Treatments for Cancer

Questions To Ask Your Doctor

If you’ve been diagnosed with cancer, consider asking your doctor some of these questions before choosing a treatment plan:

  • What are the ways to treat my type and stage of cancer?
  • What are the benefits and risks of each of these treatments?
  • What treatment do you recommend? Why do you think it is best for me?
  • When will I need to start treatment?
  • Will I need to be in the hospital for treatment? If so, for how long?
  • What is my chance of recovery with this treatment?
  • How will we know if the treatment is working?
  • Would a clinical trial (research study) be right for me?
  • How do I find out about studies for my type and stage of cancer?

For more questions to ask your doctor about cancer, see www.cancer.gov/about-cancer/treatment/questions.

Source: NIH News in Health (NIH)1

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Back to: « Cancer

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Finding a Doctor and Hospital

Experts in the field of adolescent and young adult (AYA) cancers and cancer survivors answer the question: What would you tell an adolescent or young adult with cancer?

Because cancer in young adults is rare, it is important to find an oncologist who specializes in treating the type of cancer you have. Research is finding that for some types of cancer, young adults may have better outcomes if treated with pediatric, rather than adult, treatment regimens.

Young adults who have a cancer that typically occurs in children and adolescents, such as brain tumors, leukemia, osteosarcoma, and Ewing sarcoma, may be treated by a pediatric oncologist. These doctors are often affiliated with a hospital that is a member of the Children’s Oncology Group. However, young adults who have cancers that are more common in adults are often treated by a medical oncologist through hospitals that are affiliated with an NCI-Designated Cancer Center or a clinical research network such as NCTN or NCORP.

Learn more about finding a doctor and how to get a second opinion in: How To Find a Doctor or Treatment Facility If You Have Cancer. A second opinion may be especially helpful when there are complicated medical decisions that need to be made, there are different treatment options to choose from, you have a rare cancer, or the first opinion on the treatment plan comes from a doctor who doesn’t specialize in or treat many young adults with the type of cancer that you have.

Source: NCI (NIH)2

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Treatment Choices

The type of treatment you receive is based on the type of cancer you have and how advanced the cancer is (its stage or grade). Factors such as your age, overall health, and personal preference are also important.

Your treatment options may include a clinical trial or standard medical care.

  • Standard medical care (also called standard of care) is treatment that experts agree is appropriate and accepted for a specific disease. The A to Z List of Cancers has information about treatment for specific types of cancer. You can also learn about treatments such as chemotherapy, immunotherapy, radiation therapy, stem cell transplants, surgery, and targeted therapies in Types of Treatment.
  • Clinical trials, also called clinical studies, are carefully controlled research studies that test new ways to treat diseases, such as cancer. Clinical trials are conducted in a series of steps, called phases. Each phase aims to answer specific medical questions. Once a new treatment has been shown to be safe and effective in clinical trials, it may become the standard of care. You can get answers to commonly asked questions about clinical trials and search for clinical trial for the type of cancer you have. More information about young adults and clinical trials is discussed in Overcoming Age Limits in Cancer Clinical Trials and Clinical Trials Offer a Path to Better Care for AYAs with Cancer.

Treatment decisions often come with questions and concerns, especially when considering participation in a clinical trial. We can help. Please contact our free, confidential Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237) for information and for help finding clinical trials.

Source: NCI (NIH)3

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After Treatment

For many young people, the completion of treatment is something to celebrate. However, this time may also bring new challenges. You may worry that cancer will return or struggle to get used to new routines. Some young people enter this new phase feeling stronger, whereas others are more fragile. Most young people say the transition after treatment took longer and was more challenging than they anticipated. While most of the side effects that you had during treatment will go away, long-term side effects, such as fatigue, may take time to go away. Other side effects, called late effects, may not occur until months or even years after treatment.

Although follow-up care is important for all survivors, it is especially important for young adults. These check-ups can both reassure you and help to prevent and/or treat medical and psychological problems. Some young adults receive follow-up care at the hospital where they were treated, and others see specialists at late effect clinics. Talk with your health care team to learn what follow-up care you should receive and about possible places to receive it.

Two important documents to get written copies of, and to discuss with your doctor, include:

  • A treatment summary, with detailed records about your diagnosis and the type(s) of treatment you received.
  • A survivorship care plan or follow-up care plan, which addresses both physical and psychological follow-up care that you should receive after cancer treatment. The plan is usually different for each person, depending on the type of cancer and treatment received.

