Chemotherapy regimens

Chemotherapy prescriptions are usually determined by drug regimens. Such chemotherapy regimens are considered generally accepted and are selected for each individual case individually. For an oncologist, the names of the regimens speak for themselves: FOLFIRI, XELOX, etc. But how can an ordinary patient understand such terms?

The “code” of therapeutic regimens is a combination of the initial letters of the names of cytostatic drugs recommended to the patient. Moreover, the arrangement of the capital letters also indicates the order of administration of these drugs. For example, chemotherapy according to the AC regimen means that the patient first receives Adriamycin (A), and then Cyclophosphamide (C).

There are many similar ready-made chemotherapeutic treatment schemes. They all differ from each other in medicinal components, conditions of administration and dosages, and also have a specific direction of action.

Let's look at some examples of the most common chemotherapy regimens.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]

Chemotherapy according to the AC regimen

This scheme involves the use of two medications: Cyclophosphamide (an alkylating cytostatic with chloroethylamine affinity) and Adriamycin, an analogue of which is the frequently used Doxorubicin.

Cyclophosphamide is administered intravenously in a quantity of 0.6 g per m² in isotonic solution or glucose solution. Duration of treatment is once every 21 days.

Doxorubicin is administered at a dose of 0.06 g per m², once every 21 days.

The degree of nausea (emetogenicity) of the treatment is quite high.

The most common side effects are:

• attacks of nausea and vomiting;
• baldness;
• neutropenia.

The AC regimen is used primarily for the treatment of breast cancer.

[ 9 ], [ 10 ], [ 11 ]

Chemotherapy with XELOX (CapeOx) regimen

The regimen includes the use of Capecitabine and Oxaliplatin, a combination of an antimetabolite and an alkylating agent.

The use of 0.085-0.13 g/m² Oxaliplatin in 5% glucose solution and 1 g/m² Capecitabine (twice daily) is envisaged. Treatment is carried out every 3 weeks.

Possible side effects:

• diarrhea;
• attacks of nausea and vomiting;
• neutropenia;
• irritable palms and soles syndrome.

The XELOX regimen is often prescribed for cancerous tumors of the intestine and esophagus.

[ 12 ], [ 13 ], [ 14 ]

Chemotherapy regimens for lymphoma

For lymphoma, a malignant lesion of the lymphatic system, combination therapy is usually used, with a short course of chemotherapy given before radiotherapy.

Currently, the standard regimen for lymphoma is considered to be two or three courses of the ABVD protocol - a combination of drugs such as Adriamycin (0.025 g/m2), Bleomycin (0.01 g/m2), Vinblastine (0.006 g/m2) and Dacarbazine (0.375 g/m2). The injection regimen is 1 and 15 days.

Possible side effects:

• headaches;
• baldness;
• lowering blood pressure;
• anorexia;
• leukopenia.

For Hodgkin lymphoma, an extended chemotherapy regimen may be prescribed, which is designated by the acronym BEACOPP escalated.

The extended regimen includes the following drugs: Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine, Procarbazine, and Prednisolone. This combination increases the chances of cure and improves patient survival. However, with the introduction of more drugs, the degree of toxicity to the body also increases.

[ 15 ], [ 16 ], [ 17 ], [ 18 ]

Chemotherapy according to the FAC regimen

The FAC regimen is used in the treatment of breast cancer, especially in the early stages.

The protocol includes the use of the following drugs:

• Fluorouracil – 0.5 g/m3 per day intravenously, on the first and eighth day;
• Adriamycin – 0.05 g/m intravenously on the first day;
• Cyclophosphamide – 0.5 g/m intravenously on the first day.

Possible side effects include:

• suppression of hematopoietic function;
• deterioration of the digestive system;
• baldness;
• infertility;
• liver damage.

As an analogue, it is possible to prescribe mirror chemotherapy regimens – CAF and extended CAF.

[ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ]

Chemotherapy with FOLFOX

There are several similar types of FOLFOX regimens, including an extended version of the protocol. The chemotherapy drugs used are:

• 5-fluorouracil – Day 1: 1.5-2 g over 22 hours in glucose solution; Day 2: repeat;
• Leucovorin – 0.5 g over 2 hours, repeat on the second day;
• Oxaliplatin – 0.1 g per m on the first day simultaneously with the administration of Leucovorin.

The course is held once every two weeks.

The regimen is used primarily for the treatment of malignant bowel lesions.

Possible side effects include:

• diarrhea;
• neutropenia;
• thrombocytopenia.

