Does chemo alone kill the cancer cells?

Tim6003 · October 2012

Hey all..just a quick question if I may.

Since I have seen on here and also read in the past that many times you can have radiation but not always in the same place or depending on the strength...

Does chemo alone kill cancer cells / tumors?

I would think it does / can ..and I know everybody is different ..but can you give me an "average person response" (there I go again with stats) ..be patient with me ...stats are part of my culture at work

For instance, I had Erbitux only along with radiation..nothing else. So if Erbitux is suppose to "inhibit" cancer cells from splitting, thus they can't grow...doesn't that mean that Erbitux can "kill" cancer?

If the answer is yes, then why do we endure radiation and chemo and not just chemo first? When I asked why I was not going to have surgery, the ENT / Onc said that would be an optioon AFTER radiation / chemo..so why not radiation being an option after chemo, and then surgery after radiation ? You all get where I am going with this ...

This will be a thread I print for future reference

Thanks all

Tim

blackswampboy · October 2012

I wouldn't trust anybody but an oncologist to answer that.
but this is what the erbitux product info says:

ERBITUX, in combination with radiation therapy, is indicated for the initial treatment of a certain type of locally or regionally advanced head and neck cancer.
ERBITUX, in combination with platinum-based chemotherapy with 5-fluorouracil, is indicated for the initial treatment of patients with a certain type of head and neck cancer whose tumor has returned in the same location or spread to other parts of the body.
ERBITUX is also approved for use alone to treat patients with a certain type (called squamous cell carcinoma) of head and neck cancer whose tumor has returned to the same location or spread to other parts of the body and whose disease has progressed following platinum-based chemotherapy.

my unreliable supposition is that erbitux is not "approved" to be used alone for initial treatment. who knows?--it might very well do the job by itself. but if it hasn't gone through all the rigorous testing yet, doctors aren't likely to use it that way.

Tim6003 · October 2012

blackswampboy said:
I wouldn't trust anybody but an oncologist to answer that.
but this is what the erbitux product info says:

ERBITUX, in combination with radiation therapy, is indicated for the initial treatment of a certain type of locally or regionally advanced head and neck cancer.
ERBITUX, in combination with platinum-based chemotherapy with 5-fluorouracil, is indicated for the initial treatment of patients with a certain type of head and neck cancer whose tumor has returned in the same location or spread to other parts of the body.
ERBITUX is also approved for use alone to treat patients with a certain type (called squamous cell carcinoma) of head and neck cancer whose tumor has returned to the same location or spread to other parts of the body and whose disease has progressed following platinum-based chemotherapy.

my unreliable supposition is that erbitux is not "approved" to be used alone for initial treatment. who knows?--it might very well do the job by itself. but if it hasn't gone through all the rigorous testing yet, doctors aren't likely to use it that way.

Thanks BSB
...good info...but I also wonder about any type chemo (like the platinum based ones).

Best,

Tim

ToBeGolden · October 2012

My Trip
2010: Radiation Only. Tumor was small and confined to the larynx. Radiation only was "supposed to" spare my vocal cords. It did this for a little while.
2011: Cancer was "hiding" in the cartilage. Grew to a point where the cancer was seriously inhibiting my airway. Total Laryngectomy.
2012: But even after removing everything that could be removed (and more), the cancer was still there (known by PET). So radiation with Erbitux.
Now: Cancer MAY have migrated to lungs. If true, even more awful chemo in my future.

Surgery or radiation is best because cancer is confined to an area and can be attacked. When the cancer has spread everywhere, there is nothing left but chemo, which goes everywhere. Rick.

CivilMatt · October 2012

give me the chemo, hold the rads and surgery
Tim,

Chemo disrupts the division of caner cells, where ever it may be in the body. So I guess if the chemo got every cancer cell you would be ok. Are you going to ask for a do over, because if you are I want to go back about 35 years for my do over?

Best always,

Matt

luvofmylif · October 2012

CivilMatt said:
give me the chemo, hold the rads and surgery
Tim,

Chemo disrupts the division of caner cells, where ever it may be in the body. So I guess if the chemo got every cancer cell you would be ok. Are you going to ask for a do over, because if you are I want to go back about 35 years for my do over?

Best always,

Matt

What they told us in regards
What they told us in regards to the chemo he is receving was that it is given as a "radiosensitizer". It enhances/strenghtens the radiation. I tried to read up on this and basically it's way over my head but interesting to read. So, you might want to google chemo as a radisensitizer with radiation.

Joan

longtermsurvivor · October 2012

there has never been a documented case
where an SCC was cured by chemotherapy alone. This is why it is never used as a treatment modality by itself, if the purpose of treatment is to cure rather than paliate..

Best

Pat

fisrpotpe · October 2012

simple
keeping it simple

my doc kept it very simple for me, "chemo's act like a magnet to the radiation so the radiation gives you more bang for the buck"

i had cisplatin and 5FU.

from my observation, i have heard many who have had just chemo after surgery for just a clean up of lingering/missed cancer cells.

i had my surgery post radiation, seemed to work pretty well.

surgery before in my observation are the simple surgeries where the cancer is in the early stages and in a pin pointed area

actually i do not get where your going with this, it would help me if i knew and you would share.

i go with doctors, as i know for certain they know more than me from their schooling and experience. just look at them and say "if i was your mother, how would you treat me?" and then "would you treat me or send me to someone else better than you?"

