What Are Oral Chemotherapy and Targeted Pills? Advantages and Disadvantages

What Are Oral Chemotherapy and Targeted Cancer Pills?

Oral chemotherapy and targeted pills are terms sometimes used interchangeably, but they have the differences described below.

Oral chemotherapyconsists of pill forms of conventional chemotherapy drugs administered intravenously (into a vein) (pill chemotherapy). It is designed to prevent or slow the division of cancer cells and kill them.

Targeted cancer pills work differently from chemotherapy; rather than having a direct cytotoxic (killing) effect on cancer cells, they act on cellular growth pathways by suppressing them.

As with other prescription medicines, people can take oral chemotherapy drugs and targeted cancer pills at home. Oral cancer medicines may also make a patient feel that they have more control over their treatment.

Note: Targeted cancer medicines do not come only in pill form (there are also targeted cancer medicines administered intravenously in an infusion; such as trastuzumab, pertuzumab and rituximab)

Intravenous chemotherapy treatments can unquestionably save lives; however, they have side effects of varying degrees. Conventional chemotherapy involves administering a drug or combination of drugs into a vein in an infusion and usually takes place in a hospital or clinic (chemotherapy center); it also frequently requires a venous port .

These medicines are usually in pill or capsule form, but they may also be available as liquids or dissolving tablets that dissolve under the tongue.

Examples of oral chemotherapy drugs (the active ingredient first, followed by some brand names in parentheses):

• Capecitabine (Xeloda, Kapeda): for the treatment of colon and breast cancer
• Etoposide (Lastet): for the treatment of many cancers (lung, testicular, breast, lymphoma and others)
• Cyclophosphamide (Endoksan): many cancers (leukemia, ovarian cancer, testicular cancer, breast cancer and others, as well as autoimmune diseases and organ transplantation)
• Vinorelbine (Navelbine): for the treatment of lung and breast cancer

Examples of targeted cancer pills:

• Imatinib (Glivec): CML, for the treatment of gastrointestinal stromal tumors
• Erlotinib (Tarceva): EGFR-positive for the treatment of lung cancer
• Ruxolitinib (Jakafi): for the treatment of myelofibrosis and polycythemia vera
• Palbociclib (Ibrance): for the treatment of hormone-positive breast cancer
• Sunitinib (Sutent): treatment of gastrointestinal stromal tumors, kidney cancer and pancreatic neuroendocrine tumors

In some sources, medicines used in cancer treatment that are hormone-suppressing medicines are also considered oral chemotherapy. Examples include; 

• Letrozole (Femara): breast cancer treatment
• Abiraterone (Zytiga): prostate cancer treatment

How do oral cancer medicines (oral chemotherapy and targeted pills) work, and what treatment efficacy should be expected?

All of these medicines work differently, and their dosages vary. The dosage will also depend on the type of cancer.

The doctor or oncology education nursewill share specific details about how to use the medicines with the patient and their caregiver .

Information on some targeted pills frequently used in cancer treatment can be found below: 

• Osimertinib (Tagrisso) lung cancer treatment
• Crizotinib (Xalkori) lung cancer treatment
• Alectinib (Alecensa) lung cancer treatment
• Lenvatinib (Lenvima) liver cancer treatment
• Enzalutamide (Xtandi) prostate cancer treatment

Education about oral cancer medicines should include:

Dosing

It is very important to take oral cancer medicines strictly according to the schedule recommended by the doctor.

The medicine may be less effective if the patient forgets to take a pill, takes doses too close together, takes other medicines alongside them or takes unapproved supplements without the doctor's approval. Incorrect dosing can cause serious side effects.

Patients should obtain clear dosing instructions from their doctor, including what to do if they miss an oral chemotherapy drug or targeted pill or accidentally take two. Keeping a medication diary may help remind people to take their medicines.

Side effects

Patients receiving chemotherapy may experience side effects of varying degrees. Patients are advised to keep a record of all side effects they experience and report them to their physician.

Below, we discuss the side effects of oral cancer medicines in more detail.

Patient monitoring

During cancer treatment, the immune system becomes weaker, making infections and other illnesses more dangerous, for example if leukopenia and neutropenia develop.

People receiving cancer treatment should consult a doctor if signs or symptoms such as fever or flu develop, and cancer patients who develop a fever should go to the emergency department.

Storing oral cancer medicines

Oral chemotherapy drugs and targeted cancer pills must be stored at specific temperatures. In these circumstances, home air conditioning or heating must work well enough to control the temperature.

It is very important not to keep pill containers in the bathroom / a damp environment, as this causes the medicine to deteriorate more quickly.

It is also important to keep pill containers safely out of children's reach. The container should be clearly labeled, reducing the chance of someone confusing it with another medicine.

What are the side effects of oral cancer medicines?

Side effects can occur with conventional chemotherapy, oral chemotherapy and targeted pills; however, as a general principle, oral cancer medicines have fewer side effects than intravenous chemotherapy. This is because conventional chemotherapy kills all cells, particularly cancer cells, whereas targeted pills act on intracellular growth and proliferation pathways through mechanisms that inhibit them.

Common side effects of oral cancer medicines are listed below:

• skin changes
• mouth sores
• easy bruising
• feeling tired 
• infection or flu-like symptoms 
• nausea, vomiting or diarrhea
• hair loss

The frequency and severity of side effects vary between patients. Interactions between chemotherapy drugs and other medicines may also further increase side effects.

Before starting chemotherapy, it is important to speak with your oncologist about alcohol consumption and herbal supplements . Drinking alcohol while taking certain oral cancer medicines may be dangerous.

Advantages of oral cancer medicines

Many people prefer oral chemotherapy or targeted pills to intravenous chemotherapy because they allow fewer visits to the hospital or clinic. Oral chemotherapy allows a person to receive treatment in the comfort of their own home.

Benefits of not leaving home for treatment may include:

• fewer childcare problems
• less disruption to daily activities
• less time off work
• more privacy
• fewer side effects

Some people dislike going to a clinic for treatment because it makes them feel ill or anxious.

Conventional chemotherapy is usually intravenous and requires a needle. For people with a needle phobia or veins that are difficult to access, oral chemotherapy may be a less painful and stressful option.

Disadvantages of oral cancer medicines

• Oral chemotherapy drugs or targeted pills are not available for all cancers.
• The patient may forget to take oral cancer medicines (the World Health Organization estimates that only 50 percent of people take their medicines correctly).

According to the results of a study conducted in 2012, adherence to oral chemotherapy may decline over time. Research findings show that the longer a person's treatment course, the more likely they are to stop taking their medicines.

Some cancer pills have effects so potent that people must wear gloves to touch them. People with young children should also store their medicines out of reach and dispose of leftover pills safely.

Access to these cancer pills may also be a problem. Sometimes the medicine must be ordered several days or weeks in advance, so people who do not keep up with the ordering process may miss doses.

Conclusion

Oral chemotherapy works similarly to conventional chemotherapy, while targeted cancer pills work by blocking cellular growth pathways. If such a medicine exists for a patient's type of cancer, it may be an excellent treatment option for people who adhere well to taking pills. It may also reduce the stress of regular hospital visits.

Oral cancer medicines are not available for all types and stages of cancer. Even when available, they may not be the best choice for everyone. Proper education on how to use these medicines is also essential.