You now have your cancer treatment plan in hand, and it may very well include medication. Maybe you’ve had family or friends who’ve been down this same hard road, and you’re concerned about dealing with the adverse reactions you saw them experience. Or you’ll be taking an unfamiliar medication, and not sure what you’re in for. It’s tough stuff, but we have you covered. From managing chemo’s side effects to understanding the potential of newer, targeted drugs and how they’re changing outlooks for patients like you, we at HealthCentral are here with the answers you need.
We went to some of the nation’s top experts in cancer to bring you the most up-to-date information possible.
R. Donald Harvey, PharmDOncology Pharmacist, Professor, Director of the Phase I Clinical Trials Program
John Valgus, PharmDHematology/Oncology Clinical Pharmacist Practitioner, Clinical Assistant Professor
Daniel Y. Wang, M.D.Medical Oncologist, Assistant Professor of Medicine, Medical Oncology
What Do We Mean By Medications, Exactly?
Let’s start by defining what medications actually are. The Merriam-Webster Dictionary tells us that medication is: A substance used in treating disease or relieving pain. Sounds obvious enough, but the universe of medication is a whole lot more vast and varied than you might think.
Medication can be as simple as water and salt (saline solution), or as complex as multifaceted chemicals that are derived from nature (like the commonly used chemotherapy drug, paclitaxel, or Taxol, made from the bark of the Pacific yew tree) or in a lab (such as pembrolizumab, or Keytruda, a humanized antibody used in cancer immunotherapy).
Pharmaceuticals vs. Pharmacogenomics
Any type of drug used for medicinal purposes is a pharmaceutical. Altogether, these myriad drugs make up the pharmaceutical industry, which includes top cancer drugs like Celgene’s Revlimid, Merk’s Keytruda, and Roche’s Rituxan, Avastin, and Herceptin. The word pharmacy itself comes from “pharmakon,” which means a magic charm, poison, or drug. That’s quite fitting, because cancer drugs can seem exactly that, both a “magic bullet” and literal poison, thanks to their side effects.
Pharmacogenomics is the study of how genes affect your response to drugs, a promising new field of medicine that combines the science of drugs, or pharmacology, with the study of genes, or genomics.
Why does this matter to those affected by cancer? Because drugs have traditionally been “one size fits all,” approved by the U.S. Food and Drug Administration (FDA) for what’s called “indications,” or uses, instead of tailored to your specific cancer mutations. Researchers in pharmacogenomics are working to predict how you, specifically, will respond to a medication, including whether you’ll have side effects (also called adverse drug reactions).
Will I Definitely Need Medication for My Cancer?
It all depends on the type of cancer you have and the stage. Remember, cancer occurs when abnormal cells anywhere in your body (your breasts, kidney, even your tongue) grow out of control). Medications are used in the systemic treatment of cancer, meaning they can stop cancer cells throughout your system, even those undetectable by testing—something that surgery and radiation therapy (RT) are not as effective at doing. While surgery and RT play major roles in cancer treatment too, they’re often most effective at early stages, when cancerous cells are localized (meaning they haven’t metastasized, or spread) and can be cured with excision (surgical removal) or ionizing radiation.
This all makes medication especially useful in treating advanced disease that has spread. However, research has been showing a benefit from using medication in some early stage cancers. As cancer treatments improve, new drugs could well be part of earlier treatment regimes.
Among the oldest cancer treatments, chemotherapy meds stop cancer cells from rapidly growing and dividing. Chemo was first developed for use in cancer after scientists noticed that soldiers and civilians exposed to mustard gas in World War I and II had decimated white blood cells. They wondered if that poisonous gas could target malignant cells, too. (Spoiler: It could).
Mustard gas kills cancer cells by modifying their DNA in a process known as alkylation. In 1942, a man with lymphoma was successfully treated with mustard gas as part of the U.S.’s secret Chemical Warfare Unit (though he eventually relapsed). Researchers published their findings after the Second World War, in 1946, and three years later, mustard gas (also called nitrogen mustard) was the first chemotherapy drug approved by the FDA.
