06 Aug 2024

Research blog: Decoding Chemotherapy: the backbone of leukaemia treatment

Despite advancements in treatment options, chemotherapy remains a cornerstone in the battle against leukaemia. This month we will delve into why this long-standing therapy still holds its ground as a frontline treatment for many battling this disease.

What is chemotherapy, and how does it work in treating leukaemia?

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy or damage leukaemia cells. These drugs interfere with the way leukaemia cells grow and divide. The biggest drawback of chemotherapy is that most treatments lack specificity and therefore also destroy healthy cells. This leads to a myriad of side effects and often leaves the patient with a compromised immune system, making them susceptible to common colds and infections. This in part is why chemotherapy has the reputation of being a gruelling, difficult treatment, and why some patients would rather opt for no treatment than to take on chemo(I).

How does chemotherapy target and destroys cancer cells?

Chemotherapy circulates throughout the body via the bloodstream, typically administered as an intravenous infusion. This systemic treatment allows it to target cancer cells almost anywhere in the body, making it a great mechanism for blood cancers as they circulate through the body. Chemotherapy typically works by targeting and killing cells that are in the process of dividing into two new cells. Since cancer cells divide much more frequently than most normal cells, chemotherapy is more likely to kill them. Some drugs kill dividing cells by damaging the part of the cell’s control centre that makes it divide, while others interrupt the chemical processes involved in cell division.

Despite the harsh side effects of chemotherapy, it endures as one of the leading treatment options, mainly because there are no other options as effective, versatile, and economically friendly. Its adaptability to treat different stages and types of cancer ensures it remains a cornerstone of leukaemia treatment, offering tailored solutions to meet the diverse needs of patients.

Chemotherapy plays a crucial role in overcoming drug resistance and relapse in leukaemia treatment. Combination therapies are bringing a new era of chemotherapy treatment, tailoring treatments better to patient needs and attempting to reduce side effects.

Chemotherapy does not discriminate: Mary’s Story

Chemotherapy, while effective, targets both healthy and cancerous cells, leading to significant side effects. This treatment affects fast-growing cells, including those in hair follicles, skin, and the digestive tract, which leads to common side effects such as:

• Nausea and vomiting
• Loss of appetite
• Diarrhoea
• Hair loss
• Mouth sores
• Skin dryness
• Fatigue(II)

Mary Forester, from Newbury, was given 3 rounds of chemotherapy over 6 months, after being diagnosed with acute myeloid leukaemia (AML). She eloquently described the impact of these side effects: “Chemo was rough, but even worse were the infections I got after the courses, the night sweats, and the endless rounds of antibiotics, which wiped me out, gave me a terrible upset stomach, took away my appetite, and left me wanting to sleep all day.”

For many patients, these side effects pose significant challenges. While medications can help manage symptoms like nausea, holistic care and support are crucial for improving patients’ chemotherapy experiences and aiding their recovery.

Throughout her treatment, Mary aimed to stay positive and active. She used a bike in her hospital room and tried to see the bright side in the chemotherapy side effects. She shared: “I have a very thick head of hair, but after the first round of chemo, it started falling out in handfuls. I would wake up every morning to a pillow covered in hair. Although it didn’t look too bad, the hair felt dead, so I asked the nurse to bring in her clippers and we just shaved it all off – such a relief.”

Mary continued: “I had coloured it for the previous 15 years and although I wanted to stop, I hated the thought of being a badger for months, so I kept colouring it. It started to grow back quite quickly after the second round, and thankfully the third round didn’t include the drug that causes hair to fall out. By the time I finished treatment, I had a good covering and thought I looked like Barack Obama! Since then, I have kept it au naturel and short and love my new look.”

Despite the gruelling treatment, Mary remains in remission and shares her story to help others on their journeys. Her experience demonstrates that, while chemotherapy is challenging, it is a vital and effective treatment option.

Looking ahead:

As we look to the future, chemotherapy remains a basis of leukaemia treatment, evolving alongside targeted therapies and immunotherapy. Integrating these new therapies into chemotherapy regimens promises not only to enhance efficacy but also to reduce the often-harsh side effects associated with traditional treatments. This is especially important as chemotherapy is also seen as the only treatment option in most infant and childhood leukaemia’s where the side effects are even more aggressive.

The importance of research in this field cannot be overstated. Organisations like Leukaemia UK are at the forefront, supporting vital research aimed at discovering and developing kinder, more effective treatments. Research has brought a myriad of treatment options including monoclonal antibodies and CAR-T therapy, which focus on kinder and more personalised treatments with fewer side effects. However, to make these alternative treatment options more readily available and successful more research is required – currently these do not stand to wholly replace chemotherapy which is still an important cog in the wheel that is the fight against leukaemia. `

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References:

(I) – Upadhyay VA, Fathi AT. Induction chemotherapy in acute myeloid leukaemia: origins and emerging directions. Curr Opin Hematol. 2018 Mar;25(2):67-74. doi: 10.1097/MOH.0000000000000407. PMID: 29337707.

(II) –  https://www.nhs.uk/conditions/chemotherapy/side-effects/ Accessed 12/06/2024