Studies have found that many young adult cancer survivors are often unaware of or underestimate their risk for late effects. You can learn more in For Many Young Cancer Survivors, Late Effects Pose Lasting Problems, and Many Survivors of Adolescent and Young Adult Cancers Have Chronic Health Problems, Unhealthy Behaviors.

Get additional information about survivorship and learn about resources to help you talk with your doctor in Follow-up Care after Cancer Treatment, from the NCI Office of Cancer Survivorship.

Source: NCI (NIH)4

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What targeted therapies have been approved for specific types of cancer?

The FDA has approved targeted therapies for the treatment of some patients with the following types of cancer (some targeted therapies have been approved to treat more than one type of cancer):

Adenocarcinoma of the stomach or gastroesophageal junction: Trastuzumab (Herceptin®), ramucirumab (Cyramza®)

Basal cell carcinoma: Vismodegib (Erivedge®), sonidegib (Odomzo®)

Bladder cancer: Atezolizumab (Tecentriq™)

Brain cancer: Bevacizumab (Avastin®), everolimus (Afinitor®)

Breast cancer: Everolimus (Afinitor®), tamoxifen (Nolvadex), toremifene (Fareston®), Trastuzumab (Herceptin®), fulvestrant (Faslodex®), anastrozole (Arimidex®), exemestane (Aromasin®), lapatinib (Tykerb®), letrozole (Femara®), pertuzumab (Perjeta®), ado-trastuzumab emtansine (Kadcyla®), palbociclib (Ibrance®)

Cervical cancer: Bevacizumab (Avastin®)

Colorectal cancer: Cetuximab (Erbitux®), panitumumab (Vectibix®), bevacizumab (Avastin®), ziv-aflibercept (Zaltrap®), regorafenib (Stivarga®), ramucirumab (Cyramza®)

Dermatofibrosarcoma protuberans: Imatinib mesylate (Gleevec®)

Endocrine/neuroendocrine tumors: Lanreotide acetate (Somatuline® Depot)

Head and neck cancer: Cetuximab (Erbitux®), pembrolizumab (Keytruda®), nivolumab (Opdivo®)

Gastrointestinal stromal tumor: Imatinib mesylate (Gleevec®), sunitinib (Sutent®), regorafenib (Stivarga®)

Giant cell tumor of the bone: Denosumab (Xgeva®)

Kaposi sarcoma: Alitretinoin (Panretin®)

Kidney cancer: Bevacizumab (Avastin®), sorafenib (Nexavar®), sunitinib (Sutent®), pazopanib (Votrient®), temsirolimus (Torisel®), everolimus (Afinitor®), axitinib (Inlyta®), nivolumab (Opdivo®), cabozantinib (Cabometyx™), lenvatinib mesylate (Lenvima®)

Leukemia: Tretinoin (Vesanoid®), imatinib mesylate (Gleevec®), dasatinib (Sprycel®), nilotinib (Tasigna®), bosutinib (Bosulif®), rituximab (Rituxan®), alemtuzumab (Campath®), ofatumumab (Arzerra®), obinutuzumab (Gazyva®), ibrutinib (Imbruvica®), idelalisib (Zydelig®), blinatumomab (Blincyto®), venetoclax (Venclexta™)

Liver cancer: Sorafenib (Nexavar®)

Lung cancer: Bevacizumab (Avastin®), crizotinib (Xalkori®), erlotinib (Tarceva®), gefitinib (Iressa®), afatinib dimaleate (Gilotrif®), ceritinib (LDK378/Zykadia™), ramucirumab (Cyramza®), nivolumab (Opdivo®), pembrolizumab (Keytruda®), osimertinib (Tagrisso™), necitumumab (Portrazza™), alectinib (Alecensa®), atezolizumab (Tecentriq™)

Lymphoma: Ibritumomab tiuxetan (Zevalin®), denileukin diftitox (Ontak®), brentuximab vedotin (Adcetris®), rituximab (Rituxan®), vorinostat (Zolinza®), romidepsin (Istodax®), bexarotene (Targretin®), bortezomib (Velcade®), pralatrexate (Folotyn®), ibrutinib (Imbruvica®), siltuximab (Sylvant®), idelalisib (Zydelig®), belinostat (Beleodaq®), obinutuzumab (Gazyva®), nivolumab (Opdivo®)