Fast forward to the National Cancer Institute (NCI) in the 1960s. Renegade researchers realized chemo could be used for more than palliative care (relief of symptoms), and could actually treat cancer. But most docs were using only one type of chemo drug at a time—believing that the drugs were just too toxic to combine. This meant treatment wasn’t always aggressive enough, and cancer often returned. What could they do differently, NCI oncologists wondered?
Combine drugs. And combine them so doses were just high enough to kill cancerous cells, without harming patients. One such combination treatment saw a fourfold increase in remission rates over the best drugs when used alone. These results and other research made chemo the standard cancer treatment, starting in the 1970s. As drugs became more effective, medical oncology (training in diagnosing and treating cancer) emerged, and medical oncologists and oncology pharmacists became key in the prescription and management of cancer drugs.
All the while, chemo drug development expanded. Today, there are more than 100 different chemo drugs on the market, but all fall into one of four buckets, each with a specific goal:
Goal: Eliminate cancer cells and cure the patient.
Goal: stop remaining cancer cells and prevent recurrences, often after surgery.
Goal: Shrink tumors before more invasive surgery, or to make surgery possible.
Goal: To lessen cancer side effects, slow cancer’s progress, or stop complications. It’s often used when cancer is so advanced that removing all the cancerous cells is no longer realistic.
Chemo drugs are commonly given by IV, at an infusion center, hospital, or by in-home infusion. They also come in pill form. Examples include:
Chlorambucil (Leukeran )
Methotrexate (multiple brands)
Also known as precision medicine because it targets cancer cells, rather than healthy cells too, these medications go after the abnormalities in genes, proteins and tissue environments that cause cancer cells to grow. In 1997, the FDA approved the first-ever targeted cancer drug, rituximab (Rituxan), to treat patients with B-cell non-Hodgkin lymphoma who were no longer responding to treatment.
There are two types of targeted therapy:
Small-molecule drugs that enter and target issues within cells (taken as pills or capsules)
Monoclonal antibodies that attach to targets on cancer cells, stopping them in a variety of ways (taken by needle).
Here are a few examples of targeted meds:
Trastuzumab (multiple brands) (breast cancer)
Pertuzumab (Perjeta) (breast cancer)
Neratinib (Nerlynx) (breast cancer)
Ado-trastuzumab emtansine or T-DM1 (Kadcyla) (breast cancer)
Dabrafenib (Tafinlar) (melanoma)
Vemurafenib (Zelboraf) (melanoma)
While targeted therapies offer a lot of hope, they’re not perfect. For one thing, these only work if the tumor has the target, and even then, tumors don’t always respond. Or the response might be only temporary.
Also called hormonal therapy or endocrine therapy, this is technically a targeted therapy too. Certain types of cancer, like breast and prostate, are fueled by hormones. Removing those hormones or blocking their effects may cause the cancer cells to stop growing. You can do so by taking pills (sometimes as maintenance therapy, when you’re in remission and want to stay that way), as a shot, or through surgical removal of organs that release hormones (like the ovaries, for instance).
Here are a few examples of hormone therapy meds:
Tamoxifen (multiple brands) (breast cancer)
Anastrozole (Arimidex) (breast cancer)
Letrozole (Femara) (breast cancer)
Leuprolide (Lupron, Eligard) (prostate cancer)
Goserelin (Zoladex) (prostate cancer)
Triptorelin (Trelstar) (prostate cancer)
Histrelin (Vantas) (prostate cancer)
Also called biotherapy or biological therapy, this new breakthrough treatment focuses on boosting your body’s immune system in order to fight the cancer. Researchers have discovered that cancer evades the immune system. Immunotherapy drugs (many of which are known as checkpoint inhibitors) allow the immune system to kill cancer cells directly. Immunotherapy can be given by IV, pills or capsules, as a topical cream, in your bladder, even as a treatment vaccination.
For instance, PD-1 inhibitors (a type of immune checkpoint inhibitors) can be used to treat:
What Side Effects Should I Watch Out For When Taking Cancer Medication?
Cancer drugs often cause side effects related to their mechanism of action, the fancy way of saying how they work. For instance: Chemotherapy works by killing rapidly dividing cells, right? And because it can’t distinguish between normal and abnormal cells, it kills rapidly dividing cells like hair follicles, causing hair to fall out, and white blood cells, which leads to low white blood counts, or neutropenia, which can cause the scary neutropenic fever.
