chemotherapy is injected directly into the abdomen. This approach may be used to treat ovarian cancer. This allows doctors to deliver higher doses of chemotherapy to the cancer, while minimizing the rest of the body's exposure to these drugs.  
• Topical chemotherapy is usually a cream or liquid that is applied directly to the cancer. Topical treatment is sometimes used to treat skin cancer. 

What are antibody-drug conjugates?

An antibody-drug conjugate (ADC) is a type of cancer treatment that combines a targeted therapy and chemotherapy. The targeted antibody portion of the drug is designed to find cancer cells. Once the antibody binds to the cancer cell, it releases the chemotherapy portion of the drug. The goal is to deliver high levels of chemotherapy directly to the cancer while sparing normal tissue. 

Antibody-drug conjugates are typically given by intravenous (IV) injection. 

Examples of ADCs include:

• Elahere (mirvetuximab soravtansine)
• Enhertu (trastuzumab deruxtecan)
• Kadcycla (trastuzumab emtansine)
• Trodelvy (sacituzumab govitecan)

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