Understanding Chemotherapy - Process, Nutrition, and Success Rates in the Fight Against Cancer
Chemotherapy remains the most important method of cancer treatment in 2024. Prof. Dr. Huber, a physician and experienced oncology researcher, provides an overview of its central role and latest developments in this article. He highlights how ongoing research improves treatment and establishes chemotherapy as a cornerstone in the fight against cancer.
Dear Readers,
I would like to begin this blog post on a very personal note. As a physician and scientist in oncology, I have seen many patients diagnosed with cancer over the course of my career. I have experienced their fears, their uncertainties, and their hopes. And today, I would like to share with you some important insights from my perspective as an expert.
There is no doubt that chemotherapy is an indispensable weapon in the fight against cancer. Modern conventional medicine is based on countless scientific studies and successful chemotherapy treatments that meet international standards. These facts did not come out of thin air, but are the result of decades of research and hard work by doctors and scientists around the world.
Time and time again, I meet patients who are confused by their own research on the Internet. It's important to understand that while the Internet can be a valuable source of information, it also contains a lot of conflicting and confusing information. Don't be scared off by horror stories, but trust the knowledge and experience of your healthcare provider.
It is important that patients receive clear and understandable explanations of their findings. This promotes understanding of the diagnosis, reduces anxiety, increases adherence to treatment and enables patients to play an active role in their recovery. BaluMed is here to provide you with medically sound explanations to help you better understand your disease and successfully manage your treatment. You are not alone and we are here to provide you with the best possible support. In this article, I will share with you not only the scientific facts, but also my own insights and views as a physician and scientist. Ultimately, the goal is to reach out to you as a patient and your loved ones with confidence and to guide you on your journey.
Yours sincerely
Prof. Dr. Lukas A. Huber
What is a chemotherapy?
Chemotherapy, a common form of cancer treatment, involves the use of special drugs called cytostatics to inhibit the growth and division of cancer cells. These drugs, which are chemicals, are designed to stop cancer cells from multiplying. Cells that divide rapidly, such as tumor cells, are particularly sensitive to these drugs. [1]
How chemotherapy works
Cytostatic drugs, also known as chemotherapeutic agents, intervene inside the cell, often directly at the DNA (genetic makeup) or at other points in the cell division cycle. This slows or stops cell proliferation and inhibits tumor growth. There are over 50 different cytostatic drugs with different points of attack in the cell cycle. A combination of different cytostatic drugs is often more effective because they attack cancer cells through different mechanisms.
Background: DNA (deoxyribonucleic acid) is a molecule in cells that contains the genetic information for the development and functioning of an organism. It consists of a double helix structure with nucleic bases (A, T, C, G) that carry the genetic code information. [2,3]
Categories of Cytostatic Drugs
Chemotherapy with cytostatic drugs is an important part of cancer treatment. These drugs have specific mechanisms of action to stop the growth of cancer cells. Alkylating agents interfere directly with the genetic material of cancer cells, preventing them from dividing. Antimetabolites deceive the cells with false building blocks and thus stop cell division. Mitosis inhibitors block an important structure necessary for cell division. Topoisomerase inhibitors target enzymes that are important for unraveling DNA, and taxanes, plant-based cytostatic drugs, attack the cytoskeleton of cells, also preventing cell division. These different approaches show how medicine can target cancer cells and offer hope for the treatment of this complex disease. [2]
Administration of chemotherapeutics
Chemotherapy drugs are usually administered intravenously, which allows them to spread throughout the body and reach undetected cancer cells. However, this systemic therapy also affects healthy, rapidly dividing cells such as hair roots and mucous membranes, resulting in side effects. [4]
Background: Systemic therapy is a form of medical treatment in which drugs or other substances are distributed throughout the body to combat diseases. It aims to treat diseases not only locally, but also in other parts of the body in order to control or prevent their spread. This is particularly important in the case of cancer or infectious diseases.
The main goals of chemotherapy are to
stop tumor growth, shrink or eliminate tumors
destroy metastases.
Chemotherapy increases the effectiveness of other treatments by
- Reducing the size of the tumor before surgery or radiation (neoadjuvant chemotherapy).
- Eliminating cancer cells that remain after surgery or radiation (adjuvant chemotherapy).
- Increase the effectiveness of other cancer treatments
- Fighting cancer cells that have returned or metastasized. [5]
Combination therapies
For this reason, chemotherapy is often combined with other treatments, such as surgery, radiation therapy, targeted therapy against proteins that promote cancer growth, or immunotherapy, to increase its effectiveness. It may be used before (neoadjuvant) or after (adjuvant) surgery to destroy any remaining tumor cells or to make surgery easier.
Radiochemotherapy combines radiation and chemotherapy into one treatment approach. Cancer cells are first attacked with cytostatic drugs, which are part of chemotherapy. This pre-treatment makes the cancer cells more sensitive to the subsequent or simultaneous radiation therapy. These two forms of treatment can be used together or one after the other.
For certain hormone-dependent cancers, such as certain forms of breast cancer, anti-hormonal therapy is often given first. If this therapy alone is not effective, chemotherapy may be added to intensify the treatment.