Melanoma: Ipilimumab (Yervoy®), vemurafenib (Zelboraf®), trametinib (Mekinist®), dabrafenib (Tafinlar®), pembrolizumab (Keytruda®), nivolumab (Opdivo®), cobimetinib (Cotellic™)

Multiple myeloma: Bortezomib (Velcade®), carfilzomib (Kyprolis®), panobinostat (Farydak®), daratumumab (Darzalex™), ixazomib citrate (Ninlaro®), elotuzumab (Empliciti™)

Myelodysplastic/myeloproliferative disorders: Imatinib mesylate (Gleevec®), ruxolitinib phosphate (Jakafi®)

Neuroblastoma: Dinutuximab (Unituxin™)

Ovarian epithelial/fallopian tube/primary peritoneal cancers: Bevacizumab (Avastin®), olaparib (Lynparza™)

Pancreatic cancer: Erlotinib (Tarceva®), everolimus (Afinitor®), sunitinib (Sutent®)

Prostate cancer: Cabazitaxel (Jevtana®), enzalutamide (Xtandi®), abiraterone acetate (Zytiga®), radium 223 dichloride (Xofigo®)

Soft tissue sarcoma: Pazopanib (Votrient®), olaratumab (Lartruvo™)

Systemic mastocytosis: Imatinib mesylate (Gleevec®)

Thyroid cancer: Cabozantinib (Cometriq®), vandetanib (Caprelsa®), sorafenib (Nexavar®), lenvatinib mesylate (Lenvima®)

Source: NCI (NIH)5

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Where do children with cancer get treated?

Children who have cancer are often treated at a children’s cancer center, which is a hospital or a unit within a hospital that specializes in diagnosing and treating children and adolescents who have cancer. Most children’s cancer centers treat patients up to 20 years of age. The health professionals at these centers have specific training and expertise to provide comprehensive care for children, adolescents, and their families.

Children’s cancer centers also participate in clinical trials. The improvements in survival for children with cancer that have occurred over the past half century have been achieved because of treatment advances that were studied and proven to be effective in clinical trials.

More than 90 percent of children and adolescents who are diagnosed with cancer each year in the United States are cared for at a children’s cancer center that is affiliated with the NCI-supported Children’s Oncology GroupExit Disclaimer (COG). COG is the world’s largest organization that performs clinical research to improve the care and treatment of children and adolescents with cancer. Each year, approximately 4,000 children who are diagnosed with cancer enroll in a COG-sponsored clinical trial.

Every children’s cancer center that participates in COG has met strict standards of excellence for childhood cancer care. A directory of COG locationsExit Disclaimer is available on COG’s website. Families can ask their pediatrician or family doctor for a referral to a children’s cancer center. Families and health professionals can call NCI’s Cancer Information Service (CIS) at 1-800-4-CANCER to learn more about children’s cancer centers that belong to COG.

Source: NCI (NIH)6

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Can children who have cancer be at the National Institutes of Health (NIH) Clinical Center?

Children with cancer may be eligible to be treated in clinical trials at the NIH Clinical Center in Bethesda, Maryland. Because the NIH Clinical Center is a research hospital, only patients who have a specific type or stage of cancer that is under study can be accepted for treatment. In some cases, patients with conditions that are rare or difficult to diagnose may also be accepted for treatment at the Clinical Center. All patients who are treated at the Clinical Center must be referred by a physician.

NCI’s Pediatric Oncology Branch conducts clinical trials for children, adolescents, and young adults with a wide variety of cancers. Patients with newly diagnosed cancer, as well as patients whose cancers have come back after treatment, may be eligible to participate in a clinical trial. Physicians at the Pediatric Oncology Branch can also provide a second opinion on a patient’s diagnosis or treatment plan. To refer a patient to the Pediatric Oncology Branch, the patient’s health care provider should call 301-496-4256 (local) or 1-877-624-4878 (toll-free) weekdays between 8:30 a.m. and 5:00 p.m. ET. Parents can also call these numbers to learn if their child is eligible to participate in a clinical trial.

Source: NCI (NIH)7

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What should survivors of childhood cancer consider after they complete treatment?

Survivors of childhood cancer need follow-up care and enhanced medical surveillance for the rest of their lives because of the risk of complications that can occur many years after they complete treatment for their cancer. Health problems that develop months or years after treatment has ended are known as late effects. Indeed, long-term follow-up analysis of a cohort of survivors of childhood cancer treated between 1970 and 1986 has shown that cancer survivors remain at risk of complications and premature death as they age, with more than half of survivors having experienced a severe or disabling complication or even death by the time they reach age 50 years (19). It is not known whether children treated in more recent periods will experience similar risks of late complications.

