Chemotherapy for neuroblastoma
Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It is commonly used to treat neuroblastoma. Your child’s healthcare team will consider the stage and risk group, as well as your child’s personal needs, to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.
Most children with intermediate- and high-risk disease will have chemotherapy. Some children with low-risk disease that affects vital organs will be given chemotherapy.
Chemotherapy is given for different reasons. Your child may have chemotherapy to:
- destroy cancer cells in the body
- shrink a tumour before surgery (called neoadjuvant chemotherapy)
- destroy cancer cells left behind after surgery and to lower the risk that the cancer will recur (called adjuvant therapy)
- relieve pain and control the symptoms of advanced neuroblastoma (called palliative chemotherapy)
- treat spinal cord compression, which is a cancer-related emergency that neuroblastoma can cause
- prepare for stem cell transplant
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour. The drugs may be given by mouth or by a needle in a vein (intravenous injection). Sometimes a special device called a central venous catheter may be used to safely give the drugs. It is usually placed during surgery at the start of chemotherapy and left in place until treatment is finished. Find out more about central venous catheter.
Chemotherapy drugs used for neuroblastoma
The most common chemotherapy drugs used to treat neuroblastoma are:
- cyclophosphamide (Cytoxan, Procytox)
- ifosfamide (Ifex)
- cisplatin (Platinol AQ)
- carboplatin (Paraplatin, Paraplatin AQ)
- vincristine (Oncovin)
- doxorubicin (Adriamycin)
- etoposide (Vepesid, VP-16)
- topotecan (Hycamtin)
- melphalan (Alkeran, L-PAM)
- busulfan (Busulfex, Myleran)
- teniposide (Vumon, VM-26)
- irinotecan (Camptosar)
- thiotepa (ThioTEPA)
A combination of chemotherapy drugs is more effective than any single drug. Some drug combinations used to treat neuroblastoma are:
- cisplatin, cyclophosphamide, doxorubicin and vincristine
- carboplatin, cyclophosphamide, doxorubicin and vincristine
- cyclophosphamide, doxorubicin and vincristine
- carboplatin and etoposide
- cisplatin and etoposide
- topotecan and cyclophosphamide
- irinotecan and temozolomide (Temodal)
If neuroblastoma does not respond to drugs used in earlier treatments or if it recurs, these drug combinations may be used:
- topotecan and cyclophosphamide
- irinotecan and temozolomide
Side effects can happen with any type of treatment for neuroblastoma, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.
Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child’s body seems to handle chemotherapy better than an adult’s body. Children usually have less severe side effects and will often recover from them faster than adults.
Side effects of chemotherapy will depend mainly on the type of drug or drugs given, the dose, how the drugs are given and the child’s overall health. Some common side effects of chemotherapy drugs used for neuroblastoma are:
- bone marrow suppression
- weakened immune system
- low platelet count
- low white blood cell count
- nausea and vomiting
- sore mouth or throat
- loss of appetite
- hair loss
Other side effects can develop months or years after treatment for neuroblastoma. Find out more about late effects for neuroblastoma.
Tell your child’s healthcare team if your child has side effects you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.
Information about specific cancer drugs
The following websites have information about specific drugs used to treat cancer in children.
Cancer Care Ontario (CCO) Drug Formulary is a searchable database of drugs used to treat cancer.
British Columbia Cancer Agency (BCCA) Drug Index (Professional)provides a list of drugs used to treat cancer and basic information about uses and doses.
Questions to ask about chemotherapy
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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