Chemotherapy for rhabdomyosarcoma

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Almost all children with rhabdomyosarcoma (RMS) will have chemotherapy. The type of drugs, doses and schedules of chemotherapy depend on the risk group.

Your child may also receive other treatments.

Chemotherapy is given for different reasons. Your child may have chemotherapy to:

• destroy cancer cells that may be at a distant site after surgery and reduce the risk that the cancer will come back (recur) (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 RMS (called palliative chemotherapy)

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the blood 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 every 1 to 3 weeks 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 tool called a central venous catheter is 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 catheters.

The most common chemotherapy drugs used to treat RMS are:

• vincristine
• dactinomycin (Cosmegen)
• cyclophosphamide (Procytox)
• irinotecan
• topotecan
• ifosfamide (Ifex)
• etoposide (Vepesid)
• doxorubicin

The most common chemotherapy combinations used to treat RMS are:

• VA – vincristine and dactinomycin
• VAC – vincristine, dactinomycin and cyclophosphamide
• VI – vincristine and irinotecan
• VDC – vincristine, doxorubicin and cyclophosphamide
• IE – ifosfamide and etoposide

If RMS does not respond to drugs used in earlier treatments or if the cancer comes back, the following drugs may be used:

• carboplatin and etoposide
• ifosfamide, carboplatin and etoposide
• cyclophosphamide and topotecan
• irinotecan, with or without vincristine
• vinorelbine
• vinorelbine and cyclophosphamide
• gemcitabine and docetaxel
• topotecan, vincristine and doxorubicin
• vincristine, irinotecan and temozolomide

A targeted therapy drug, temsirolimus (Torisel), may be given with chemotherapy for intermediate-risk RMS as part of a clinical trial.

Cyclophosphamide and ifosfamide can irritate the bladder. When these chemotherapy drugs are used, mesna (Uromitexan) is also given to protect the bladder.

Side effects can happen with any type of treatment for RMS, but every child's experience is different. Some children have many side effects. Other children have only a few side effects.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If your child develops side effects, they can happen 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, the dose, how it's given and your child's overall health. Some side effects of chemotherapy drugs used for RMS are:

• low blood cell counts
• low white blood cell count (neutropenia)
• infection
• low platelet count (thrombocytopenia)
• low red blood cell count (anemia)
• hair loss
• fatigue
• sore mouth and throat
• nausea and vomiting
• loss of appetite
• taste changes
• diarrhea
• constipation

Other side effects can develop months or years after treatment for RMS. Find out more about late effects of treatments for RMS.

Tell the healthcare team if your child has these side effects or others 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.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for your child, ask the healthcare team questions about chemotherapy.