Historically chemotherapy was the predominant treatment for advanced cancers, however within the last decade there has been an explosion of new systemic therapies that complement chemotherapy. These are often treatments that divide significantly fromchemotherapy in terms of how they are delivered and potential side-effects.

Some of these include:

  • Highly selective endocrine treatments for hormone responsive cancers (e.g. prostate cancer).
  • Small molecules known as tyrosine kinase inhibitors (TKI’s) which have activity on selective mutations in certain cancers.
  • Monoclonal antibodies (MABs) – which target cell surface receptors to manipulate cell signalling.

These include:

  • Immunotherapy (agents designed to activate the immune system to recognise and destroy the cancer).
  • Targeted agents which have the ability decrease the blood supply to the cancer, or to reduce the chance of fractures and pain resulting from cancer which has spread to the bone.

Clinical trials are running in Cairns and throughout the world which are likely to o’er more treatment options in the coming years.

Important Info

Systemic therapies fall into 3 categories of use:

  • Curative intent – where the goal is to cure the cancer completely.
  • Palliative intent – where the cancer has spread to such an extent that it is incurable and the goal of therapy is to control the disease, extend life, and improve symptoms/quality of life.
  • Neo-adjuvant or Adjuvant – treatment either before or after surgery to optimise cure rates. This can sometimes be given concurrentlywith radiotherapy.

Chemotherapy drugs have multiple different mechanisms of action, although they are all cytotoxic (i.e. kill cells). Many of these were discovered in nature (plants and bacteria) and are now synthesised in laboratories. As they kill a percentage of cells with every treatment, multiple doses are often required, with a rest period in between to allow the normal cells to recover.

Small molecule inhibitors are often given as tablets, and are able to get into the cell by naturally occurring pathways to inhibit the targeted cellular machinery that is leading to the growth of the cancer.

Monoclonal antibodies are given intravenously or subcutaneously (under the skin) and move via the bloodstream to the targeted cells and often bind irreversibly to the target cell receptor and thus inhibit them.

Most chemotherapy and antibody therapy is given intravenously via a drip in the arm in an oncology day unit. Treatment times may range from 5 minutes up to 5 hours depending on the type of treatment. Other therapies are given orally as tablets. There are some treatments that are given locally, such as treatment to the bladder in early bladder cancer.

Patients are seen as an initial consult and a discussion and plan is formulated for treatment and ongoing follow-up. Chemotherapy is given in the oncology day unit at Cairns Private Hospital and patients are free to go home the same day. Side effects are managed under the close supervision of the treating medical oncologist and nursing staff.