Chemotherapy regimens

Chemotherapeutic purposes, as a rule, are determined by the schemes of drug administration. Such chemotherapy regimens are generally accepted and are selected for each individual case individually. For the oncologist, the names of the schemes speak for themselves: FOLFIRI, XELOX, etc. And how to understand such terms in an ordinary patient?

The "code" of therapeutic schemes is a combination of the initial letters of the names of cytostatic drugs that are recommended to the patient. Moreover, the arrangement of capital letters also means the order of application of these medicines. For example, AC chemotherapy means that the patient first receives Adriamycin (A) and then Cyclophosphamide (C).

There are a lot of similar schemes for chemotherapy. All of them differ from each other by their medicinal components, the conditions of administration and dosages, and also have a specific effect orientation.

Let us examine several examples of the most common chemotherapeutic schemes.

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

Chemotherapy according to the AC scheme

This scheme involves the use of two medications: Cyclophosphamide (alkylating cytostatics with chloroethylamine accessory) and Adriamycin, whose analogue is often used Doxorubicin.

Cyclophosphamide is injected into a vein in an amount of 0.6 g / m2 in isotonic solution or glucose solution. Duration of treatment - once in 21 days.

Doxorubicin is administered in an amount of 0.06 grams per m², once every 21 days.

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

The most common side effects are:

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

The AC scheme is used mainly for the treatment of malignant diseases of the mammary glands.

[9], [10], [11]

Chemotherapy according to the XELOX scheme (CapeOx)

The scheme includes the use of drugs Capecitabine and Oxaliplatin - a combination of antimetabolite and alkylating agent.

It is envisaged to use 0,085-0,13 g per m2 of oxaliplatin in 5% glucose solution and 1 g per m2 of capecitabine (twice a day). Treatment is carried out every 3 weeks.

Possible side effects:

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

The XELOX scheme is often prescribed for cancers of the intestine and esophagus.

[12], [13], [14]

Chemotherapy regimens for lymphoma

With lymphoma - a malignant lesion of the lymphatic system - usually combined therapy with the introduction of a brief chemotherapeutic course, which is performed before radiotherapy.

Currently, the standard scheme for lymphoma is two or three courses of the ABVD protocol - a combination of drugs such as Adriamycin (0.025 g / m), Bleomycin (0.01 g / m), Vinblastine (0.006 g / m) and Dakarbazine 0.375 g / m). Injection mode - 1 and 15 days.

Possible side effects:

• pain in the head;
• baldness;
• lowering of blood pressure;
• anorexia;
• leukocytopenia.

With Hodgkin's lymphoma, an extended chemotherapy regimen may be prescribed, which is designated abbreviation BEACOPP escalated.

The extended formulation includes the following drugs: Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine, Procarbazine and Prednisolone. This combination allows you to increase the chances of recovery and raise the survival rate of patients. Nevertheless, with the introduction of more drugs, the degree of toxicity to the body also increases.

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

Chemotherapy according to FAC

The FAC scheme 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 per m per day intravenously, on the first and the eighth day;
• Adriamycin - 0,05 g per m intravenously on the first day;
• Cyclophosphamide 0.5 g per m intravenously on the first day.

Among the possible side effects are:

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

As an analogue, the appointment of mirror chemotherapy schemes - CAF and CAF extended.

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

Chemotherapy according to the FOLFOX scheme

There are several similar types of FOLFOX circuits, including the extended version of the protocol. Used chemotherapy:

• 5-fluorouracil - Day I: 1.5-2 g for 22 hours in a glucose solution; II day: repeat;
• Leucovorin - 0.5 g for 2 hours, repeat on the second day;
• Oxaliplatin - 0,1 g per m in the first day simultaneously with the introduction of leucovorin.

The course is held once in two weeks.

The scheme is used mainly for the treatment of malignant lesions of the intestine.

Of the possible side effects can be identified:

• diarrhea;
• neutropenia;
• thrombocytopenia.

Currently, the most commonly used chemotherapy scheme FOLFOX 7, the course of which is designed for one day.

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

Chemotherapy regimens for gastric cancer

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

• ECF - a combination of Epirubicin, Cisplatinum and Ftoruracil;
• ECX - a combination of Epirubicin, Cisplatinum and Capecitabine;
• FEMTX is a combination of fluorouracil, epirubicin and methotrexate.

Prior to surgery, capecitabine or Cisplatin with 5-fluorouracil may be prescribed in combination with radiotherapy.

To treat patients with advanced stages of stomach cancer, other protocols can be used:

• DCF - a combination of docetaxel, cisplatin and 5-fluorouracil;
• combination of cisplatin and irinotecan;
• Oxaliplatin and capecitabine.

Most specialists try to limit the amount of chemotherapy in the protocols to reduce the degree of adverse events. As is known, undesirable side effects are a frequent consequence of chemotherapy.

[29], [30]

Chemotherapy according to the Mayo scheme

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

The scheme involves the use of leucovorin in an amount of 0.02 g per m2 from 1 to 5 days, as well as 5-fluorouracil in an amount of 0.425 g per m², from 1 to 5 days. The course alternates every 4 weeks, and beginning with the third course - 5 weeks. The number and names of the drugs used in the scheme may vary, and the frequency of admission remains the same.

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, Mayo's scheme is actively used in most known oncological clinics. This is a convenient and simple program that can be used to treat patients with different stages of cancer processes.

[31], [32], [33]

Chemotherapy according to CAF

The CAF scheme is a mirror image of a similar FAC program and is used primarily for the treatment of breast cancers. Chemotherapy for this protocol is as follows:

• Cyclophosphamide 0.1 g per m2 per day (from day 1 to day 14);
• 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 the treatment - every 28 days.

Another CAF scheme is also applicable:

• Cyclophosphamide 0.5 g / m² on the first day;
• Adriamycin - 0.05 grams per m² on the first day;
• 5-fluorouracil - 0,4-0,5 g per m² on the first day.

This course should be repeated for every 28 days.

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

[34], [35], [36],

Anthracycline chemotherapy regimens

Anthracyclines are anticancer antibiotics presented by Doxorubicin, Daunorubicin, Idarubicin, and also less used Epirubicin. The property of such chemopreparations is to oppress DNA isomerase and to provoke one-electron and two-electron oxidation. As a consequence, hydroxyl radicals are formed with an effective degree of anti-cancer effect. True, in addition, anthracycline drugs have a pronounced toxic effect on the blood and digestive system. Often at the site of the introduction of such chemotherapy, there is dermatone necrosis, for the elimination of which it is necessary to resort to the transplantation of the skin.

Daunorubicin is most often present in anthracycline regimens. It is used in an amount of 0.045 grams per m² per day. Recently, experts have noticed the effectiveness of replacing this drug with a newer drug, Idarubicin.

With long-term use of anthracycline protocols cardiotoxic effect can be observed - the development of doxorubicin cardiomyopathy, which should be known not only to physicians, but also to their patients.

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

[37], [38], [39], [40], [41], [42]