Chemotherapy uses anti-cancer drugs that are given intravenously (into a vein) or by mouth. These drugs enter the bloodstream and reach throughout the body, making this treatment especially useful for cancer that may have spread to organs beyond the thymus.

Chemotherapy may be used in several situations.

• It may be given as adjuvant therapy after surgery to try to kill any cancer cells that may have been left behind.

• It may be given before surgery to try to shrink tumors that are not otherwise resectable. This is known as neoadjuvant therapy.

• In people who have advanced cancer or are not healthy enough for surgery, chemotherapy may be the main treatment.

Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically involves 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.

Several chemotherapy drugs may be used in the treatment of thymomas and thymic carcinomas, including:

• doxorubicin (Adriamycin)
• cisplatin
• carboplatin
• cyclophosphamide
• ifosfamide
• prednisone
• vincristine
• etoposide
• paclitaxel
• pemetrexed
• 5-fluorouracil (5-FU)
• gemcitabine

These drugs are usually given in combination to try to increase their effectiveness. For example, a commonly used combination used to treat thymic cancer includes cisplatin, doxorubicin, and cyclophosphamide.

Possible side effects of chemotherapy

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs you are given and on how long they are used for. These side effects can include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

Some drugs can have other side effects. For example, cisplatin can damage nerves. This can sometimes lead to hearing loss or symptoms in the hands and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. (This is called peripheral neuropathy.) In most cases this goes away once treatment is stopped, but it may last a long time in some people. You should report this, as well as any other side effects or changes you notice while getting chemotherapy, to your medical team so that you can get prompt treatment for them. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

Octreotide: A drug called octreotide may also help some people with advanced thymoma. This is not a typical chemotherapy drug. It is a man-made version of a hormone called somatostatin. The drug is effective in some cases because somatostatin attaches to the thymomas cells and causes them to stop growing or die. Side effects of this drug can include pain or burning at the injection site, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue.

For more general information about chemotherapy, please see the separate American Cancer Society document, Understanding Chemotherapy: A Guide for Patients and Families.

Last Medical Review: 05/18/2009
Last Revised: 05/18/2009