Many other drugs and combinations used to boost drug effectiveness or minimize toxicity are under study. They include vincristine, vinblastine, cisplatin, tamoxifen, carboplatin and sorafenib.
The combination of carboplatin, paclitaxel and sorafenib for patients with unresectable stage III or IV melanoma is being studied at the National Cancer Institute. Sorafenib is a new drug that works by blocking key proteins important for cell proliferation and for generating new blood vessels to tumors (angiogenesis). The researchers hope sorafenib will weaken melanoma tumors and enhance the lethal effects of chemotherapy.
*Side Effects. Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment.
Common side effects include the following:
- Nausea and vomiting. Drugs known as serotonin antagonists, especially ondansetron (Zofran), can relieve these side effects in nearly all patients given moderate drugs and most patients who take more powerful drugs. In one study, a combination of dexamethasone (a corticosteroid) with ondansetron taken within 24 hours of chemotherapy achieved either a major or complete reduction in nausea and vomiting.
- Diarrhea.
- Temporary hair loss.
- Weight loss.
- Fatigue.
- Anemia. Erythropoietin stimulates red blood cell production and can help reduce or prevent this side effect. It is available as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp). Aranesp persists longer in the blood than epoetin alfa and so requires fewer injections.
- Depression.
Serious short- and long-term complications can also occur and may vary depending on the specific agents used. They include the following:
- Increased chance for infection from suppression of the immune system.
- Severe drops in white blood cells (neutropenia). Certain agents, such as taxanes, pose a higher risk for this than other chemotherapeutic drugs. White blood cell count may be improved with the addition of a drug called granulocyte colony-stimulating factor (either filgrastim or lenograstim).
- Liver and kidney damage.
- Abnormal blood clotting (thrombocytopenia).
- Allergic reaction.
- Menstrual abnormalities and infertility in women. A natural hormone medication called a gonadotropin-releasing hormone analogue that puts women in a temporary pre-pubescent state during chemotherapy may preserve fertility in some women.
- Rarely, secondary cancers such as leukemia.
- Problems in concentration, motor function, and memory, which may be long-term.
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