Chemotherapy

Chemotherapy refers to a cancer treatment where medicine is utilised to kill cancer cells. There are many distinct types of chemotherapy medicine, but they all work in similar way. They impede cancer cells from reproducing, which prevents them from growing as well as spreading in the body.

When is chemotherapy utilized?

Chemotherapy is employed in situations where cancer has metastasized or presents a risk of spreading. Its utilization encompasses various objectives, comprising:

• Striving for a complete cure for cancer (curative chemotherapy)
• Improving the effectiveness of other treatments, like combining it with radiotherapy (chemoradiation) or administering it prior to surgery (neo-adjuvant chemotherapy)
• Lowering the risk of cancer recurrence following radiotherapy or surgical intervention (adjuvant chemotherapy)
• Alleviating manifestations and improving quality of life in instances where a complete cure is not feasible (palliative chemotherapy)

Types of chemotherapy

Chemotherapy can be given in several ways. The most common types are:

• Chemotherapy is administered into a vein (intravenous chemotherapy) – this is usually done in the hospital and involves medicine being provided through a tube in a vein in hand, arm, or chest.
• Chemotherapy tablets (oral chemotherapy) – this usually comprises taking a course of medicine at home, with regular check-ups in the hospital.

Types of chemo drugs

Chemo drugs can be grouped by their work, chemical structure, and relationships to other medicines. Some drugs work in more than one way and maybe part of more than one group. 

Knowing how the drug works is essential in predicting its side effects. This aids medical professionals decide which drugs are likely to work well together. If more than one drug will be utilised, this information also aids them plan exactly when each drug should be given (in which order and how often).

Alkylating agents

They keep the cell from making copies of itself by damaging its DNA. These drugs show action in all phases of the cell cycle as well as are utilized to treat several distinct cancers, comprising cancers of the lung, and ovary, as well as leukaemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma.

Because these medications harm DNA, they can impact the cells of the bone marrow, which makes new blood cells. In unusual cases, this can lead to leukaemia. The chances of leukaemia from alkylating agents are dose-dependent meaning that the risk is less with lower doses but increases as the total quantity of the drug used increases. The risk of leukaemia post getting alkylating agents is highest about 5 to 10 years post-treatment.

Examples of alkylating agents comprise:

• Carboplatin
• Cisplatin
• Cyclophosphamide

Nitrosoureas

They are a group of alkylating agents that have a particular action. They can enter the brain because they can cross through the area known as the blood-brain barrier, a particular area that keeps most drugs out of the brain. This action makes these drugs helpful in treating certain types of brain tumors.

Examples of nitrosoureas comprise:

• Carmustine
• Lomustine

Antimetabolites

They interfere with DNA and RNA by acting as a substitute for the standard building blocks of RNA and DNA. When this occurs, the DNA cannot make copies of itself, and a cell cannot reproduce. They are commonly utilised to treat blood cancer, cancers of the breast, ovary, as well as intestinal tract, as well as other forms of cancer.

Examples of antimetabolites include:

• 5-fluorouracil (5-FU)
• 6-mercaptopurine (6-MP)
• Hydroxyurea
• Methotrexate

Anti-tumour antibiotics

These drugs alter the DNA inside cancer cells to keep them from growing and multiplying.

Anthracyclines

They are anti-tumour antibiotics that interfere with enzymes taking part in copying DNA during the cell cycle. They bind with DNA, so it cannot replicate, and a cell cannot reproduce. They are widely utilised for a variety of cancers.

Examples of anthracyclines comprise:

• Doxorubicin (Adriamycin)
• Doxorubicin liposomal
• Valrubicin

A major concern when administering these drugs is that they can permanently harm the heart if administered in high doses. For this reason, lifetime dose limits (also known as cumulative dose) are often placed on these drugs.

Anti-tumour antibiotics that are not anthracyclines comprises:

• Bleomycin
• Mitomycin-C

Topoisomerase inhibitors

These drugs are also known as plant alkaloids. They interfere with enzymes called topoisomerases, which aid segregate the DNA strands so they can be copied. Topoisomerase inhibitors are utilised to treat certain leukaemia and lung, gastrointestinal, and pancreatic cancers.

Topoisomerase inhibitors are classified according to which type of enzyme they impact:

Topoisomerase I inhibitors comprise:

• Irinotecan
• Irinotecan liposomal

Topoisomerase II inhibitors comprise:

• Mitoxantrone (also acts as an anti-tumor antibiotic)
• Topoisomerase II inhibitors can increase the probability of a second cancer.

Mitotic inhibitors

They are also called plant alkaloids. They are compounds derived from natural products, like plants. They work by stopping cells from multiplying to form new cells but can harm cells in all phases by keeping enzymes from synthesizing proteins required for cell reproduction.

Examples of mitotic inhibitors include taxanes and vinca alkaloids.

Taxanes comprise:

• Cabazitaxel
• Paclitaxel

Vinca alkaloids comprise:

• Vinblastine
• Vincristine

They are utilised to treat many different types of cancer comprising breast, lung, lymphomas, and leukemias. These medications may cause nerve damage, which can restrict the quantity that can be given.

Corticosteroids

They are often called steroids, which are natural hormones and hormone-like drugs that are in the treatment of several types of cancer, as well as other illnesses. When these drugs are utilized as a part of cancer treatment, they are regarded chemotherapy drugs.

Examples of corticosteroids comprise:

• Prednisone
• Dexamethasone

Steroids are also commonly utilised to aid prevent nausea and vomiting caused by Chemo. They are utilised before some types of Chemo to aid prevent severe allergic reactions, too.

Common side effects of Chemo

Below are some of the more frequent side effects associated with chemotherapy:

• Tiredness
• Hair loss
• Increased susceptibility to bruising and bleeding.
• Risk of infection
• Anaemia (reduced red blood cell counts)
• Nausea and vomiting
• Alterations in appetite
• Constipation
• Diarrhoea
• Oral, lingual, and throat complications, like ulcers and discomfort when swallowing.
• Peripheral neuropathy and other nerve-related issues comprise numbness, tingling, and pain.
• Alterations in skin and nail appearance, like dryness and discoloration
• Changes in urinary habits, bladder function, and potential renal complications
• Fluctuations in weight
• Experience of "chemo brain," which may impact concentration and focus
• Mood fluctuations
• Changes in libido and sexual function
• Fertility problems

Innovation

A groundbreaking study leveraged a machine learning algorithm to handle one of the biggest challenges faced by cancer researchers: predicting when cancer will resist chemotherapy.

In a nutshell, chemotherapy remains a cornerstone in the cancer treatment, providing ray of hope and relief to millions of patients across the globe. Its diverse array of drugs, each with unique mechanisms of action, enables oncologists to tailor treatment regimens to individual patients' needs, striving for optimal efficacy while minimizing adverse effects.

Despite its efficacy, chemotherapy is not without its challenges. The side effects linked with treatment can be debilitating, impacting patients' quality of life and, in some cases, necessitating dose adjustments or treatment modifications. However, ongoing research and innovation push the boundaries of chemotherapy, seeking to enhance its therapeutic index and improve patient outcomes.

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