Neoadjuvant chemotherapy

Neoadjuvant chemotherapy at a glance

• Chemotherapy (or “chemo”) is the use of powerful chemical drugs to kill cancer cells, stop their growth or alleviate symptoms.
• Neoadjuvant chemotherapy refers to the use of chemotherapy to reduce a tumor’s size prior to a main treatment course.
• Neoadjuvant chemotherapy (NACT) is often prescribed when a tumor is presently too large to be operable or in cases when vital organs may be impacted by a tumor’s growth.
• While this type of chemo carries the same risks and side effects as standard chemo, patients who don’t respond to NACT do run the additional risk of having delayed their primary treatment course.
  

What is neoadjuvant chemotherapy?

Neoadjuvant chemotherapy refers to a chemical drug treatment used to shrink a cancerous tumor prior to a primary course of treatment. (Conversely, adjuvant chemotherapy is when chemo is given after primary therapy to increase the chance of long-term survival.)

During NACT chemo drugs are used to attack and kill cancer cells prior to other treatment, such as surgery or radiation. For example, a woman may undergo NACT to shrink a gynecologic tumor that’s inoperable in its current state, so it can then be surgically removed. NACT is often prescribed for patients with cervical or ovarian cancer, increasing the chances for operability and minimizing the need for radical surgical procedures.

Chemotherapy treats by killing cancer cells, usually by attacking them at a specific stage of their reproduction. All cells, both normal and cancerous, go through a regeneration process to replace cells that die from injury or wear. This process is called the cell cycle and involves several phases. Cells divide, copy and then enter a resting stage. The process repeats when new cells are needed.

Chemotherapy drugs work by attacking cells during the reproduction cycle, but never at the resting phase. Unfortunately, chemo also kills normal cells, because the drugs can’t differentiate between a cancer cell and a normal cell undergoing reproduction.

How are neoadjuvant chemotherapy treatments given?

Neoadjuvant chemotherapy is administered in cycles, with each cycle consisting of a treatment period followed by a resting phase. Chemotherapy agents are given orally or intravenously in cycles spanning between 3 to 6 months.

Otherwise NACT follows the typical chemotherapy administration options, taking into account the type and stage of cancer and other factors relating to a patient’s health.

Options for chemo delivery are:

• Oral (by mouth)
• Intravenous (IV), which means injected into a vein, usually in a continuous drip through a catheter
• Injected under the skin (subcutaneous)
• Topical, as a cream
• Injected into a muscle

Chemotherapy treatment can take place in a hospital, a doctor’s office, the patient’s home, and even at the patient’s workplace. To decide where and how to administer chemo, the oncologist (a physician who’s a tumor specialist) will consider the specific chemo drug, dose and anticipated side effects.

What are the risks of neoadjuvant chemotherapy treatments?

NACT treatment presents the same risks as the primary treatment. These side effects can be short term or late, meaning they can appear months after treatment has ceased. Side effects include nausea, loss of appetite, fever, bruising and pain. Other, more severe, side effects can include infertility, cancer reoccurrence, or nerve or lung damage.

Most chemo side effects are due to the destruction of normal, healthy cells. Since chemotherapy targets all fast growing cells, such as those of bone marrow, the linings of the digestive and reproductive tracts, and hair follicles, these parts of the body are likely to experience side effects.

In addition to side effects from medications, patients may face risk of infection, plus soreness and swelling at their injection site. Moreover, some tumors may not respond well to neoadjuvant chemotherapy. For these patients, the administration of NACT does delay the principle treatment (surgery or radiation).

Oncologists will discuss patients’ options and continually review their course of treatment prior, during and after NACT.

University care is driven by its patients, not profits.

The Division of Gynecologic Oncology at CU Anschutz provides comprehensive treatments and services for all patients.

Because the University of Colorado Anschutz is a research-backed institution, our doctors can take on even the most complex cases, and patients receive the best and most modern care available.

Patients may also participate in the many available cancer research and clinical trials.