But you might not experience any side effects, or very few. Or you might be hit hard. It depends on your body, your health, and other factors. And your doctor might give you medication for side effects before you actually experience them, called prophylactic treatment.
Want more details on chemo side effects? Here you go:
Nausea and Vomiting
This is common with some (not all!) chemo drugs. If you’re suffering, tell your doctor, ASAP. Your doc might prescribe one of the below to bring your relief:
Also called mucositis, these can be so. very. painful. Chemo harms healthy, rapidly dividing mouth cells, which divide rapidly too. Use lip moisturizer often, brush your teeth after each meal and before bed time, and rinse with water often, because preventing infection is key here (and there are no specific meds to help with this). Sucking on hard candies can help, too. If an infection happens, your doctor can prescribe:
Antifungals including nystatin, clotrimizole, fluconozole
Chlorhexidine gluconate (Peridex, PerioGard)
Antivirals including acyclovir (Zovirax) or famciclovir (Famvir)
Everyone has different bowel habits, so constipation is an individual thing, but you know you—haven’t gone in one or two days and you’re usually as regular as anything? Have hard, painful, and/or difficult to pass stools? It’s probably constipation. Some chemo drugs (and pain meds, which we’ll talk about more later) can cause it. Your doc can recommend solutions (most of which you can find over-the-counter, or OTC, also known as being right on the shelf at your local pharmacy), including:
Docusate sodium (Colace)
Magnesium hydroxide (Milk of Magnesia)
So, What Are the Side Effects of Targeted Therapy and Immunotherapy?
Targeted therapy and immunotherapy can have adverse events, too. These side effects are different than traditional chemotherapy, including:
Liver problems includes hepatitis and elevated liver enzymes
Skin problems such as acneiform rash, dry skin, nail changes, hair depigmentation
High blood pressure
Here’s a fascinating thing: Certain side effects from targeted therapies have been linked to better patient outcomes, according to the NCI. Some examples:
Patients who have an acne-like rash while on signal transduction inhibitors erlotinib (Tarceva) or gefitinib (Iressa) have responded better to these drugs than patients who don’t have this rash.
Patients who have high blood pressure while on angiogenesis inhibitor bevacizumab have shown better outcomes.
One thing to note: These newish drugs have side effects that non-oncologists may not know about, so if you go to the emergency room with an adverse reaction, ER docs might not recognize that what’s happening is related to your cancer meds. This is why it’s important to discuss not only side effects with your doctor before starting treatment, but also what to do if and when they happen. Your doctor can help you with what’s called supportive care, or drugs to stop the side effects of the drugs you’re on. Just ask!
Should I Take Opioids For Cancer Pain?
Can opioids be addictive? Abso-freakin-lutely. But if you’re a cancer patient using opioids for relief from the serious, searing pain of the disease, the chance of becoming addicted is very small when appropriately managed, experts say.
So don’t let fear deter you from taking these drugs if your doctor prescribes them. Instead, work with your doctor (and possibly an oncology pharmacist, if you have access to one) throughout your course of treatment. Your healthcare professional will likely lower the dose at the right time for you to taper off, in a way that helps you feel safe and supported.
The side effects of opioids are important to be aware of too. These include:
Tell your doctor and/or oncology pharmacist if you’re experiencing any of these issues, so they can help you counterbalance these effects.
What Should I Discuss With My Doctor Before Starting Cancer Meds?
Here are five questions that might be helpful to ask your doctor before you get your prescription filled:
How do I take my medication? And when? Continuously? Intermittently? Some drugs aren’t taken daily—you may take them for a period of time and then have a rest period.
Where do I get my medication? Can you walk into your local pharmacy and get a script filled, or is it only available by specialty pharmacy, likely mail order? Or at an infusion center?
What are the potential side effects (and what should I do about them)? You should know how to prevent or treat them. Having medicine on hand to help is important, too.
What’s the cost of this medication—and how will I pay for it? Ask your healthcare team as soon as possible, so you don’t lose time in receiving help or miss cost-saving tips.