The specific late effects that a person who was treated for childhood cancer might experience depend on the type and location of his or her cancer, the type of treatment he or she received, and patient-related factors, such as age at diagnosis.

Children who were treated for bone cancer, brain tumors, and Hodgkin lymphoma, or who received radiation to their chest, abdomen, or pelvis, have the highest risk of serious late effects from their cancer treatment, including second cancers, joint replacement, hearing loss, and congestive heart failure (20,21).

It’s important for childhood cancer survivors to have regular medical follow-up examinations so any health problems that occur can be identified and treated as soon as possible. The Children’s Oncology Group has developed long-term follow-up guidelinesExit Disclaimer for survivors of childhood, adolescent, and young adult cancer.

It is also important to keep a record of the cancer treatment that someone received as a child. This record should include:

  • The type and stage of cancer
  • Date of diagnosis and dates of any relapses
  • Types and dates of imaging tests
  • Contact information for the hospitals and doctors who provided treatment
  • Names and total doses of all chemotherapy drugs used in treatment
  • The parts of the body that were treated with radiation and the total doses of radiation that were given
  • Types and dates of all surgeries
  • Any other cancer treatments received
  • Any serious complications that occurred during treatment and how those complications were treated
  • The date that cancer treatment was completed

Several cancer support organizations have developed kits that can help parents keep track of this information. The NCI booklet Facing Forward: Life After Cancer Treatment includes a list of these organizations in the section "Guidelines for Follow-up Care." The record should be kept in a safe place, and copies of the record should be given to all doctors or other health care providers who are involved with the child’s follow-up care, even as the child grows into adulthood.

Many children’s cancer centers have follow-up clinics where survivors of childhood cancer can go for follow-up until they reach their early 20s. Some cancer centers are now creating clinics dedicated to follow-up care for long-term cancer survivors.

Source: NCI (NIH)8

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Treating Childhood Cancer

Children's cancers are not always treated like adult cancers. Pediatric oncology is a medical specialty focused on the care of children with cancer. It's important to know that this expertise exists and that there are effective treatments for many childhood cancers.

Types of Treatment

There are many types of cancer treatment. The types of treatment that a child with cancer receives will depend on the type of cancer and how advanced it is. Common treatments include: surgery, chemotherapy, radiation therapy, immunotherapy, and stem cell transplant. Learn about these and other therapies in our Types of Treatment section.

Source: NCI (NIH)9

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Treatment Effects

Children face unique issues during their treatment for cancer, after the completion of treatment, and as survivors of cancer. For example, they may receive more intense treatments, cancer and its treatments have different effects on growing bodies than adult bodies, and they may respond differently to drugs that control symptoms in adults. For more information, see the PDQ® Pediatric Supportive Care summary. Late effects of treatment are discussed later on this page in the Survivorship section.

Source: NCI (NIH)10

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Where Children with Cancer Are Treated

Children who have cancer are often treated at a children’s cancer center, which is a hospital or unit in a hospital that specializes in treating children with cancer. Most children’s cancer centers treat patients up to age 20.

The doctors and other health professionals at these centers have special training and expertise to give complete care to children. Specialists at a children’s cancer center are likely to include primary care physicians, pediatric medical oncologists/hematologists, pediatric surgical specialists, radiation oncologists, rehabilitation specialists, pediatric nurse specialists, social workers, and psychologists. At these centers, clinical trials are available for most types of cancer that occur in children, and the opportunity to participate in a trial is offered to many patients.

At the National Institutes of Health’s Clinical Center in Bethesda, Maryland, NCI’s Pediatric Oncology Branch cares for children with cancer. Health professionals and scientists conduct translational research that spans basic science to clinical trials to improve outcomes for children and young adults with cancer and genetic tumor predisposition syndromes.

Source: NCI (NIH)11

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Drugs Approved for Conditions Related to Cancer

People with cancer may have other conditions caused by the cancer or its treatment. Drugs approved by the FDA for some of these cancer-related conditions are listed on this page. The drug names link to NCI's Cancer Drug Information summaries that provide information about these drugs. There may be other drugs used in these conditions that are not listed here.

