Chemotherapy for stomach cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is usually used to treat stomach cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is sometimes combined with radiation therapy to treat stomach cancer. This is called chemoradiation. The 2 treatments are given during the same time period. The chemotherapy drugs help make the cancer cells more sensitive to radiation therapy.

Chemotherapy is given for different reasons. You may have chemotherapy or chemoradiation to:

• destroy cancer cells in the body
• shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• relieve pain or control other symptoms of advanced stomach cancer (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 stomach.

Chemotherapy drugs used alone or in combination to treat stomach cancer are:

• fluorouracil (also called 5-fluorouracil or 5-FU)
• capecitabine (Xeloda)
• cisplatin
• carboplatin
• oxaliplatin
• epirubicin
• paclitaxel
• docetaxel
• etoposide (Vepesid)
• irinotecan

Some common chemotherapy drug combinations used to treat stomach cancer are:

• fluorouracil and leucovorin (often used as a part of chemoradiation)
• fluorouracil and cisplatin (may be used as a part of chemoradiation)
• ECF – epirubicin, cisplatin and fluorouracil
• paclitaxel and carboplatin (may be used as a part of chemoradiation)
• ECX – epirubicin, cisplatin and capecitabine
• EOF – epirubicin, oxaliplatin and fluorouracil
• ELF – etoposide, leucovorin and fluorouracil
• FOLFIRI – leucovorin, fluorouracil and irinotecan
• FOLFOX – leucovorin, fluorouracil and oxaliplatin
• DCF – docetaxel, cisplatin and fluorouracil
• FLOT – fluorouracil, leucovorin, oxaliplatin and docetaxel
• XELOX – capecitabine and oxaliplatin

If stomach cancer does not respond to drugs used in earlier treatments or if it comes back, different drugs or combinations may be used.

Chemotherapy for stomach cancer is usually given by a needle into a vein (intravenously). It is usually given every 2 to 4 weeks. How often and how long chemotherapy is given depends on the type of drug or drug combination used and if radiation therapy is used at the same time. It is usually given for several months (up to 8 cycles).

Side effects can happen with any type of treatment for stomach cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop 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.

Side effects of chemotherapy will depend mainly on the type of drug or combination, the dose, how it's given, if radiation therapy is given at the same time and your overall health. Some common side effects of chemotherapy used for stomach cancer are:

• loss of appetite
• nausea and vomiting
• diarrhea
• low blood cell counts, which may cause infection, bleeding and fatigue
• sore mouth and throat
• hair loss
• skin problems, such as hand-foot syndrome, mainly with fluorouracil
• nerve damage (peripheral neuropathy), including burning and tingling in the hands and feet

Tell your healthcare team if you have 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 you 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 you, ask your healthcare team questions about chemotherapy.