Chemotherapy

Key points about chemotherapy

  • Chemotherapy is used in the treatment of cancer using cytotoxic (toxic to cells) medicines.
  • Cancer cells are cells in our body that divide and multiply quickly in an uncontrolled fashion.
  • Find out about how chemotherapy is delivered and possible side effects.
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The aim of chemotherapy is to kill the cancer cells, often by directly targeting cell growth cycles, while doing the least possible damage to normal cells. Cancer cells can form a lump or mass that keeps getting bigger and bigger (local spread) and can also travel to other parts of the body through the lymphatic system and bloodstream (metastatic spread).

Examples of chemotherapy agents available in Aotearoa New Zealand


The tables below list some examples of currently funded chemotherapy agents available in Aotearoa New Zealand.

These chemotherapy agents can be used alone or in combination with other chemotherapy agents, medicines or treatments that increase the effectiveness of the chemotherapy agent or help prevent side effects.

Read more about chemotherapy side effects. Read more about immune checkpoint inhbitors and hormone treatments for breast cancer.

Oral chemotherapy agents 
The table below lists some examples of funded chemotherapy agents taken by mouth, that are available in Aotearoa New Zealand, and used as treatments for our country's most common cancers.

Name of medicine

Also known as
(brand name)

Class of oral chemotherapy agent

alectinib

Alecensa®

Tyrosine kinase inhibitor

capecitabine

Capecitabine (Viatris)®

Antimetabolite

cyclophosphamide

Cyclonex®

Alkylating agent

etoposide

Vepesid®

Topoisomerase II inhibitor

hydroxycarbamide (hydroxyurea)

Hydroxycarbamide (Devatis)®

Antimetabolite

imatinib

Imatinib (Rex)®

Protein kinase inhibitor

irinotecan

Irinotecan (Accord)®, (Actavis)®, (Rex)®

Topoisomerase I inhibitor

methotrexate

Trexate®

Antimetabolite

palbociclib

Ibrance®

Protein kinase inhibitor

temozolamide

Temaccord®,
Apo-Temozolomide®, Temozolamide (Accord)®

Alkylating agent

vinorelbine

Vinorelbine Te Arai®

Vinca alkaloid


Intravenous (IV) chemotherapy agents
 

The table below lists some examples of funded chemotherapy agents given intravenously (through a vein), that are available in Aotearoa New Zealand, and used as treatments in our country's most common cancers.

Name of medicine 

Also known as
(brand name)

Class of IV chemotherapy agent

atezolizumab

Tecentriq®

Immune checkpoint inhibitor 

carboplatin

Carbaccord®, Carboplatin(Ebewe)®,
DBL Carboplatin ®

Platinum compound

cisplatin

Cisplatin (Ebewe)®,
DBL Cisplatin®

Platinum compound

cetuximab

Erbitux®

Epidermal growth factor receptor inhibitor

cyclophosphamide

Cytoxan®, Endoxan®

Alkylating drug

dacarbazine

Dacarbazine APP®,
DBL Dacarbazine®

Alkylating drug

docetaxel

Docetaxel (Accord)®,  (Sandoz)®, DBL Docetaxel®

Taxane

doxorubicin

Doxorubicin (Accord)®,(Ebewe)®,
Arrow-Doxorubicin®

Anthracycline

durvalumab

Imfinzi®

Immune checkpoint inhibitor

epirubicin

Epirubicin (Ebewe)®

Anthracycline

etoposide

Etopophos®, Etoposide (Rex)®

Topoisomerase II inhibitor

fluorouracil (also called 5FU)

Fluorouracil (Accord)®

Antimetabolite

gemcitabine

DBL Gemcitabine®, Gemcitabine (Ebewe)®

Antimetabolite

methotrexate

DBL Methotrexate®, Methotrexate (Sandoz)®,
Methotrexate (Ebewe)®

Antimetabolite

nivolumab

Opdivo®

Immune checkpoint inhibitor 

oxaliplatin

Oxaliplatin (Accord)®, (Alchemy)®, (Ebewe)®

Platinum compound

paclitaxel

Anzatax®, Paclitaxel (Actavis)®, (Ebewe)®

Taxane

pembrolizumab

Keytruda®

Immune checkpoint inhibitor 

trastuzumab 

Herceptin®, Herzuma® [PDF, 85 KB]  

Immune checkpoint inhibitor 

trastuzumab emtansine

Kadcyla®

Immune checkpoint inhibitor 

vinblastine

DBL Vinblastine®

Vinca alkaloid

vinorelbine

Navelbine®, Vinorelbine (Ebewe)®,(Sagent)®

Vinca alkaloid

 

Chemotherapy can travel through the bloodstream and kill cells in the body that grow quickly (such as cancer cells). They also kill fast-growing normal cells, eg, those that make up our blood, hair growth and the lining of the gastrointestinal tract. This is why they can cause side effects throughout the body.

Fortunately, our bodies are good at healing and growing. Even when normal cells are damaged, they can repair and grow again. Cancer cells lose their ability to control growth and repair, therefore when damaged they are less likely to grow back. This is why chemotherapy can slow or stop the spread of cancer.


What does it do?


Depending on your type of cancer and how advanced it is, chemotherapy can:

  • Cure cancer when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they won't grow back. Sometimes cure is achieved with a mix of chemotherapy and/or surgery or radiotherapy.
  • Control cancer when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of the body.
  • Ease cancer symptoms when chemotherapy shrinks tumours that are causing pain or pressure.

