Chemotherapy

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Hazelly
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Hi,

I am doing some research into therapies for cancer, specifically chemotherapy moreover than radiotherapy.

I understand that chemotherapy varies from patient to patient, however, is there a guideline of how many doses a patient should receive in a week? I assume they would then have a week of intense chemotherapy, then a week to recover and it starts again?

Additionally, radiotherapy is then used every day for aggressive tumours for a period of time?

I hope this makes sense to whoever reads this!

Thanks a bunch,
Hazel
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username2998742
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nexttime
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ecolier
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(Original post by Hazelly)
Hi,

I am doing some research into therapies for cancer, specifically chemotherapy moreover than radiotherapy.

I understand that chemotherapy varies from patient to patient, however, is there a guideline of how many doses a patient should receive in a week? I assume they would then have a week of intense chemotherapy, then a week to recover and it starts again?

Additionally, radiotherapy is then used every day for aggressive tumours for a period of time?

I hope this makes sense to whoever reads this!

Thanks a bunch,
Hazel
(Original post by Glaz)
nexttime GANFYD Helenia ecolier not really sure which of you lot know about chemo but I'm just tagging the usual medical bunch :ninja:
I would leave this to @nexttime. He's an oncologist after all!
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RN2MD
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Hi Hazel!

I think there should be some NICE guidelines on Ca treatment regimes and if you're looking at specific chemo drugs, the BNF will be very helpful in telling you the max doses for people. I don't know exactly where radiotherapy will be featured other than the NICE guidelines. If you can get hold of an oncologist perhaps they may be able to offer you more details about how a treatment plan is made for a specific patient's Ca. Not much help, but hopefully it's a step closer to the answer you want!
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username2998742
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(Original post by ecolier)
I would leave this to @nexttime. He's an oncologist after all!
He is? That's great then

*removes the other tags*
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nexttime
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(Original post by Hazelly)
Hi,

I am doing some research into therapies for cancer, specifically chemotherapy moreover than radiotherapy.

I understand that chemotherapy varies from patient to patient, however, is there a guideline of how many doses a patient should receive in a week? I assume they would then have a week of intense chemotherapy, then a week to recover and it starts again?

Additionally, radiotherapy is then used every day for aggressive tumours for a period of time?

I hope this makes sense to whoever reads this!

Thanks a bunch,
Hazel
This is a huge topic. Also you missed out the thing revolutionising oncology at the moment - immunotherapy!

Most chemotherapyies are less than weekly. Say once every 3 weeks, or 2 weeks out of 3 weeks, for say 4 -10 cycles. You might also have a main treatment one week then a 'top up' (rarely actually just a top up) the next. There are some intense regimes that require daily administration, but these are much less common. They tend to be for your curative patients, and there aren't actually that many cancers that can be cured purely by chemotherapy.

Some chemotherapy is oral, in which case you generally do take it daily.

There are dozens of different types of chemotherapy, and for each the dose and frequency will depend on indication (type of cancer, intent of treatment). Almost all doses depend on the patient's weight, and sometimes renal function. Even when it says x dose for say metastatic bladder cancer 2nd line palliative treatment, and you know the renal function and weight, you can still adjust the dose based on what you think the patient can tolerate, or based on side effects they've had to previous cycles.

Radiotherapy is completely different... you talk in terms of amount of radiation ("Gray", Gy) in a certain number of 'fractions (#) So a curative regime for head and neck cancer might be 70Gy/35#. i.e. 2Gy every weekday for 7 weeks. Alternatively palliative regimes tend to be either 1 fraction or 5. Or you can hyperfractionate and give it 3 times per day including weekends, which is what they do in some kinds of lung cancer.

Immunotherapy tends to be very simple! One dose fits all (for a specific drug, for a specific indication). Frequency changes though - every 2-4 weeks generally. The main thing that makes this complicated for me is that so many patients are part of a medical trial with very specific protocols I have to follow!