Targeted therapies target specific characteristics of tumor cells to slow or stop tumor growth. To determine whether a tumor is suitable for this type of treatment, the tumor tissue is tested for certain biomarkers. Chemotherapy may be used in addition to targeted therapies to increase their effectiveness.
It is also possible to combine immunotherapy with chemotherapy, known as immunochemotherapy. Immunotherapy supports and strengthens the body's immune system to fight cancer cells more effectively. Together with chemotherapy, this creates a two-pronged attack on the cancer.
Some patients prefer to supplement their conventional medical treatment with complementary therapies. However, it is important to discuss these complementary therapies with your healthcare team. This is because complementary approaches can interfere with the effectiveness of chemotherapy or cause unwanted and sometimes life-threatening interactions.
Chemotherapy cycles
Chemotherapy with cytostatic drugs is given in cycles to effectively fight cancer cells and give your body enough time to recover. Each cycle consists of a treatment phase, during which you receive the drugs, followed by a recovery phase. These breaks are important so that your body can recover from the side effects and make new, healthy cells. The number of cycles and their duration depend on the type of cancer and the medication used, and will be determined by your doctor. Your condition will be carefully monitored throughout your treatment and your treatment will be adjusted if necessary. Supportive care may also be used to help manage side effects. The goal of this structured approach is to make treatment as effective and gentle as possible, while keeping your well-being in mind.
Chances of success for chemotherapy
Chemotherapy will remain an essential part of cancer treatment in 2024, largely due to its ever-improving effectiveness and advances in research. Long-term studies have shown significant improvements in survival and reductions in mortality for several types of cancer, particularly colorectal, breast and lung cancer, underscoring the importance of chemotherapy in combination with other treatments.
In metastatic colorectal cancer, median overall survival has increased from around 16 months to between 27.4 and 30 months in Phase III trials. This improvement is a clear sign that patients with this type of cancer now have a much better prognosis than two decades ago. [7]
Background: Median overall survival is a statistical term used in clinical trials to describe the length of time that half of the study participants are still alive after starting treatment. It is an important measure of the effectiveness of cancer treatments. For example, if the median overall survival in a cancer treatment trial is 30 months, this means that half of the patients are still alive at least 30 months after starting treatment.
In breast cancer, studies show that the combination of anthracyclines and taxanes in chemotherapy improves 5-year survival. [8-10]
In addition, the use of adjuvant osimertinib therapy in breast cancer has been found to improve survival rates. Specifically, in patients with stage II to IIIA tumors, the 5-year survival rate was 85% in the osimertinib group compared to 73% in the placebo group. [11]
Background: Osimertinib is a targeted drug used to treat certain types of non-small cell lung cancer (NSCLC), especially in patients whose tumors have EGFR mutations. These mutations cause cancer cells to grow and spread more quickly. Osimertinib blocks the activity of the EGFR protein and may slow or stop the growth and spread of cancer cells.
In lung cancer, a Phase III study showed that the addition of anlotinib to a combination of a novel PD-1 inhibitor and chemotherapy improved median overall survival by 7.4 months in patients with extensive small cell lung cancer compared to chemotherapy alone (19.3 months vs. 11.9 months). [12]
Background: Phase III trials are a central component of clinical research, particularly in the development of new drugs. They typically enroll hundreds to thousands of patients and are often multicenter, conducted at many different sites or medical centers to reach a broad patient base. This large and diverse number of participants is critical to reliably assess the efficacy and safety of a treatment and to obtain generalizable results.
Anlotinib is a tyrosine kinase inhibitor that inhibits cancer cell growth by blocking the formation of new blood vessels in the tumor. PD-1 inhibitors, on the other hand, are part of immunotherapy and help the immune system fight cancer cells more effectively by blocking an interaction that normally prevents the immune system from attacking these cells. Combining these drugs with traditional chemotherapy provides a multi-faceted approach to fighting cancer by simultaneously targeting cell division, the tumor's blood supply and the immune response against the cancer. This strategy may be more effective than either treatment alone.
Side effects of chemotherapy
Chemotherapy can cause side effects because the drugs affect not only the cancer cells, but also some fast-growing healthy cells. This explains common side effects such as nausea, hair loss, and fatigue. Nausea occurs because the gastrointestinal tract is very sensitive to chemotherapy. Hair loss occurs because hair follicles are fast-growing cells. Fatigue is often a result of the general stress on the body caused by treatment. In addition, there may be an increased risk of infection because chemotherapy also affects white blood cells, which are important for fighting infection. Damage to germ cells is also a possible side effect because these cells divide rapidly.
However, it is important to understand that modern medicine has made great strides in reducing these side effects. Modern chemotherapy drugs are more targeted, which means they attack cancer cells more effectively and affect healthy cells less. This results in fewer and milder side effects.
In addition, there are supportive medicines and therapies that help manage side effects. For example, there are very effective medications for nausea, and special treatments can reduce the risk of infection. For hair loss, cooling scalp caps can help minimize hair loss. There are also measures to protect fertility if this is a concern.