Sometimes 1 type of chemotherapy drug is given by itself, either as tablets or capsules, or in a drip (intravenous or IV infusion). More often, 2 or more medicines are given together.

In cancers where many intravenous (IV) chemotherapies are given or blood tests will need to be taken, a central line may be put in to help with these. A central line can be a long intravenous line inserted through a vessel in your arm or chest, or may be a device placed in a large vessel in the chest to allow easy access during your treatments. These lines can be used long term, and are often cleaned and redressed by nurses.

Chemotherapy doesn't get into the brain, spinal cord or fluid around the brain and spinal cord very well so, for a few cancers, the medicines are inserted into the base of the spine through a process called lumbar puncture.


Is it painful?

Having chemotherapy doesn't usually hurt. If you have a drip (IV) you may feel a brief sting as the needle goes in, but then the pain should stop. However, if the pain continues, or starts during the infusion, let the doctor or nurse know immediately.

Medicines to help with pain, nausea and swelling are often given with chemotherapy so any side effects can be managed well throughout your treatments.  Read more about chemotherapy side effects.

 

Most people have their chemotherapy as an outpatient. Usually you have to spend a few hours at the hospital for each treatment. At your treatment, it is likely you will have a blood test first, or on the day before. Your doctors and nurses will check if you are well enough and check the results before they can give you the treatment. Some people stay in hospital overnight or for 2 or 3 days.

If you live a long way from the hospital, you will probably be able to receive financial support for travel and accommodation. Talk to your treatment team to arrange this. Where possible, you can get support to bring whānau and support people to stay with you.

The type of treatment that your specialist chooses for you depends on:

  • what type of cancer you have
  • how far it has spread
  • your general health.

Chemotherapy has been used for many years, and new and better treatments are being discovered all the time, so your doctors will select the best treatment for you and your type of cancer.

Your doctors will keep a close eye on you during your treatment. You may have blood tests, x-rays and scans to see how you are doing.

If necessary, your doctors will change your medicines or how they give them to you. Sometimes they will stop the treatment early or continue it for longer than planned. It all depends on how your body and the cancer respond to the treatment.

Your treatment could last several weeks or several months. You will probably get 1 dose of treatment at a time or over a few days, and then you will be given a rest before having the next treatment. Treatments are usually given in ‘cycles’ – usually 1–2 weeks of treatment at a time, followed by 2–4 weeks break, before starting again. Spacing out your treatment in this way gives your body a chance to recover from any side effects.

This will be decided by the team treating you, but it is likely you will have regular blood tests before and during each treatment. These may test your blood cell count, liver and renal function and also check markers of your response to chemotherapy. You need to have blood counts because chemotherapy can lower blood cell levels.

If any part of your blood count is too low, your doctors might give you a longer time between treatments, they may change your chemotherapy or give you additional treatment that boosts blood counts.

Chemotherapy can be used alone for treatment. Sometimes it is started after surgery, when a tumour or bulk of the cancer is removed. In this way, the chemotherapy kills any cancer cells that were not removed during surgery. In other cases chemotherapy is given before surgery or radiation, to make the cancer smaller, so that these treatments are likely to work better.

Before you start chemotherapy, give your specialist a list of all the medicines and supplements that you are taking, including occasional paracetamol (eg, Panadol), aspirins, anti-inflammatories (eg, Nurofen), vitamins, or treatments from herbalists, naturopaths, homoeopaths, etc.

If you want to take any new medicines while having chemotherapy, check with your GP or specialist about these before you begin taking them. Some chemotherapy does not mix well with other medicines or there might be a better time in your treatment to begin them.

It is usually fine to drink a little alcohol during treatment, but check with your specialist first – some chemotherapy doesn't mix well with alcohol or you may need to avoid alcohol at certain points during the treatment cycle. 

You will probably find it best to get someone to drive you to and from hospital for the first treatment, as you might not feel well enough to drive. If you feel okay to drive after your first treatment, you will probably be fine to do so for following appointments.

If you live far away from the hospital, you should arrange for someone to drive you or ask about transport options.

Very rarely, some people who have chemotherapy may get another form of cancer much later in life. However, it is much more likely that your treatment will either cure you or control your cancer. If this question concerns you, talk it over with your GP or specialist.

In terms of carrying out other activities while being treated, do only what you feel comfortable doing. You may find you can mostly go on with your normal life, or that you have to take things much easier.

  • The important thing is to look after yourself during chemotherapy so that your body is strong enough to cope with the treatments.
  • Look to those who can support you and plan to do as little as possible. Put your needs and wishes first.
  • Most people keep working during their chemotherapy and arrange time off to go to hospital for each treatment. Some people work part-time instead of full-time, while others take a few days off around each treatment. Others take an extended break for the whole course of the treatment.
  • Talk to your employer, whānau and friends and work out what suits you. There may even be more flexible work arrangements if you make a time to talk about it. Try to not push yourself to do too much.

There are a number of support services available, talk to your treating team for further recommendations.

How can we help?(external link) Cancer Society of NZ, 2022
Emotions and cancer(external link) Cancer Society of NZ, 2022
Questions you may wish to ask Cancer Society of NZ, 2022 
Questions to ask your doctor about chemotherapy(external link) Cancer Society of NZ, 2022
Find a cancer hospital/service near you(external link) Healthpoint, NZ
Cancer(external link) Ministry of Health NZ, 2022
National Travel Assistance Scheme(external link) Health New Zealand | Te Whatu Ora
Cancer support Healthify
Patient Information sheets(external link) eviQ, Australia

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Reviewed by: Dr Bryony Harrison

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