Chemotherapy for Wilms tumour
Chemotherapy is the use of anticancer, or cytotoxic, drugs to destroy cancer cells. Most children with Wilms tumour will have chemotherapy. The healthcare team will consider your child’s personal 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:
- shrink a tumour before surgery (called neoadjuvant chemotherapy)
- destroy cancer cells left behind after surgery and reduce the risk of the cancer recurring (called adjuvant chemotherapy)
- treat advanced cancer
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. Drugs used to treat Wilms tumour are given by intravenous injection, usually through a special device called a central venous catheter. It allows safe delivery of the chemotherapy. The surgeon will typically place this device at the start of chemotherapy.
Chemotherapy drugs commonly used for Wilms tumour
The most common chemotherapy drugs used to treat Wilms tumour are:
- vincristine (Oncovin)
- dactinomycin (Cosmegen, actinomycin-D)
- doxorubicin (Adriamycin)
- cyclophosphamide (Cytoxan)
- cisplatin (Platinol AQ)
- carboplatin (Paraplatin, Paraplatin AQ)
- etoposide (Vepesid)
A combination of chemotherapy drugs is more effective than any single drug. Some chemotherapy combinations used to treat Wilms tumour are:
- vincristine and dactinomycin
- vincristine, doxorubicin and dactinomycin
- vincristine, doxorubicin, etoposide and cyclophosphamide
- dactinomycin or carboplatin may be added to this combination
Cyclophosphamide can irritate the bladder. When this chemotherapy drug is used, mesna (Uromitexan) is also given to protect the bladder.
If Wilms tumour does not respond to drugs used in earlier treatments or if it recurs, other chemotherapy regimens may be given. These may be used in alternating sequence or given as high-dose chemotherapy, sometimes with a stem cell transplant. Some of the chemotherapy combinations used include:
- vincristine, doxorubicin and cyclophosphamide
- ifosfamide (Ifex), carboplatin and etoposide
- cyclophosphamide and etoposide
- carboplatin and etoposide
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
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.