What drugs that I’m on might impact cancer meds? Make sure your cancer doctor has a list of all your medications, including any supplements and vitamins, so they can alert you to what’s called drug-drug interactions (negative interactions between medications).
How Much Do Cancer Meds Cost?
The price of meds varies wildly, depending on the type of drugs (also called oral therapies), how frequently your doc prescribes you take them, at what dose and of course, your insurance plan, among other variables. Another thing to be aware of? Drugs are sometimes billed on your prescription benefit instead of your medical benefit. You may run out of benefits and be faced with potentially hefty out-of-pocket costs. Take comfort in knowing that oncology pharmacists (and others in oncology healthcare) do a lot of work on the front end to make sure your cancer medication treatment is affordable, minimizing that out-of-pocket cost.
Financial toxicity—meaning, so expensive, you might not be able to afford treatment—is real. Your doctor, oncology pharmacist, social worker, oncology nurse, and others on your healthcare team can help you figure out finances. But again, you have to ask.
Minimize your out-of-pocket expenses with these tactics:
Use copay cards
Insure that full prior authorization is completed by your healthcare provider before you start medication
Inquire about manufacturer patient assistance programs
Seek grants from foundations that could help assist
Only 5% of adult Americans with cancer take part in cancer clinical trials (studies to investigate new ways of treating the disease), but don’t let that deter you. By participating, you can receive medications not yet approved by the FDA, gaining more options. You can also benefit future generations. Consider this: Any med that’s helping patients now was pioneered by those who came before us.
Some things to know about clinical trials for cancer drugs:
In the vast majority of cases, placebos are not used in cancer trials. You will likely reap the benefit of new therapies.
Clinical trials can be an option at all parts of your cancer journey, not just when it seems all treatments have been exhausted.
Phase 1 trials study the drug dose, its safety and its side effects, making them very safety-focused.
As a patient, clinical trials give you access to many different healthcare professionals you wouldn’t likely have otherwise in your cancer treatment, which often means more direct and focused care.
By asking your treatment team for opportunities at their institution
At other institutions
Patient organizations with your cancer type
From other patients
From social media
Frequently Asked QuestionsCancer Medication
How effective is chemotherapy?
This question is tricky to answer because chemo is often used alongside other cancer treatments, like radiation therapy and surgery, so it can be tough to parse out data and know which treatment was the most effective—and responsible for good outcomes. Chemo is used in some cancer types, but not others, and use can even vary within one cancer type depending on stage—so its effectiveness can vary, too. It’s best to ask your doctor the effectiveness rate for your particular type of cancer and stage.
How much does chemotherapy cost?
This varies too. According to research presented by a doctor at the University of Texas MD Anderson Cancer Center during the 2016 American Society of Clinical Oncology Annual Meeting, for breast cancer patients who received chemotherapy drug Herceptin (trastuzuma) therapies, median insurance payments were $160,590, varying by up to $46,936, relative to the most common regimen. According to the research, median out-of-pocket costs were $3,381, with relative differences as much as $912.
What types of cancer can be treated with immunotherapy?
This form of targeted therapy isn’t effective in every cancer type and stage. It has been founde effective for melanoma, non-small cell lung cancer, kidney cancer, Hodgkin lymphoma, stomach cancer, liver cancer, and head and neck cancer.
How effective is hormone therapy for cancer?
Hormone therapy is used to treat and lessen symptoms for breast and prostate cancers. In breast cancer, about 2 out of 3 cases are hormone receptor-positive. The oldest drug on the market for hormone treatment in that cancer type, Tamoxifen, can reduce the risk of breast cancer returning by 40% to 50% in postmenopausal women and 30% to 50% in premenopausal women. It can also reduce the risk of new cancer in a breast by about 50%, and shrink large hormone-receptor-positive breast cancer before surgery. It does come with side effects, some severe, like endometrial cancer and blood cots in the lungs (but the more serious side effects also tend to be rare). You typically take the drug for 5 years, and then switch to another hormonal therapy (aromatase inhibitor) for another 5 years, for a total of 10 years on hormonal therapy for breast cancer.
Every case of this disease is different and so is every treatment plan. The choices can be a little complex, but this overview of potential options will help you get a clearer picture of the road ahead.