• Chemotherapy for Ovarian Cancer

    Chemotherapy uses drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body in order to kill cancer cells. The side effects from the chemotherapy come from the fact that it also destroys normal cells.
    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:
    • Nausea and vomiting
    • Fatigue or tiredness
    • Hair loss
    • Decreased blood counts

    Chemotherapeutic Agents

      First line agents, used separately or in combination, include:
      • Paclitaxel (Taxol)
      • Cisplatin (Platinol-AQ)
      • Carboplatin (Paraplatin)
      Other agents (used primarily if no response to or recurrence after the first line agents, or for the rarer germ cell tumors) include:
      • Etoposide (VePesid)
      • Ifosfamide (Ifex)
      • Cyclophosphamide (Cytoxan)
      • Doxorubicin (Adriamycin)
      • Topotecan (Hycamtin)
      • Docetaxel (Taxotere)
    Common names include:
    • Taxol
    • Onxol
    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 reactions
    • Heart damage
    • Bone marrow damage
    • Nerve damage
    • Nausea
    • Vomiting
    • Diarrhea
    • Unusual infections
    Common names include:
    • Platinol-AQ (Cisplatin)
    • Paraplatin (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 reactions
    • Kidney damage
    • Hearing loss
    • Bone marrow damage
    • Liver damage
    • Nerve damage
    • Blood vessel damage
    Common name:
    • VePesid
    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 damage
    • Severe allergic reactions
    • Nausea
    • Vomiting
    • Hair loss
    • Heart muscle injury
    Common names include:
    • Cytoxan
    • Neosar
    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 hoarseness
    • Fever or chills
    • Lower back or side pain
    • Missed menstrual periods
    • Painful or difficult urination
    • Darkening of skin and fingernails
    • Loss of appetite
    • Nausea or vomiting
    • Sterility in men
    • Bone marrow damage and risk of leukemias
    Common name:
    • Adriamycin
    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 lips
    • Fast or irregular heartbeat
    • Damage to the heart muscle
    • Pain at place of injection
    • Shortness of breath
    • Swelling of feet and lower legs
    Common name:
    • Hycamtin
    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, constipation
    • Hair loss, rash, mouth sores
    • Weakness and headache
    • Cough and trouble breathing
    • Fatigue, fever, pain
    • Bone marrow damage
    Common name:
    • Taxotere
    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 loss
    • Weakness and nerve damage
    • Diarrhea, nausea, vomiting
    • Mouth sores
    • Fluid retention
    • Liver damage
    • Bone marrow damage

    References

    Detailed guide: ovarian cancer. American Cancer Society website. Available at: http://www.cancer.org/ . Accessed April 8, 2009.

    Ovarian cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/ovarian/ . Accessed April 8, 2009.

    Thomson Micromedex website. Available at: http://www.micromedex.com/ .

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