In addition, there are many things you can do to feel better during chemotherapy. Eating a balanced diet, getting light exercise, resting, and avoiding sources of infection are important steps. It is also important to talk openly with your healthcare team about any side effects, as there are often ways to make them less severe.
Chemotherapy and ability to work
The ability to work during chemotherapy varies greatly from person to person. It depends on several factors, including the type of chemotherapy, the patient's general health, and how the patient reacts to the treatment. Some people may be able to continue working during chemotherapy, while others may be limited due to side effects such as fatigue or a weakened immune system. It is important that each patient discusses individually with their doctor what is feasible in their specific situation.
Nutrion and work during chemotherapy
Chemotherapy can affect eating habits and may require adjustments to your diet. A balanced diet can help ensure that the body gets enough nutrients to help it recover. A balanced diet can also help your body respond better to cancer treatment. Certain nutrients can help reduce the side effects of treatment and help the body recover more quickly. [13]
For nutrition tips, see our blog post 10 rules for healthy eating with cancer.
The ability to work during chemotherapy varies greatly from person to person. It depends on several factors, including the type of chemotherapy, the patient's overall health, and how the patient responds to the treatment. Some people may be able to continue working during chemotherapy, while others may be limited due to side effects such as fatigue or a weakened immune system. It is important for each patient to discuss with their doctor what is feasible in their specific situation.
Concluding remarks
In closing, I would like to emphasize that chemotherapy will continue to play a critical role in the treatment of cancer well beyond the year 2024. It is not always the only treatment, but in combination with other methods such as surgery, radiotherapy, targeted therapies and immunotherapies, it enables tailored treatment that increases the chances of survival and significantly improves patients' quality of life.
It is important for patients and their families to understand that medical advances continue to offer new hope and better treatment options. Ongoing research and innovation in cancer care aim to fight the disease more effectively and help patients live longer, more fulfilling lives.
Don't let fear and uncertainty keep you from seeing treatment as an opportunity to beat the disease and improve your quality of life. You are not alone in this journey, and medicine is constantly evolving to help you in the best way possible.
Have confidence in the knowledge and experience of your healthcare team and let us work together to meet the challenges of living with cancer. With hope, determination, and a positive attitude, you can make it through chemotherapy and other treatment options and look forward
Sources
For the US consider the NIH-National Cancer Institute web page:
https://www.cancer.gov/about-cancer/treatment/types/chemotherapy
[1] Die Chemotherapie | DKG (krebsgesellschaft.de), zuletzt abgerufen am 11.01.2024.
[2] Flexikon Zytostatikum, zuletzt abgerufen am 11.01.2024.
[3] https://www.gesundheitsinformation.de/wie-funktioniert-eine-chemotherapie.html, zuletzt abgerufen am 26.07.2023.
[4] Wie läuft eine Chemotherapie ab? (krebsinformationsdienst.de), zuletzt abgerufen am 26.07.2023.
[5] https://www.onkologie-partner.de/gesundheit/behandlungsziele, zuletzt abgerufen am 11.01.2024.
[6] Flexikon Radiochemotherapie, zuletzt abgerufen am 11.01.2024.
[7] Zeineddine, F.A., Zeineddine, M.A., Yousef, A. et al. Survival improvement for patients with metastatic colorectal cancer over twenty years. npj Precis. Onc. 7, 16 (2023). https://doi.org/10.1038/s41698-023-00353-4
[8] Peto R, Davies C, Godwin J, et al. for the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 379(9814):432-44, 2012.
[9] De Laurentiis M, Cancello G, D’Agostino D, et al. Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials. J Clin Oncol. 26(1):44-53, 2008.
[10] Ferguson T, Wilcken N, Vagg R, Ghersi D, Nowak AK. Taxanes for adjuvant treatment of early breast cancer. Cochrane Database Syst Rev. (4):CD004421, 2007.
[11] Osimertinib with or without Chemotherapy in EGFR-Mutated Advanced NSCLC. Planchard D, Jänne PA, Cheng Y, Yang JC, Yanagitani N, Kim SW, Sugawara S, Yu Y, Fan Y, Geater SL, Laktionov K, Lee CK, Valdiviezo N, Ahmed S, Maurel JM, Andrasina I, Goldman J, Ghiorghiu D, Rukazenkov Y, Todd A, Kobayashi K; FLAURA2 Investigators. N Engl J Med. 2023 Nov 23;389(21):1935-1948. doi: 10.1056/NEJMoa2306434. Epub 2023 Nov 8. PMID: 37937763 Clinical Trial.
[12] Cheng Y, Yang R, Chen J, et al: Benmelstobart with anlotinib plus chemotherapy as first-line therapy for ES-SCLC: A randomized, double-blind, phase III trial. 2023 World Conference on Lung Cancer. Abstract OA01.03. Presented September 10, 2023.
[13] Nahrungsergänzung bei Krebs | DKG (krebsgesellschaft.de), zuletzt abgerufen am 11.01.2024.