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Chemotherapy is the use of anti-cancer (cytotoxic) drugs to treat cancer. It is usually a systemic therapy that circulates throughout the body and destroys cancer cells, including those that may have broken away from the primary tumour.
Chemotherapy is not part of first-line treatment for neuroendocrine cancers. Surgery and other treatments that reduce the bulk of tumours, as well as targeted therapies, are more effective than chemotherapy. Chemotherapy is generally used in aggressive late-stage disease. Ki-67 measurements are reliable indicators of neuroendocrine tumour growth rate. Neuroendocrine cancers with low Ki-67 levels are unlikely to benefit from chemotherapy.
Chemotherapy may be given to specific areas of the body as a regional therapy. Hepatic artery infusion (HAI), a type of regional chemotherapy, delivers drugs directly to the liver. The chemotherapy drug is pumped continuously through a catheter that is placed in the hepatic artery (the main artery of the liver). The pump may be portable or implanted under the skin.
Chemoembolization is another type of regional chemotherapy. The chemotherapy drug is mixed with an oily substance, such as Lipiodol, and injected through a catheter placed in the hepatic artery. The mixture blocks the artery and stops the normal blood flow. This blockage prevents nutrients and oxygen from reaching the tumour. Most of the drug is trapped near the tumour and exposes the tumour to the drug for longer than regular chemotherapy. Depending on the substance that is mixed with the drug, the blockage of the artery may be temporary or permanent. The liver continues to receive blood flow through the portal vein. This procedure can be repeated several times. It may be done before surgery to shrink the tumour.
Chemotherapy may be used:
Drugs, doses and schedules vary from person to person.
Neuroendocrine carcinomas are usually treated with chemotherapy regimens that include streptozocin (Zanosar) and 5-fluorouracil (Adrucil, 5-FU).
For more detailed information on specific drugs, go to sources of drug information.