Chemotherapy

Chemotherapy uses anti-cancer drugs that are injected into a vein or a muscle or taken by mouth to kill cancer cells. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for some types of cancers that have spread to other organs.

Unfortunately, carcinoid tumors often do not respond to chemotherapy. Because of this, chemotherapy generally is used only for tumors that have spread to other organs, are causing severe symptoms, and have not responded to other medicines. Some of the chemotherapy drugs used include 5-fluorouracil (5-FU), doxorubicin, etoposide, dacarbazine, streptozocin, cisplatin, and cyclophosphamide. Tumors may be treated with more than one drug, although it's not clear that this is any more effective than using a single drug.

Chemotherapy drugs kill cancer cells but also damage some normal cells, which can cause some side effects. Side effects depend on the type of drugs, the amount taken, and the length of treatment. Short-term side effects might include:

• nausea and vomiting
• loss of appetite
• hair loss
• mouth sores
• low blood counts

Because chemotherapy can damage the blood-making cells of the bone marrow, you may have low blood cell counts. This can result in an increased risk of infection (due to a shortage of white blood cells); bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets); and fatigue or shortness of breath (due to low red blood cell counts).

Most side effects go away within a short time after treatment. There are often medicines that can help prevent or minimize many side effects. For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting.

Intra-arterial therapy and chemoembolization: When carcinoid cancer has spread to the liver, it is sometimes treated by directly injecting the chemotherapy drug into the hepatic artery, which supplies blood to parts of the liver. This exposes the liver tumors to high doses of the drug but limits exposing the rest of the body. This allows patients to avoid many of the side effects described above. Sometimes the chemotherapy drug is injected together with a material that plugs up the artery (an approach called chemoembolization). When the arteries leading to them are blocked, the tumors become starved for nutrients and oxygen and many die off.

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

Other drugs for treating carcinoid tumors

Several medicines can help control the symptoms of carcinoid syndrome in patients with metastatic neuroendocrine cancers.

Octreotide is an agent chemically related to a natural hormone, somatostatin. It is very helpful in treating flushing, diarrhea, and wheezing from carcinoid syndrome. While this drug rarely shrinks carcinoid tumors, it may slow or stop their growth. Although this is not curative, it can prolong life. The main side effects are pain at the site of the injection, and rarely, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue. Octreotide causes sludging of bile in the gallbladder which can lead to gallstones (cholelithiasis). It can also result in insulin resistance that can make pre-existing diabetes more difficult to control.

This drug has become available as a long-acting injection that needs to be given only once a month, which may help patients more than the short-acting version. A similar drug, lanreotide, is also available. It is also given as an injection once a month. A newer drug called pasireotide is currently being studied..

Interferons are natural substances that normally activate the body's immune system. They also slow the growth of tumor cells. Interferon-alfa is sometimes helpful in shrinking or slowing the growth of metastatic neuroendocrine cancers and improving symptoms of carcinoid syndrome. Its usefulness is sometimes limited by its flu-like side effects, which may be severe. The drug is given by injection.

Cyproheptadine is an antihistamine that can help relieve some of the symptoms of carcinoid syndrome. Other medicines are also available to control specific symptoms. Please ask your doctor about these, or describe your symptoms and ask about medicines to control them.

Last Medical Review: 06/19/2009
Last Revised: 06/19/2009