Currently, the most commonly used chemotherapy regimen is FOLFOX 7, which is a one-day course.

[ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ]

Chemotherapy regimens for stomach cancer

Several schemes with different combinations of drugs are suitable for chemotherapy of a cancerous tumor in the stomach. The choice of scheme is left to the doctor, who takes into account the features of the clinical symptoms and the general condition of the patient. The following combinations of cytostatic drugs are most often used:

• ECF – combination of Epirubicin, Cisplatin and Fluorouracil;
• ECX – combination of Epirubicin, Cisplatin and Capecitabine;
• FEMTX is a combination of Fluorouracil, Epirubicin and Methotrexate.

Capecitabine or Cisplatin with 5-Fluorouracil in combination with radiation therapy may be prescribed prior to surgery.

Other protocols can also be used to treat patients with advanced stages of stomach cancer:

• DCF – combination of Docetaxel, Cisplatin and 5-fluorouracil;
• combination of Cisplatin and Irinotecan;
• Oxaliplatin and Capecitabine.

Most specialists try to limit the number of chemotherapy drugs in protocols to reduce the degree of side effects. As is known, unwanted side effects are a common consequence of chemotherapy.

[ 29 ]

Chemotherapy according to the Mayo regimen

The Mayo regimen is a standard program of adjuvant chemotherapy treatment, that is, treatment that is prescribed in addition to the main therapy.

The regimen involves the use of leucovorin in the amount of 0.02 g per m² from day 1 to day 5, as well as 5-fluorouracil in the amount of 0.425 g per m², from day 1 to day 5. The course is alternated every 4 weeks, and starting from the third course - 5 weeks. The number and names of drugs used in the regimen may vary, but the frequency of administration remains the same.

The side effects of the proposed scheme do not differ from those that can be observed with other combinations of drugs. The protocol is characterized by diarrhea and stomatitis, inhibition of hematopoiesis, dermatitis.

Due to its therapeutic effectiveness, the Mayo scheme is actively used in most well-known oncology clinics. This is a convenient and simple program that can be used to treat patients with different stages of cancer processes.

[ 30 ], [ 31 ], [ 32 ]

Chemotherapy with CAF regimen

The CAF regimen is a mirror image of the similar FAC program and is used primarily for the treatment of breast cancer. The chemotherapy drugs for this protocol are as follows:

• Cyclophosphamide – 0.1 g per m² per day (from the first to the 14th day);
• Adriamycin – 0.03 g per m² per day (on the first and 8th day);
• 5-fluorouracil – 0.4-0.5 g per m² per day (on the first and 8th day).

Repeat treatment every 28 days.

Another CAF scheme is also applicable:

• Cyclophosphamide – 0.5 g per m² on the first day;
• Adriamycin – 0.05 g per m² on the first day;
• 5-fluorouracil – 0.4-0.5 g per m² on the first day.

This course should be repeated every 28 days.

In addition, there is an extended high-dose CAF protocol supplemented with granulocyte colony-stimulating factor: this treatment is more effective, but it is a considerable burden on the body. Therefore, high-dose treatment can only be prescribed to patients with good general health indicators.

[ 33 ], [ 34 ], [ 35 ]

Anthracycline chemotherapy regimens

Anthracyclines are anticancer antibiotics represented by Doxorubicin, Daunorubicin, Idarubicin, and the less commonly used Epirubicin. The property of such chemotherapeutic agents is to inhibit DNA isomerase and provoke single-electron and double-electron oxidation. As a result, hydroxyl radicals with an effective degree of anticancer action are formed. However, in addition to this, anthracycline drugs have a pronounced toxic effect on hematopoiesis and the digestive system. Often, dermatonecrosis occurs at the site of administration of such chemotherapeutic agents, which requires skin transplantation to eliminate it.

Anthracycline regimens most often include Daunorubicin. It is used in the amount of 0.045 g per m² per day. Recently, specialists have noted the effectiveness of replacing this drug with a newer agent – Idarubicin.

With long-term use of anthracycline protocols, a cardiotoxic effect may be observed - the development of doxorubicin cardiomyopathy, which should be known not only by doctors, but also by their patients.

Many types of cancer can only be cured with chemotherapy. As a rule, chemotherapy regimens are prescribed taking into account all the positive and negative aspects of treatment, which is discussed in advance, at the stage of choosing drugs.

[ 36 ], [ 37 ], [ 38 ], [ 39 ], [ 40 ], [ 41 ]