Chemotherapy for Thymus Cancer

When is chemotherapy used for thymus cancer?

When treating thymus cancers (thymomas and thymic carcinomas), chemo may be used in these situations.

• It may be used before surgery to try to shrink tumors so that they can be completely removed. This is called neoadjuvant therapy.
• It may be used after surgery to try to kill any cancer cells that may have been left behind because they were too small to see. This is called adjuvant treatment.
• It might be the main treatment for people who have advanced cancer or are not healthy enough for surgery.
• It is sometimes combined with radiation to help it work better. This is known as chemoradiation or chemoradiotherapy.

How is chemotherapy given?

Chemo is given in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks, and treatment typically has 4 to 6 cycles. Chemo is often not recommended for people in poor health. An advanced age is not a barrier to getting chemo.

Several chemo drugs may be used to treat thymomas and thymic carcinomas, including:

• Doxorubicin (Adriamycin)
• Cisplatin
• Carboplatin
• Capecitabine
• Cyclophosphamide
• Fluorouracil/ Leucovorin
• Gemcitabine
• Ifosfamide
• Vincristine
• Etoposide (VP-16)
• Paclitaxel
• Pemetrexed
• 5-fluorouracil (5-FU)

These drugs usually are given in combination to try to increase their effectiveness. The combination used often depends on whether the cancer is a thymoma or a thymic carcinoma.

• For thymoma, the most preferred combination is cyclophosphamide, doxorubicin, and cisplatin (CAP).
• For thymic carcinoma, the most preferred combination is carboplatin and paclitaxel.
• Etoposide and cisplatin is another combination that may be used for either type, especially for people who have trouble with the preferred combination.

What are side effects of chemotherapy for thymus tumors?

Chemo drugs work by attacking cells that are dividing quickly, which can lead to certain side effects.

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

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Fatigue and weakness

Chemo can also affect the blood-forming cells of the bone marrow, leading to:

• Increased chance of infections due to low white blood cell counts
• Easy bruising or bleeding due to low blood platelet counts
• Fatigue and weakness due to low red blood cell counts

Many of these side effects can be lessened. For instance, drugs can be used to help prevent or reduce nausea and vomiting. Most side effects go away over time after treatment ends. If you do have side effects, be sure to ask your doctor or nurse about medicines to help reduce or manage them.

Some chemo drugs can also have other side effects. For example:

• Cisplatin and paclitaxel can cause nerve damage (neuropathy). This can sometimes lead to pain, burning or tingling sensations, sensitivity to cold or heat, or weakness in the hands and feet.
• Cisplatin can also affect the nerves of the ear, leading to hearing loss. It can also cause kidney damage.
• Doxorubicin can affect the heart muscle and reduce its function. It can also irritate the veins in the arm. This can be avoided by giving the drug through a special catheter placed before treatment starts.

Most often these problems get better or even go away once treatment is stopped, but they may last a long time for some people. Be sure to tell your healthcare team about any side effects or changes you notice while getting chemo. That way you can get treatment for them right away. In some cases, the doses of the chemo drugs might need to be reduced. Or your treatment may be delayed or stopped to keep the effects from getting worse.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.