• Chemotherapy and Targeted Therapy for Stomach Cancer

    Chemotherapy and targeted therapy are options to treat stomach cancer. Chemotherapy uses drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body to the cancer cells. Targeted therapy uses medications to attack or block specific factors that help cancer cells grow. It may help increase survival time and increase time to recurrence.

    Chemotherapy

    Chemotherapy for stomach cancer is most often used in combination with radiation therapy (called chemoradiation). Chemotherapy may be used:
    • Before surgery—to shrink the tumor and decrease the amount of tissue that needs to be removed
    • After surgery—to kill any remaining cancer cells and decrease the risk of return
    • To help relieve symptoms of metastatic cancer and extend survival time

    Chemotherapy Drugs and Delivery

    There are a variety of chemotherapy drugs. For some people, a combination of drugs may be more effective. The choice and combination of drugs will be based on your particular cancer and reaction to drugs. Chemotherapy drugs for stomach cancer may include:
    • Fluorouracil (5-FU)
    • Leucovorin
    • Doxorubicin
    • Capecitabine
    • Carboplatin
    • Cisplatin
    • Docetaxel
    • Epirubicin
    • Irinotecan
    • Oxaliplatin
    • Paclitaxel
    • Mitomycin
    Chemotherapy is most often given through an IV, but some forms can be given by mouth. It is delivered in cycles over a set period of time. A medical oncologist will determine how many cycles of chemotherapy are needed and what combination of drugs will work best.

    Side Effects

    Though the drugs are targeted to cancer cells, they can affect healthy cells as well. The death of cancer cells and impact on healthy cells can cause a range of side effects. A medical oncologist will work to find the best drug combination and dosage to have the most impact on the cancer cells and minimal side effects on healthy tissue. Side effects or complications from chemotherapy may include:
    • Skin rash or irritation
    • Numbness, pain, or burning sensation in the the hands and feet—peripheral neuropathy
    • Nausea and vomiting
    • Diarrhea
    • Fatigue due to anemia
    • Low blood cell counts (white cells or platelets) that can lead to infection or bleeding
    • Confusion, forgetfulness
    • Heart or kidney damage

    Targeted Therapy

    Unlike chemotherapy, targeted therapy drugs are designed to attack cancer cells with little to no damage to healthy cells. They may be used in combination with standard chemotherapy, as a primary treatment, or if other treatment methods fail. Targeted therapy drugs for stomach cancer include:
    • Trastuzumab—To stop tumor growth in cancers with an excess amount of a protein called human growth factor receptor (HER2). HER2 is an oncogene that spurs the growth of certain tumors.
    • Ramucirumab and bevacizumab—Blocks the development of new blood vessels that feed tumor growth.
    Common side effects include:
    • Fever
    • Diarrhea
    • Fatigue
    • Headache
    • High blood pressure
    • Slow wound healing (ramucirumab, bevacizumab)
    • Bleeding (bevacizumab)

    Managing Side Effects

    A variety of treatments are available to help manage side effects including medication, lifestyle changes, and alternative treatments. In some cases, the chemo- and/or targeted therapy regimens may be adjusted to reduce severe side effects. The earlier the side effects are addressed, the more likely they will be controlled with a minimum of discomfort.

    References

    Chemotherapy for stomach cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/stomach-cancer/treating/targeted-therapies.html. Updated April 27, 2017. Accessed September 1, 2017.

    Drugs approved for stomach cancer. National Cancer Institute website. Available at: https://www.cancer.gov/about-cancer/treatment/drugs/stomach. Updated March 15, 2016. Accessed September 1, 2017.

    Gastric carcinoma. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116155/Gastric-carcinoma. Updated September 27, 2016. Accessed September 1, 2017.

    Stomach cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/stomach-cancer. Updated January 2017. Accessed September 1, 2017.

    Targeted therapies for stomach cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/stomach-cancer/treating/targeted-therapies.html. Updated April 27, 2017. Accessed September 1, 2017.

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