Actinic Keratosis

  • Aminolevulinic Acid (Levulan)
  • Fluorouracil--Topical (5-FU, Carac, Efudex, Fluoroplex, Tolak)
  • Imiquimod (Aldara)

Aggressive Systemic Mastocytosis

  • Imatinib Mesylate (Gleevec)

Anemia (Low Red Blood Cells)

Cardiac Toxicity (Heart Side Effects)

  • Dexrazoxane Hydrochloride (Zinecard)
  • Uridine Triacetate (Vistogard)

Condyloma Acuminatum (Genital Warts)

  • Imiquimod (Aldara)
  • Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine (Gardasil 9)
  • Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine (Gardasil)
  • Recombinant Interferon Alfa-2b (Intron A)

Drug Extravasation (Drug Leakage in Tissues)

  • Dexrazoxane Hydrochloride (Totect)

Drug Toxicity (Severe Side Effects)

  • Dexrazoxane Hydrochloride (Zinecard)—for Doxorubicin Toxicity
  • Glucarpidase (Voraxaze)—for Methotrexate Toxicity
  • Uridine Triacetate (Vistogard)—for Capecitabine or Fluorouracil Toxicity

Hemorrhagic Cystitis (Bleeding in the Bladder)

  • Mesna (Mesnex)

Hepatic Veno-occlusive Disease (Blocked Liver Veins)

  • Defibrotide Sodium (Defitelio)

Hepatitis C Infection

  • Peginterferon Alfa-2b (PEG-Intron)

Hypercalcemia of Malignancy (High Blood Calcium)

Malignant Effusion

  • Bleomycin (Blenoxane)
  • Mechlorethamine Hydrochloride (Mustargen)
  • Talc (Sterile Talc Powder, Sclerosol Intrapleural Aerosol, Steritalc)
  • Thiotepa

Mucositis (Inflamed Mucous Membranes)

  • Palifermin (Kepivance)

Nausea and Vomiting

  • Aprepitant (Emend)
  • Netupitant and Palonosetron Hydrochloride (Akynzeo)
  • Ondansetron Hydrochloride (Zofran)
  • Palonosetron Hydrochloride (Aloxi)
  • Rolapitant Hydrochloride (Varubi)

Neurotoxicity (Nervous System Side Effects)

  • Uridine Triacetate (Vistogard)

Neutropenia (Low Blood Neutrophils)

  • Filgrastim (Neupogen, Zarxio)
  • Pegfilgrastim (Neulasta)

Osteoporosis (Loss of Bone Density)

  • Denosumab (Prolia)
  • Raloxifene Hydrochloride (Evista, Keoxifene)

Skin Changes Due to Cutaneous Metastases

  • Bexarotene (Targretin)

Thrombocytopenia (Low Blood Platelets)

Tumor Lysis Syndrome (Cell Breakdown and Organ Damage)

  • Rasburicase (Elitek)

Updated: April 7, 2016

Source: NCI (NIH)12

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Some cancers can be cured if the tumour is detected and surgically removed before the cancer cells spread. Chemotherapy (anti-cancer drugs) and radiotherapy (radiation treatment) are also used to treat cancer. Often these treatments are most effective when used together.

Source: Queensland Health13

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I'm starting cancer treatment. How can I best take care of my mouth?

Cancer treatment can cause side effects in your mouth. A dental checkup before treatment starts can help prevent painful mouth problems. Serious side effects in the mouth can delay, or even stop, cancer treatment. To fight cancer best, your cancer care team should include a dentist. A dentist will help protect your mouth, teeth, and jaw bones from damage caused by head and neck radiation and chemotherapy.

Source: OWH (DHHS)14

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Cancer treatment

Surgery is the first treatment to try for most types of cancer, as solid tumours can usually be surgically removed.

Two other commonly used treatment methods are:

Source: NHS Choices UK15

Treatments for Cancer

Supplements: Many current and former cancer patients take vitamin and mineral supplements. They may believe these supplements can help reduce treatment side effects. They may think extra vitamins will keep cancer from coming back or help them live longer. But research in these areas hasn’t yet found whether many of these beliefs are true. And some doctors worry that supplements can interact with cancer treatments or have other unintended consequences.

No matter what your medical condition, it’s always a good idea to discuss any supplement use with your doctor.

Source: NIH News in Health (NIH)16

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Pharmacogenomics: Tests to predict how patients will respond to some cancer medicines are already on the market. The Food and Drug Administration, NIH's sister agency, has also begun including pharmacogenomic information on some drug labels.

Source: NIH News in Health (NIH)17

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Palliative Sedation: Key Points

  • Sedation may be considered for comfort.
  • Choices about care and treatment at the end of life should be made while you are still able to make them.

