Chemotherapy for Gastrointestinal Neuroendocrine Tumors

Chemo is most often used to treat gastrointestinal (GI) neuroendocrine tumors (NETs) if they:

• Have not responded to other medicines (such as somatostatin drugs or targeted therapy)
• Have spread to other organs
• Are large or growing quickly
• Are causing severe symptoms
• Are high grade (grade 3)

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

Chemo drugs can be given alone or combined with another chemo drug. The drugs used most often for GI neuroendocrine tumors include:

• Fluorouracil (5-FU)
• Capecitabine (Xeloda)
• Dacarbazine (DTIC-Dome)
• Oxaliplatin (Eloxatin)
• Temozolomide (Temodar)

Common combinations of chemo for GI NETs include:

• Capecitabine and oxaliplatin, which is a combination called CAPEOX
• Fluorouracil with oxaliplatin, which is a combination called FOLFOX

How is chemotherapy given?

Chemo drugs may be given in different ways, such as by mouth or by vein (intravenous, IV).

When chemo is a pill or capsule, usually you can take it at home. Your care team may give you a calendar showing which day to take the pills and how many to take. Your doctor will want to see you frequently to make sure you are doing well while you get the treatment at home.

When the chemo is given by vein, it is an injection over a few minutes or infusion over a longer period. This can be done in a doctor’s office, chemotherapy clinic, or a hospital setting.

In general, chemo is given in cycles, which include a period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Each chemo cycle can range from 2 to 3 weeks. The schedule will vary depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

The length of treatment for advanced GI NETs is based on how well t works and what side effects you have.

Possible side effects of chemotherapy

Chemo drugs damage cells that are dividing quickly, which is why they can work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and  how long they are taken. Common side effects can include:

• Nausea and vomiting
• Diarrhea or constipation
• Loss of appetite
• Hair loss
• Mouth sores
• Skin rashes
• Hand-foot syndrome
• Heart issues
• Fatigue (from having too few red blood cells)
• Increased chance of infections  (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)

Most side effects go away after treatment is finished. Tell your cancer care team about any side effects or changes you notice while getting chemotherapy, so that they can be treated promptly. Often medicines can help prevent or minimize many of the side effects. For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting. In some cases, the doses of the chemo drugs might need to be lowered, or treatment might need to be delayed or stopped to keep the effects from getting worse.