You mentioned aggressive tumours... it just depends on the tumour. Sometimes the most aggressive tumours are the easiest to treat. Sometimes they are not.

This is why it takes 14 years of training to be an oncologist!
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Hazelly
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(Original post by nexttime)
This is a huge topic. Also you missed out the thing revolutionising oncology at the moment - immunotherapy!

Most chemotherapyies are less than weekly. Say once every 3 weeks, or 2 weeks out of 3 weeks, for say 4 -10 cycles. You might also have a main treatment one week then a 'top up' (rarely actually just a top up) the next. There are some intense regimes that require daily administration, but these are much less common. They tend to be for your curative patients, and there aren't actually that many cancers that can be cured purely by chemotherapy.

Some chemotherapy is oral, in which case you generally do take it daily.

There are dozens of different types of chemotherapy, and for each the dose and frequency will depend on indication (type of cancer, intent of treatment). Almost all doses depend on the patient's weight, and sometimes renal function. Even when it says x dose for say metastatic bladder cancer 2nd line palliative treatment, and you know the renal function and weight, you can still adjust the dose based on what you think the patient can tolerate, or based on side effects they've had to previous cycles.

Radiotherapy is completely different... you talk in terms of amount of radiation ("Gray", Gy) in a certain number of 'fractions (#) So a curative regime for head and neck cancer might be 70Gy/35#. i.e. 2Gy every weekday for 7 weeks. Alternatively palliative regimes tend to be either 1 fraction or 5. Or you can hyperfractionate and give it 3 times per day including weekends, which is what they do in some kinds of lung cancer.

Immunotherapy tends to be very simple! One dose fits all (for a specific drug, for a specific indication). Frequency changes though - every 2-4 weeks generally. The main thing that makes this complicated for me is that so many patients are part of a medical trial with very specific protocols I have to follow!

You mentioned aggressive tumours... it just depends on the tumour. Sometimes the most aggressive tumours are the easiest to treat. Sometimes they are not.

This is why it takes 14 years of training to be an oncologist!
Hi :hi:, thank you for replying!

I didn’t think of immunotherapy, is it used alongside chemotherapy drugs? Or would that be pointless because chemotherapy essentially destroys both healthy and cancerous cells?

If a patient receives daily administration how long would they typically be on chemotherapy for, before they have have a week off?

Immunotherapy sounds interesting to hear about, is this a new therapy/treatment plan for specific patients?

Thanks for the guidance and information given, hopefully I haven’t sent too many questions

Hazel
Last edited by Hazelly; 1 year ago
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Hazelly
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(Original post by MjMarcelo99)
Hi Hazel!

I think there should be some NICE guidelines on Ca treatment regimes and if you're looking at specific chemo drugs, the BNF will be very helpful in telling you the max doses for people. I don't know exactly where radiotherapy will be featured other than the NICE guidelines. If you can get hold of an oncologist perhaps they may be able to offer you more details about how a treatment plan is made for a specific patient's Ca. Not much help, but hopefully it's a step closer to the answer you want!
Hi!

I will have a look at the NICE guidelines thank you for commenting
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nexttime
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(Original post by Hazelly)
Hi :hi:, thank you for replying!

I didn’t think of immunotherapy, is it used alongside chemotherapy drugs? Or would that be pointless because chemotherapy essentially destroys both healthy and cancerous cells?

If a patient receives daily administration how long would they typically be on chemotherapy for, before they have have a week off?

Immunotherapy sounds interesting to hear about, is this a new therapy/treatment plan for specific patients?

Thanks for the guidance and information given, hopefully I haven’t sent too many questions

Hazel
For daily chemo it really just depends. The regimes I'm most familiar with are 3 days and 5 days, with 2 weeks in between (but sometimes a 1 day 'top up').

Immunotherapy is normally used in isolation but can be given alongside chemo. It has loads of indications, and this number increases seemingly every month. I think its no exaggeration to say it may be used more than chemotherapy in the not too distant future. Have a quick google.
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