Chemotherapy is usually injected or infused into a vein, but some forms can be given by mouth. Your medical oncologist will tell you how many cycles or courses of chemotherapy are best for you. In most cases, chemotherapy is given after surgery for six cycles, although recent data suggests that as few as three cycles of chemotherapy may be as good as six cycles, which means fewer side effects. Sometimes, the cancer is too large to remove surgically, and the doctor may give you chemotherapy first to make the cancer smaller so that it can all be removed during surgery. There is still some debate about whether it is better to have chemotherapy before or after surgery, but the standard at this time is to receive chemotherapy after surgery.
The side effects and amount of time required in your doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you receive and how often. The most common chemotherapy-associated side effects are:
First line agents, used separately or in combination, include:
Other agents (used primarily if no response to or recurrence after the first line agents, or for the rarer germ cell tumors) include:
Paclitaxel combined with cisplatin or carboplatin is a favored regimen for treating epithelial cell ovarian cancer. It produces complete disease regression in about a quarter of patients with Stage III disease.
Possible side effects of taxanes include:
Life-threatening allergic reactionsHeart damageBone marrow damageNerve damageNauseaVomitingDiarrheaUnusual infections
Cisplatin and Carboplatin
Cisplatin is used alone for certain ovarian cancers and in combination with either cyclophosphamide or paclitaxel to treat advanced disease. Cisplatin is also a member of the standard BEP regimen for germ cell cancers (with bleomycin and etoposide). Due to its lower toxicity, carboplatin is being tested as a substitute for cisplatin in this combination.
Possible side effects of platinum coordination complexes include:
Life-threatening allergic reactionsKidney damageHearing lossBone marrow damageLiver damageNerve damageBlood vessel damage
The second member of BEP treatment for germ cell cancers, epipodophyllotoxin may be given on days 1-5 of each 21-day cycle.
Possible side effects of epipodophyllotoxin include:
Severe bone marrow damageSevere allergic reactionsNauseaVomitingHair lossHeart muscle injury
Cyclophosphamide ma y combined with cisplatinum to treat advanced disease. Cyclophosphamide interferes with the growth of cancer cells, which are eventually destroyed. Since cyclophosphamide may also affect the growth of normal body cells, other effects will also occur. Cyclophosphamide is given either by mouth or by injection.
Possible side effects of cyclophosphamide include:
Cough or hoarsenessFever or chillsLower back or side painMissed menstrual periodsPainful or difficult urinationDarkening of skin and fingernailsLoss of appetiteNausea or vomitingSterility in menBone marrow damage and risk of leukemias
Doxorubicin is used in combination treatments for very advanced or resistent cancer. Doxorubicin seems to interfere with the growth of cancer cells, which are then eventually destroyed by the body. Since the growth of normal body cells may also be affected by doxorubicin, other effects will also occur. Doxorubicin is given as an injection.
Possible side effects of doxorubicin include:
Sores in mouth and on lipsFast or irregular heartbeatDamage to the heart musclePain at place of injectionShortness of breathSwelling of feet and lower legs
Topotecan is used in combination treatments for very advanced, resistent, or recurrent cancer. Topotecan inhibits an enzyme topoisomerase I, causing DNA damage to tumor cells. It is commonly given intravenously daily for five days every three weeks.
Possible side effects of topotecan include:
Abdominal pain, diarrhea, nausea, vomiting, constipationHair loss, rash, mouth soresWeakness and headacheCough and trouble breathingFatigue, fever, painBone marrow damage
Docetaxel is similar to paclitaxel and is a semisynthetic compound derived from yew plants. It is commonly given intravenously every three weeks, often with corticosteroids to prevent problems with sensitivity to the medication.
Possible side effects of docetaxel include:
Hair lossWeakness and nerve damageDiarrhea, nausea, vomitingMouth soresFluid retentionLiver damageBone marrow damage