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Chemotherapy for rhabdomyosarcoma
Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. Almost all children with rhabdomyosarcoma will have chemotherapy. Your child’s healthcare team will consider your child’s needs to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.
Chemotherapy is given for different reasons. Your child may have chemotherapy to:
- destroy cancer cells left behind after surgery and reduce the risk of the cancer recurring (called adjuvant chemotherapy)
- shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
- relieve pain or control the symptoms of advanced rhabdomyosarcoma (called palliative chemotherapy)
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 in the muscle. Chemotherapy is often given for 6 months to a year. 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 rhabdomyosarcoma
The most common chemotherapy drugs used to treat rhabdomyosarcoma are:
- vincristine (Oncovin)
- dactinomycin (Cosmegen, actinomycin-D)
- cyclophosphamide (Cytoxan, Procytox)
- ifosfamide (Ifex)
- etoposide (Vepesid)
- doxorubicin (Adriamycin)
- irinotecan (Camptosar)
The most common chemotherapy combinations used to treat rhabdomyosarcoma are:
- VA – vincristine and dactinomycin
- VAC – vincristine, dactinomycin and cyclophosphamide
- VDC – vincristine, doxorubicin and cyclophosphamide
- VI – vincristine and irinotecan
- IE – ifosfamide and etoposide
Some common chemotherapy combinations used for recurrent rhabdomyosarcoma include:
- carboplatin (Paraplatin, Paraplatin AQ) and etoposide
- ifosfamide, carboplatin and etoposide
- cyclophosphamide and topotecan (Hycamtin)
- irinotecan, with or without vincristine
- vinorelbine (Navelbine)
- vinorelbine and cyclophosphamide
- gemcitabine (Gemzar) and docetaxel (Taxotere)
- topotecan (Hycamtin), vincristine and doxorubicin
- vincristine, irinotecan and temozolomide (Temodal)
Cyclophosphamide and ifosfamide can irritate the bladder. When this chemotherapy drug is used, mesna (Uromitexan) is also given to protect the bladder.
Side effects can happen with any type of treatment for rhabdomyosarcoma, 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. 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 your child’s overall health. Some side effects of chemotherapy drugs used for rhabdomyosarcoma are:
- low blood cell counts (bone marrow suppression)
- low white blood cell count
- low platelet count
- hair loss
- skin problems
- sore mouth or throat
- nausea and vomiting
- loss of appetite
- taste changes
Other side effects can develop months or years after treatment for rhabdomyosarcoma. Find out more about late effects of treatments for rhabdomyosarcoma.
Tell the healthcare team if your child has any 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) is 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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