Are all chemo agents toxic?

Short answer: no. Longer answer: all drugs have side effects but we do not normally consider most drugs toxic. Chemo agents are intended to kill malignant cells or retard their growth, but they are not intended to kill the person. The “old” chemo agents, which are still widely used, are cytotoxic, meaning they kill cells. The idea is that cancerous cells will be killed faster and/or at lower levels of agent.  These drugs often produce substantial side effects.  The newer chemo agents – often classified as targeted therapies – tend to yield less severe side effects.

How does the doctor choose which drugs to give me?  Do I have any say in the question?

The type and dose of chemotherapy your doctor gives you depends on many factors, including:

• The type of cancer you have
• Your age and general health
• Where the cancer originated in your body and whether it has metastasized.
• Cytological analysis – what the cancer cells look like under a microscope and in some cases, the genetic signature identified by sequencing the genome of the malignant cells.

As far as patient involvement, we generally feel patients should know what therapies they are getting and why.  But patients rarely have the expertise to identify which medicines they should take, much less the drug regimens.  You can talk to your doctor, though.

Should I get the flu shot when I am on chemotherapy?

This is definitely a question for your doctor, as the answer depends on many factors including your overall health, age, and type of chemotherapy regimen. The concern is that chemotherapy treatment can compromise the immune system and that vaccines modify the immune system. The American Cancer Society says chemo patients should not get a vaccine with a live virus, but in some cases vaccination with an inactivated virus is appropriate.

How is chemotherapy different from other drugs?

Chemotherapy is given for cancer. Unlike some drugs, chemotherapy is intended to be given over a long period of time. The chemotherapy drugs don’t directly attack an infectious agent. The conventional cytotoxic drugs are intended to kill cells, while most drugs are not intended to kill bodily cells, although they may target invasive pathogens. Chemotherapy is often given in spurts – a course of several weeks followed by a recovery period followed by another course. Most drugs are either taken continuously for long terms or in a short campaign until the disease is cured or another drug is tried.

Many chemotherapy medicines are administered intravenously. Many are delivered at a clinic or doctor’s office. Chemotherapy, especially older drugs, tends to produce serious side effects. The drugs can be very expensive, especially the newer ones that are under patent. The drugs are often given as part of a treatment regimen in conjunction with surgery or radiation.

How is targeted chemotherapy agents different from conventional agents?

Conventional agents attack all cells, and count on the fact that they will kill malignant cells faster than healthy ones. There are different types of targeted therapies, but they are all called targeted because they have better specificity and closer focus on cancer cells. Targeted agents tend to leave the healthy cells alone. The result is fewer and less severe side effects. (All drugs have some side effects.) That means the therapeutic window is wider for targeted agents than for conventional agents and doctors can prescribe higher doses with less fear of harming the patient. Many targeted treatments are administered along with conventional agents as part of a combination regimen.

Is Immunotherapy different from chemotherapy?

As far as we are concerned at Callaix, immunotherapy is a form of chemotherapy.  Chemicals are given to the patient in order to cure or curtail cancer, and that meets the definition of chemotherapy.  When immunotherapy first showed up for cancer treatment, many reserved the word “chemotherapy” for old-style cytotoxic drugs.  The targeted drugs used in immunotherapy and small molecule targeted therapy (e.g. the kinase inhibitors) have milder side effects and work by different processes, so many did not consider them chemotherapy.

How is hormone therapy different from drug therapy?

Hormone therapy is also called hormone suppressant therapy and it is designed to lower the levels of hormone in the body or to block the effects of hormones. The agents given to produce these effects to not directly attack cancer the way drugs do. The idea is that some hormones facilitate the growth of tumors, so stopping the action of those hormones will slow the cancer.

How does sperm banking play into chemotherapy treatment?

Chemotherapy medicines sometimes damage the cells that grow into sperm. Sometimes chemotherapy-induced infertility recedes and the patient can produce viable sperm again, but when treatment starts, neither the patient nor the medical team can be sure that fertility will recover. Because of this, some patients choose to deposit semen to a storage facility where it will remain frozen. Semen will still be viable after years of being frozen at a low temperature.

Will chemotherapy drugs show up in an employment drug test?

Employers (or courts) can test for anything they want to. Whether the results of the analysis can be used for hiring or firing decisions is a different question. However, standard tests in the marketplace look for specific compounds or their metabolites. Sometimes legal medicines that a person takes can produce false positives. Do chemotherapy patients have to worry about this?

For the most part, no. The chemotherapy medicines and their metabolites will not produce a positive reading on these tests. Side medicines cancer patients take, can be a problem, but not the chemotherapy medicine per se.

The most common drugs tests look for are amphetamines, THC (active ingredient in marijuana), cocaine, opiates, and phencyclidine (PCP). Also, most tests look for barbiturates, benzodiazepines, methaqualone (Quaaludes), Methadone, and Propoxyphene (Darvon pain reliever)

In some jurisdictions, medical use of marijuana is permitted to combat the nausea associated with chemotherapy. Patients who use medical marijuana will test positive for THC. Barbiturates are less used in medicine than they were decades ago but benzodiazepines are widely prescribed for anxiety disorders and the cancer patient’s doctor may feel they are warranted. Pain relievers in the opioid and propoxyphene classes are given to some cancer patients and they will show up in workplace drug tests, too.

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