Sedation may be considered for comfort.

Patients with advanced cancer or near the end of life may have:

Sedation can be given to ease these conditions. This is called palliative sedation. Deciding to use palliative sedation may be difficult for the family as well as the patient. The patient and family can get support from the health care team and mental health professionals when palliative sedation is used.

Choices about care and treatment at the end of life should be made while you are still able to make them.

Your thoughts and feelings about end-of-life sedation may depend on your own culture and beliefs. Some patients who become anxious facing the end of life may want to be sedated. Other patients may wish to have no procedures, including sedation, just before death. It is important for you to tell family members and health care providers of your wishes about sedation at the end of life. When you make your wishes about sedation known ahead of time, doctors and family members can be sure they're doing what you would want.

Source: NCI (NIH)18

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Off-Label Drug Usage: Off-Label Drug Use in Cancer Treatment

About Off-Label Drugs

Drugs can be legally sold in the U.S. only after the U.S. Food and Drug Administration (also known as the FDA) has approved them. Drugs are approved after research shows they are safe and effective for a specific use.

Off-label drug use refers to the practice of prescribing a drug for a different purpose than what the FDA approved. This practice is called “off-label” because the drug is being used in a way not described on its package insert. This insert is known as its “label.”

The label describes details of the drug, such as:

  • What the drug is made of.
  • How it works in the body.
  • The research studies that led to its approval.
  • Side effects it may cause.

The FDA must make sure that a drug is safe and effective for a specific use. However, it does not control the decision doctors make about which drugs to use for their patients. This means that once the FDA approves a drug, doctors can prescribe it for any purpose they think makes sense for the patient.

Off-label uses may include using an approved drug:

  • For a different type of cancer than the one it is approved to treat
  • At a different dose or frequency
  • To treat a child when it is approved to treat adults

Off-label uses of a drug can become approved uses if the company that makes it obtains approval from the FDA. To gain the added approvals, the company must conduct research studies to show that the treatment is safe and effective for the new uses. However, a company may decide not to invest time and money in this research.

The Role of Off-Label Drug Use in Cancer Treatment

Research has shown that off-label use of drugs is very common in cancer treatment. Often, usual care for a specific type or stage of cancer includes the off-label use of one or more drugs.

Off-label drug use is common in cancer treatment because:

  • Many cancer drugs are effective against more than one type of cancer.
  • Cancer treatment often involves the use of combination chemotherapy.

Combination chemotherapy (which is treatment using more than one drug) is effective in treating many types of cancer. Examples of combination chemotherapy include:

These combinations might include one or more drugs not approved for the type of cancer they are being used to treat.

The FDA usually does not approve combinations of chemotherapy. There are so many of them that it would not be practical to approve each combination.

  • Research studies find new uses for drugs that are already approved. The results of research studies are published in medical journals and shared in the medical community. Doctors then adopt the new use and it may become an accepted and widely-used treatment for a different cancer, even if the FDA has not approved the drug for that use.

Drawbacks to Off-Label Drug Use

There are times when off-label drug use may cause harm, such as when:

  • It has not been shown to be effective against a certain cancer.
  • There is no reason to believe the drug might be effective.
  • The possible risks of giving the drug outweigh the possible benefits.

However, if your doctor prescribes a drug for an off-label use to treat your cancer, he or she is basing the decision on knowledge of and experience with the drug, as well as on research that shows it might be helpful for your stage and type of cancer.

Health Insurance Coverage of Off-Label Drugs in Cancer Treatment

Medicare and many insurance companies pay for off-label drugs for cancer treatment, as long as the off-label uses are listed in an approved compendium. A compendium is a collection of drug summaries put together by experts who have reviewed data about the drug’s use in patients.

If your doctor prescribes an off-label drug for your treatment, check your plan to make sure the drug is covered. If coverage is denied, it may be helpful for the doctor to provide the insurance company with copies of documents that support the suggested off-label use.

Questions to Ask Your Doctor About Off-Label Drugs

Discussing these questions with your doctor can help you understand why your doctor might prescribe an off-label drug for you.

  • Why do you think the off-label use of this drug will help the type of cancer that I have?
  • Is the off-label drug likely to work better than an approved drug?
  • What are the risks and benefits of treatment with this drug?
  • Will my health insurance cover my treatment with this drug?
  • If my treatment involves combination chemotherapy and one of the drugs is off-label, will my health insurance cover it?

