Thymus Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines travel all through your body in your bloodstream. They attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm normal healthy cells as well as cancer cells. This can cause side effects.

When might chemo be used for a thymus tumor? 

Chemo might be used to treat a thymus tumor:

• Before surgery if you have a thymus tumor that might be hard to remove. This is done to try to shrink the tumor to make it easier to take it out. This is called neoadjuvant chemotherapy. 

• After surgery to help make sure all the cancer cells are killed. This is called adjuvant chemo.

• That hasn’t spread but can't be removed with surgery, or if you're not healthy enough to have surgery. In these cases, chemo is often part of the main treatment. It can help shrink the cancer and/or keep it under control for as long as possible. It might also help ease symptoms caused by the cancer.

In any of these cases, chemo may be given alone or along with radiation. When chemo and radiation are given together, it's called chemoradiation.

How is chemo given for thymus tumors?

Before treatment starts, you’ll meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines like chemo. The provider will discuss your treatment choices with you and explain what you might expect. 

When treating thymus tumors, chemo is most often given right into your blood through an IV (intravenous) line. This means a small tube (catheter) is put into a vein. You may have a special catheter surgically placed into a large vein called a central venous line. This is to prevent toxic effects of chemo to a small vein. The chemo may drip in slowly over several hours. Or it may be given more quickly over a few minutes. Sometimes it's given nonstop for a few days. In this case, you might go home with a bag that holds the chemo and a small pump that controls how fast it flows into your blood.

Chemo is normally given in an outpatient setting. This means that you get it at a hospital, infusion center, or healthcare provider's office. Then you go home after treatment. Much less often, you may need to stay in the hospital during treatment. You will be closely watched for reactions during chemo. Since each treatment may last for a while, you may want to take along something that’s comforting, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

You’ll get chemo in cycles over a period of time. This means you get the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is 1 cycle. Having treatment in cycles helps to reduce the damage to healthy cells and to give them a chance to recover. Each cycle may last 3 or 4 weeks. Most people get 4 to 6 cycles. This often takes many months. Your healthcare provider will discuss your schedule with you so you know what to expect.

What chemo medicines are used to treat thymus tumors?

These are some common chemo medicines used to treat thymus tumors:

• Doxorubicin

• Cisplatin

• Cyclophosphamide

• Paclitaxel

• Carboplatin

• Etoposide

• Ifosfamide

• Fluorouracil (5-FU) with leucovorin

• Capecitabine (oral medicine)

• Gemcitabine

• Pemetrexed

Often 2 or more of these medicines are combined as the first treatment.

People who are not healthy enough to get combinations of medicines, or people who have already gotten chemo for their thymus tumor may only get 1 medicine.

Other medicines used to treat thymus tumors

Sometimes medicines that are not chemo are used to treat thymus tumors. Some of these are:

• Octreotide. This is a synthetic version of a hormone called somatostatin. It might be used in some cases of advanced cancer. It works by attaching to the cancer cells to kill them or stop their growth.

• Targeted medicines.  These medicines sometimes work with chemo or when chemo stops working. They are better able to target cancer cells, rather than all cells that are quickly dividing, including healthy ones. This limits side effects. They work on certain parts of cancer cells to damage them or to stop their growth. Targeted therapy medicines that currently might be used for thymus cancer include:

  • Sunitinib

  • Everolimus

  • Lenvatinib

What are common side effects of chemo?

Side effects of chemo are different for everyone. They vary based on the medicines you get, the doses used, and how long you're treated. Ask your healthcare provider what side effects to watch for based on the medicines you're getting. Below is a list of the some of the most common chemo side effects:

• Hair loss

• Fatigue and weakness

• Upset stomach (nausea) and vomiting

• Mouth sores

• Loss of appetite

• Changes in the way things taste

• Diarrhea

Other common side effects are related to a decrease in blood counts, such as:

• A decrease in white blood cells. This puts you at a higher risk for infections.

• A decrease in platelet cells. This can make you bleed and bruise more easily.

Some other side effects can also be seen with certain chemo medicines. For instance, cisplatin, carboplatin, paclitaxel, and some other medicines can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet.

It is important to tell your healthcare team about any side effects that you have. They can help you manage side effects and prevent complications.

Increased risk for infection

During chemo, your white blood cell count may become low. This means your immune system won’t be working as well as it should. Wash your hands often. It’s important to stay away from people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. It is important to prevent infections. This is because of your risk for more severe illness when you are immunocompromised. It is especially important that you are up-to-date with all routine vaccines.

Your healthcare provider will check your blood counts regularly during your treatment. Let your provider know if you have any signs of an infection. Symptoms can include fever, chills, sore throat, a new cough, or burning feeling when peeing.

Working with your healthcare provider

It's important to know which chemo medicines you're taking. Write down the names of your medicines. Ask your healthcare team how each one works and what side effects they might cause.

Talk with your providers about what signs to look for and when to call them. For instance, chemo can make you more likely to get infections. Make sure you know what number to call with problems or questions. Is there a different number for evenings, weekends, and holidays?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.