Teaching pack: Chemotherapy

Chemotherapy collects the cytotoxic drugs that kill fast-dividing cells: platinums, taxanes, anthracyclines, antimetabolites and topoisomerase inhibitors. These agents remain curative in several cancers and now serve as the payloads inside antibody-drug conjugates, so progress lies in dosing, sequencing, biomarker-guided de-escalation and toxicity mitigation rather than in new cytotoxics alone. Technologies that point here include cytotoxic chemotherapy, platinum agents, topoisomerase-I inhibitors, autologous and tandem stem cell transplant, PET-adapted therapy, HIPEC and PIPAC, TACE, chronotherapy and metabolic therapy. Scalp cooling and the company PharmaMar also link to this section.

• Acupuncture and acupressure for chemotherapy nausea: Stimulating the P6 point on the inner wrist, with needles, electrical stimulation or a pressure band, adds a small further reduction in chemotherapy vomiting on top of modern anti-sickness drugs. It is safe and cheap, and guidelines say it can be offered.
• Acupuncture for chemotherapy-induced neuropathy: Numb, tingling or painful hands and feet after taxanes, platinum or bortezomib have no proven preventive treatment. Small trials suggest acupuncture may ease the symptoms, but they are too small and inconsistent to be sure, so it is an option to try inside a trial or with careful tracking rather than an established treatment.
• Autologous stem cell transplant (high-dose therapy): Autologous stem cell transplant collects the patient's own blood-forming stem cells, gives melphalan or another chemotherapy at a dose that would otherwise destroy the marrow, then returns the cells to rebuild it. It is standard consolidation in myeloma and for relapsed lymphoma, though CAR-T has displaced it in early-relapsing large B-cell lymphoma.
• Bimatoprost for eyelash and eyebrow regrowth: Eyelashes and eyebrows often fall out with chemotherapy and can be slow to return. Bimatoprost, a glaucoma eye drop approved for thin lashes, applied along the lash line each night increased lash length and thickness in a randomised trial that included people after chemotherapy.
• Cannabinoids for chemotherapy nausea (dronabinol, nabilone, medical cannabis): Two synthetic cannabinoid tablets, dronabinol and nabilone, have been approved for chemotherapy nausea since 1985 and can help when standard anti-sickness drugs fail. Modern antiemetics work better for most people, and evidence for herbal cannabis or vaped products is thin.
• Chronotherapy: timing treatment to the body clock: Giving the same drug at a different time of day, because the body clock changes how much damage it does and how well the immune system responds.
• Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield): Sealed connectors that let a pharmacist or nurse draw up and give chemotherapy without any drug vapour or droplet escaping, protecting the staff who handle these drugs every day.
• Creams and lotions tried to prevent chemotherapy hair loss: Several drugs have been put on the scalp to stop chemotherapy hair loss before it starts: minoxidil lotion, vitamin D analogues, and others. The trials were done and they did not work. Scalp cooling remains the only method cleared by a regulator to prevent it.
• Cytotoxic chemotherapy: Cytotoxic chemotherapy drugs (platinums, antimetabolites, microtubule agents and topoisomerase inhibitors) kill rapidly dividing cells by damaging DNA or the mitotic spindle. They still cure testicular cancer, lymphoma and leukaemia, and they are the warhead inside antibody-drug conjugates, but a narrow margin between effective and toxic doses is their limitation.
• DPYD genotyping and DPD phenotyping before fluoropyrimidines: A one-off blood test done before fluorouracil or capecitabine that finds the roughly one in twenty-five people who cannot break the drug down; halving their dose prevents severe and occasionally fatal toxicity without losing effect.

• Melphalan hepatic delivery system (approved): High-dose melphalan pumped through the liver's own blood supply while the blood leaving the liver is filtered, the first approved treatment for uveal melanoma that has spread to the liver.

• Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs · From poison to the first cures (historic)
• Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs · New classes, adjuvant cures and the supportive care that made them deliverable (historic)
• Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs · The backbone that immunotherapy and ADCs are built on (current)
• Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs · Giving it to fewer people (current)
• Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs · The warhead moves inside an antibody (current)
• Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs · The right dose, the right schedule, the right patient (emerging)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · A cancer with a visible precursor, and the first proof that finding it early saves lives (historic)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · Total mesorectal excision, and radiotherapy before the operation (historic)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · Chemotherapy after the operation, and how small the benefit is when the nodes are clear (historic)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · The screening programmes, and the discovery that uptake is the whole game (current)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · Antibodies, and the two things that decide whether they work (current)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · The genome, the subtypes and the hypermutated sixth (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Surgery arrives, and the cancer is found by accident (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Staging by depth, then by side (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · The incidental cancer pathway: re-resect from T1b, but who, when and how much (current)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · A borrowed chemotherapy standard (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Adjuvant capecitabine and second-line FOLFOX, from UK trials (current)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Radiotherapy: one single-arm trial and a nomogram (historic)
• Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting · Two viruses, found because lymphoma is the cancer you can get hold of (historic)
• Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting · How little is enough: the Hodgkin de-escalation programme begins (historic)
• Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting · Reading the genes, and the twenty years it took to make that useful (historic)
• Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting · Everything that failed to beat R-CHOP, and the one thing that did (current)
• Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting · The scan after two cycles, and what it is good for (current)
• Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting · Indolent lymphoma: how long to treat, and the two-year mark that splits the disease (current)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · One operation, and still the only cure (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · A blood marker with a blind spot and an oncogene in nearly every tumour (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Gemcitabine, and chemotherapy after surgery (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Combination chemotherapy for metastatic disease (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Genomes, subtypes and the inherited five percent (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Adjuvant modified FOLFIRINOX, and the neoadjuvant question (current)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · A cancer is shown to depend on a hormone, and systemic cancer therapy begins (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · A blood test arrives, and an epidemic of diagnoses follows it (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · Does treating localised disease help? Three trials, three answers, one rule (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · The screening trials disagree, and the policy swings twice (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · Chemotherapy works, a little, and then the receptor drugs arrive (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · The genome: a quiet sequence, a rearranged structure, and one actionable fifth (historic)
• Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem · Defined by three negative tests (historic)
• Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem · The basal-like subtype and its link to BRCA1 (historic)
• Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem · Founder mutations: hereditary disease has a geography (historic)
• Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem · A name, a natural history and a disparity (historic)
• Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem · Anthracycline and taxane chemotherapy, and the residual disease paradox (historic)
• Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem · Several diseases: molecular subtypes (historic)

• IALT (International Adjuvant Lung Cancer Trial) (phase 3, n=1,867): Overall survival at 5 years: 44.5% vs 40.4%, HR 0.86
• ANITA (Adjuvant Navelbine International Trialist Association) (phase 3, n=840): Overall survival (median): 65.7 months vs 43.7 months, HR 0.8
• OAK (phase 3, n=1,225): Overall survival (intention to treat): 13.8 months vs 9.6 months, HR 0.73
• PRIME (phase 3, n=1,183): Overall survival (RAS wild-type): 26 months vs 20.2 months, HR 0.78
• PROSELICA (phase 3, n=1,200): Overall survival (median): 13.4 months vs 14.5 months, HR 1.024
• RECOURSE (phase 3, n=800): Overall survival: 7.1 months vs 5.3 months, HR 0.68

1. Does scalp cooling prevent hair loss from chemotherapy?
   Answer

   Partly: roughly half of patients on taxane-based regimens keep at least 50% of their hair with DigniCap or Paxman; it is less effective with anthracyclines and reimbursement varies.

• NCI: Chemotherapy to treat cancer: https://www.cancer.gov/about-cancer/treatment/types/chemotherapy