Source: NCI (NIH)19

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Chemotherapy: Chemotherapy is the use of drugs to destroy cancer cells. Chemotherapy drugs used in the treatment of cancer may be taken as tablets or, more commonly, given by intravenous drip directly into a vein.

Many different drugs are available, which generally work by killing or slowing the growth of fast-growing cells. Cancers are made up of fast-growing cells. Other fast-growing cells, such as the cells that make up hair follicles, are also affected. This is why one of the side effects of chemotherapy is hair loss. Chemotherapy medications are also known as cytotoxic or anti-cancer medications.

Source: Queensland Health20

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Radiotherapy: Radiotherapy is the use of precisely targeted x-rays to destroy cancer cells. Normal cells can recover from radiotherapy. The length of treatment varies depending on individual factors such as the location, type and stage of the cancer, and whether or not the radiotherapy is combined with other treatments such as chemotherapy or surgery. Radiotherapy can cure cancer in many sites of the body.

Undergoing external radiotherapy is similar to undergoing a regular x-ray examination. There is no need for anaesthesia (except for infants). Internal radiotherapy (also called c - from the Greek words meaning "treatment from a short distance’) is given from a localised implant. It is a painless treatment given in a number of doses.

Common side effects of radiotherapy include fatigue and skin problems such as itchiness and colour changes. It is important to remember that almost all side effects will disappear once treatment is completed. Later effects will need to be monitored along with your progress.

Source: Queensland Health21

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Dietician: Dietitians are allied health professionals who use their knowledge of human nutrition to help people manage their health. They provide support and services to both inpatients and outpatients, and can be helpful to people who:

On your first visit, the dietitian will:

  • discuss the reason for your visit and work with you to plan goals and strategies for improving your health
  • take some measurements (including height, weight and waist circumference)
  • ask questions about your medical, social and diet history
  • refer you to additional health services if necessary
  • plan any follow-up appointments.

At follow-up appointments, they may take your measurements again and ask questions to see how much progress you have made, and recommend some new strategies to help you reach your goals.

Source: Queensland Government22

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Palliative care: Palliative care

If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care.

Palliative care also includes psychological, social and spiritual support for you and your family or carers.

There are different options for terminal care in the late stages of cancer. You may want to think about whether you'd like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor.

Some organisations who provide care for people with cancer include:

  • Macmillan Cancer Support - which has specially trained nurses who help to look after people with cancer at home. To be referred to a Macmillan nurse, ask your hospital doctor or GP, or call 0808 808 00 00.
  • Marie Curie Cancer Care - have specially trained nurses who help to look after people with cancer at home. They also run hospices for people with cancer.
  • Hospice UK - provides information about hospice care and how to find a hospice.

Source: NHS Choices UK23

Drugs for Cancer

A to Z List of Cancer Drugs

This list includes more than 200 cancer drug information summaries from NCI. The summaries provide consumer-friendly information about cancer drugs and drug combinations.

Summaries for individual cancer drugs cover the uses of these drugs, research results, possible side effects, approval information, and ongoing clinical trials. The list includes brand and generic names for the drugs.

Summaries for cancer drug combinations are listed by abbreviation or common name and are shown in capital letters. Each summary gives a list of the drugs that make up the combination and explains what the combination is used for. It also has links to summaries for individual drugs in the combination.

Source: NCI (NIH)24

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Drugs Approved for Conditions Related to Cancer

People with cancer may have other conditions caused by the cancer or its treatment. Drugs approved by the FDA for some of these cancer-related conditions are listed on this page. The drug names link to NCI's Cancer Drug Information summaries that provide information about these drugs. There may be other drugs used in these conditions that are not listed here.

Actinic Keratosis

  • Aminolevulinic Acid (Levulan)
  • Fluorouracil--Topical (5-FU, Carac, Efudex, Fluoroplex, Tolak)
  • Imiquimod (Aldara)

Aggressive Systemic Mastocytosis

  • Imatinib Mesylate (Gleevec)

Anemia (Low Red Blood Cells)

Cardiac Toxicity (Heart Side Effects)

  • Dexrazoxane Hydrochloride (Zinecard)
  • Uridine Triacetate (Vistogard)

Condyloma Acuminatum (Genital Warts)

  • Imiquimod (Aldara)
  • Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine (Gardasil 9)
  • Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine (Gardasil)
  • Recombinant Interferon Alfa-2b (Intron A)

Drug Extravasation (Drug Leakage in Tissues)

