Chemotherapy: Single Drug and Combination Treatments

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy is a well-established and widely used treatment for all cancers and most of us probably know someone who has undergone "chemo". It follows, then, that most of us also know that chemotherapy has serious side effects.

The side effects are largely due to the fact that, because chemotherapy is applied to the whole body (a "systemic" treatment), it not only destroys cancer cells in a specific location but harms many normal, noncancerous cells as well. Chemotherapy drugs are engineered to attack cells that divide rapidly. They do a good job of attacking metastasizing cancer cells but also damage rapidly dividing cells such as red and white blood cells, platelets, cells in the digestive lining and, as you might guess, hair follicles.

Many advances have been made (and are still underway) in chemotherapy over the years, and more and more drugs are becoming available to target specific kinds of cancer cells and to minimize side effects.

Undergoing "chemo," however, is still a difficult process for the patient. But for lymphoma patients--especially non-Hodgkin lymphoma patients--chemotherapy is often an essential treatment because the disease often spreads throughout the body.

Chemotherapy treatments for lymphomas vary widely depending on the patient and the stage of the disease. Drugs may be taken by pill, or administered via injection. A lymphoma patient may take only a single drug or undergo a regimen involving a combination of drugs.

Two types of drug agents are routinely used for chemotherapy: alkylating agents and nucleosides:

Alkylating Agent: A cytotoxic (toxic to cells) agent that inhibits cell division by reacting with DNA.
Nucleosides: These inhibit DNA and RNA replication and thereby prevent cancer cells from growing.

These are no longer the only options as researchers continue to develop new drugs. In fact, there are countless possible treatment regimens because drugs are frequently used in combination. With so many variables it is very important to get second or even third opinions regarding the type and stage of your lymphoma and the recommended treatment.

Here we list some of the more prevalent treatments. The type of treatment depends on the patient and on the type and stage of lymphoma. Multiple treatments might also be necessary for some patients. This is by no means comprehensive and is only intended to present a broad outline.

Single Drug Treatments (usually for slow-developing NHL)

• Fludarabine
• Cladribine
• Chlorambucil (Leukeran®)
• Cyclophosphamide (Neosar®)

Combination Treatments

CHOP: cyclophosphamide (Neosar®), hydroxydaunomycin, vincristine (Oncovin®), prednisone

CVP: cyclophosphamide, vincristine and the steroid prednisone - often given with rituximab (Mabthera®)

BACOD: bleomycin, doxorubicin (Adriamycin®), cyclophosphamide (Neosar®), vincristine (Oncovin®), dexamethasone

DHAP: dexamethasone, cytarabine, cisplatin - sometimes given with rituximab (Mabthera®)

EPOCH: etoposide, prednisone, vincristine (Oncovin®), cyclophosphamide (Neosar®), fluoxymesterone (Halotestin®)

ESHAP: etoposide, methylprednisolone, cytarabine and cisplatin - sometimes given with rituximab (Mabthera®)

FAD: fludarabine, doxorubicin, and the steroid dexamethasone

FMD: fludarabine, mitoxantrone and dexamethasone

ICE: ifosfamide, carboplatin, and etoposide - often given with rituximab (Mabthera®)

MACOP-B: methotrexate, doxorubicin (Adriamycin®), cyclophosphamide, vincristine (Oncovin®), prednisone, bleomycin

PMitCEBO: prednisolone, mitoxantrone, cyclophosphamide, etoposide, bleomycin and vincristine

Pro-MACE-CytaBOM: prednisone, methotrexate (with leucovorin rescue), doxorubicin (Adriamycin®), cyclophosphamide (Neosar®), etoposide, cytarabine, bleomycin, vincristine (Oncovin®)

Side Effects of Chemotherapy

Chemotherapy is tough on the body. The drugs attack the entire body and this can produce a variety of complications. Common side effects include nausea and vomiting, diarrhea, hair loss, weight loss, Depression, mouth sores, leukopenia (decreased white blood cell count; may lower resistance to infection)

Most of the above side effects are temporary and usually (though not always) not too serious. Potentially serious side effects may include neutropenia (a severe drop in white blood cells), anemia (decreased red blood cell count), peripheral neuropathy (nerve damage), liver and kidney damage, thrombocytopenia (abnormal blood clotting), allergic reaction, and tumor lysis syndrome (specific to bulky lymphomas–cells split apart and release fragments into the bloodstream).

Alternatives to Chemotherapy

Chemotherapy is not always the best option for all lymphomas, and new treatments are emerging. Follow the links below for more information.

• Bone marrrow and stem cell transplants
• Clinical trials (testing new therapies)
• Immunotherapy
• The Zevalin radioimmunotherapy regimen is now approved for certain types of NHL.

Related Reading

General Chemotherapy Info

• "Chemotherapy and You" from NCI
• "About Chemotherapy for NHL," Cancer Research UK

Catheters

• Intravenous Catheter Lines
• CHOP Chemotherapy Information
• The Lymphoma Chemotherapy Drug Reference Page
• The immunotherapy information page - also see the new monoclonal antibody page for all the latest or jump to the pages on Rituxan, Bexxar, or Zevalin

Drug Information

• Odansetron (Zofran®)
• Granisetron (Kytril®)

Side Effects

• Coping With Hair Loss
• "Coping With Cancer," NCI
• Peripheral Neuropathy - nerve damage in the arms and feet

Non-Hodgkin's Lymphoma Information Pages:

• Non-Hodgkin's Lymphoma: Treatment
• Non-Hodgkin's Lymphoma: Resources
• Bone Marrow and Stem Cell Transplants
• Clinical Trials
• Non-Hodgkin's Lymphoma: Diagnosis
• Lymphoma Classification and Types
• Non-Hodgkin's Lymphoma: Aggressive NHLs
• Non-Hodgkin's Lymphoma: Indolent NHLs
• Non-Hodgkin's Lymphoma: Introduction

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