Chemotherapy is the use of anti-cancer drugs that are injected into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for some types of lung cancer that have spread or metastasized to organs beyond the lungs.

Unfortunately, carcinoid tumors are not usually very sensitive to chemotherapy. Chemotherapy is mainly used for carcinoid tumors that have spread to other organs, are causing severe symptoms, and have not responded to other medicines. In some cases it may be given after surgery

Because chemotherapy does not always shrink carcinoid tumors, it is important to discuss with your doctors whether your chances of benefit outweigh the side effects you may have.

Some of the chemotherapy drugs that may be used for advanced lung carcinoids include:

• streptozotocin
• etoposide
• cisplatin
• cyclophosphamide
• 5-fluorouracil
• doxorubicin
• dacarbazine

In most cases, several chemotherapy drugs are used together, often in combination with other types of medicines.

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.

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 given and the length of time they are taken. 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 or keep them from occurring. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting.

Some drugs such as cisplatin can damage nerves. This may lead to symptoms (mainly 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 they can be treated promptly. 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.

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

Other drugs for treating carcinoid tumors

For people with metastatic carcinoid tumors who have carcinoid syndrome (facial flushing, diarrhea, wheezing, rapid heart rate), several medicines can help control the symptoms and may help keep tumor growth in check for a time.

Octreotide is a drug related to somatostatin, a natural hormone that seems to help slow the growth of neuroendocrine cells. It is very helpful in treating the symptoms of carcinoid syndrome. Sometimes octreotide can temporarily shrink carcinoid tumors, but it does not cure them. Side effects can include pain or burning at the injection site, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue.

The original version of octreotide (Sandostatin) is given as an injection under the skin (subcutaneously) at least twice daily. Some people can learn to give this injection themselves at home. A newer, long-acting version of the drug (Sandostatin LAR) is given as an injection into a muscle once a month by your doctor or nurse. When first starting treatment, most people are given daily injections. Once the doctor finds the correct dose, the longer-acting form may be used.

Lanreotide (Somatuline) is a drug similar to octreotide. It is given as an injection under the skin once a month. It may be given by your doctor or nurse, or you may learn how to give the injection at home. Side effects are similar to those of octreotide, although pain at the injection site is less common.

Interferons are natural substances that normally help activate the body's immune system. They also suppress the growth of some tumors. Interferon alfa is sometimes helpful in shrinking or slowing the growth of metastatic carcinoid tumors and improving symptoms of carcinoid syndrome. But its usefulness is limited by its flu-like side effects, which may be severe. It can also cause depression. Interferon alfa is given by injection, either daily or several times a week.

Other medicines can be used to help control specific symptoms. It is important to describe your symptoms to your doctor so that they can be treated effectively.

Last Medical Review: 03/09/2009
Last Revised: 03/09/2009