  • Dexrazoxane Hydrochloride (Totect)

Drug Toxicity (Severe Side Effects)

  • Dexrazoxane Hydrochloride (Zinecard)—for Doxorubicin Toxicity
  • Glucarpidase (Voraxaze)—for Methotrexate Toxicity
  • Uridine Triacetate (Vistogard)—for Capecitabine or Fluorouracil Toxicity

Hemorrhagic Cystitis (Bleeding in the Bladder)

  • Mesna (Mesnex)

Hepatic Veno-occlusive Disease (Blocked Liver Veins)

  • Defibrotide Sodium (Defitelio)

Hepatitis C Infection

  • Peginterferon Alfa-2b (PEG-Intron)

Hypercalcemia of Malignancy (High Blood Calcium)

Malignant Effusion

  • Bleomycin (Blenoxane)
  • Mechlorethamine Hydrochloride (Mustargen)
  • Talc (Sterile Talc Powder, Sclerosol Intrapleural Aerosol, Steritalc)
  • Thiotepa

Mucositis (Inflamed Mucous Membranes)

  • Palifermin (Kepivance)

Nausea and Vomiting

  • Aprepitant (Emend)
  • Netupitant and Palonosetron Hydrochloride (Akynzeo)
  • Ondansetron Hydrochloride (Zofran)
  • Palonosetron Hydrochloride (Aloxi)
  • Rolapitant Hydrochloride (Varubi)

Neurotoxicity (Nervous System Side Effects)

  • Uridine Triacetate (Vistogard)

Neutropenia (Low Blood Neutrophils)

  • Filgrastim (Neupogen, Zarxio)
  • Pegfilgrastim (Neulasta)

Osteoporosis (Loss of Bone Density)

  • Denosumab (Prolia)
  • Raloxifene Hydrochloride (Evista, Keoxifene)

Skin Changes Due to Cutaneous Metastases

  • Bexarotene (Targretin)

Thrombocytopenia (Low Blood Platelets)

Tumor Lysis Syndrome (Cell Breakdown and Organ Damage)

  • Rasburicase (Elitek)

Updated: April 7, 2016

Source: NCI (NIH)25

Alternative Treatments for Cancer

Are there herbal products that can cure cancer?

No. Although some studies suggest that alternative or complementary therapies, including some herbs, may help patients cope with the side effects of cancer treatment, no herbal products have been shown to be effective for treating cancer. In fact, some herbal products may be harmful when taken during chemotherapy or radiation therapy because they may interfere with how these treatments work. Cancer patients should talk with their doctor about any complementary and alternative medicine products—including vitamins and herbal supplements—they may be using. For more information, see the Botanicals/Herbal Products section in Topics in Integrative, Alternative, and Complementary Therapies.

Source: NCI (NIH)26

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References

  1. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ feb2016/ feature1
  2. Source: NCI (NIH): cancer.gov/ types/ aya
  3. ibid.
  4. ibid.
  5. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ types/ targeted-therapies/ targeted-therapies-fact-sheet
  6. Source: NCI (NIH): cancer.gov/ types/ childhood-cancers/ child-adolescent-cancers-fact-sheet
  7. ibid.
  8. ibid.
  9. Source: NCI (NIH): cancer.gov/ types/ childhood-cancers
  10. ibid.
  11. ibid.
  12. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ drugs/ related-conditions
  13. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 7/ 177/ 251/ chemotherapy
  14. Source: OWH (DHHS): womenshealth.gov/ a-z-topics/ oral-health
  15. Source: NHS Choices UK: nhs.uk/ conditions/ Cancer/ 
  16. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2008/ March/ docs/ 02capsules.htm
  17. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2005/ June2005/ docs/ 01features_01.htm
  18. Source: NCI (NIH): cancer.gov/ about-cancer/ coping/ feelings/ depression-pdq
  19. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ drugs/ off-label
  20. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 7/ 177/ 251/ chemotherapy
  21. Source: Queensland Health: conditions.health.qld.gov.au/ HealthCondition/ condition/ 7/ 177/ 537/ radiotherapy
  22. Source: Queensland Government: qld.gov.au/ health/ staying-healthy/ diet-nutrition/ dietitians
  23. Source: NHS Choices UK: nhs.uk/ conditions/ cervical-cancer/ complications/ 
  24. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ drugs
  25. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ drugs/ related-conditions
  26. Source: NCI (NIH): cancer.gov/ about-cancer/ causes-prevention/ risk/ myths

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Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.