"nothing good comes out by taking the easy road"

john

katenorwood · October 2012

Excellant idea...
Tim,
Knowledge in case of future reoccurrances....not a bad idea. I agree to ask these questions to a qualified oncologist. Research done by these people is immense...and it never hurts us as survivors to know and document any and all information that relates to our specific dx. For some not all it gives us peace of mind to know our options. Good post Tim ! Katie

corleone · October 2012

Short answer yes, but not all of the cancer cells.
Hi Tim,
Virtually no malignancies have been cured using single modalities of treatment. Hence the concept of combining 2 modalities of cancer treatment, radiation and drug therapy, to provide enhanced tumor cell kill in the treatment of cancer. These drugs may be traditional chemotherapeutic agents or some of the newer molecular targeting agents (like Erbitux). Their use to augment the effectiveness of external beam radiation therapy in the treatment of solid tumors is established and well documented in the medical literature. Sensitization probably results when cancer cells misrepair DNA damage inflicted by radiation.

cureitall66 · October 2012

We were told..
the same thing that luvofmylife and fisrpotp were told. The chemo acts as an enhancer, magnet, or radiosensitizer. They do very well together. Not sure if your just concerned about the recurrence and the need of just needing chemo alone or what...I just led a thread couple days ago about radiation limits in a lifetime if you want to check that out.

I have a list of questions the length of my arm for our next doctor appointment...he's gonna love me.

D Lewis · October 2012

cureitall66 said:
We were told..
the same thing that luvofmylife and fisrpotp were told. The chemo acts as an enhancer, magnet, or radiosensitizer. They do very well together. Not sure if your just concerned about the recurrence and the need of just needing chemo alone or what...I just led a thread couple days ago about radiation limits in a lifetime if you want to check that out.

I have a list of questions the length of my arm for our next doctor appointment...he's gonna love me.

In my case...
I was told that for my SCC, radiation was the primary treatment, and the chemo was adjunct, i.e. it sensitized the cells to radiation, and also killed wandering cancer cells on its own.

Tim6003 · October 2012

D Lewis said:
In my case...
I was told that for my SCC, radiation was the primary treatment, and the chemo was adjunct, i.e. it sensitized the cells to radiation, and also killed wandering cancer cells on its own.

Ooops...
Sorry if I confused some.

1st. I have no worry or specific goal......If I had to give a reason for the question it would ceratainly be along the lines of "knowledge for future, but not specifically for me. Most of you know, maybe some do not, but last year I lost my Dad and my brohter to cancer .....I had plenty of questions then, but my brother was the type of individual who just accepted what the docs said, 4% chance to be around in 3 years (brain cancer like waht Ted Kennedy had) ...My Dad was dx with acute Leukemia and given 30 days to live, he made it 3 months, but really suffered, he never had a good day after dx (he showed up in the hospital with a 105' fever and was there for 10 days before they gave him the dx). Dad was super healthy for a 73 year old, he still walked 2 miles a day and ran his brokerage out of his home office.

It's just a question I have had ever since I was diagnosed with cancer. I am the type of person who loves to read up on anything and everthing. I asked a visiting onc one time during tx when my reg onc was out if the Erbitux actually kills the cancer cells, he said yes. I asked my reg onc one time if the Erbitux kilss the cancer cells, he said it sensitizes them to radiation ..and over the months I would sneak that question in and "walla" ..I would get multiple answers...that is the kind of stuff that drives my kind of brain crazy ...so I thought I would just ask you all

As you can see, we all kind of got different answers ...but that's okay....

My oldest son is going to be like me. ever asking and seeking answers. He asked me one day "Dad, who invented money"? I really could not answer his question to well, then he just matter of factly stated "Well, whoever did it, it was a dumb idea, because it sure does nothing but cause problems"! ...I just laughed so hard at that.

...this is the same boy that asked me one time when we were going camping if we could "catch a fish and eat it"? I explained to him that unfortunately your dad was never taken fishing when I was young and I am not sure I would know how to clean the fish to eat it...there was a long pause in the back seat of the truck and then he just blurted out "that's okay dad, we can just catch a clean fish"!!!

Best,

Tim

Skiffin16 · October 2012

I Hear What You Are Saying...But...
Pat, and others...I hear what you say, but can only speak of my experience.

As you know I had nine weeks in cycles of cisplatin, taxotere and 5FU up front before another seven weeks of concurrent weekly carboplatin with daily rads.

Going in I had STGIII SCC Tonsils and a lymphnode on the same side as the affected tonsil (right).

They removed the tonsils (both), extra tissue scooped out on the right side. But left the tumor pending results of treatment.

The thinking was it would end up somewhere between being gone, shrinking and less envasive surgery, or dissection.

In my case the tumor (which did light up on it's own with the first PET), was completely gone after the nine weeks of Chemo...

This was confirmed with a CT before starting the additional seven weeks of chemo and rads.

Soooo....

Though if what you say is true, I presume that I could have still had cancer cells floating around. But the chemo zapped the tumor before I had rads...

Thoughts, opinions...?

JG

blackswampboy · October 2012

Tim6003 said:
Ooops...
Sorry if I confused some.

1st. I have no worry or specific goal......If I had to give a reason for the question it would ceratainly be along the lines of "knowledge for future, but not specifically for me. Most of you know, maybe some do not, but last year I lost my Dad and my brohter to cancer .....I had plenty of questions then, but my brother was the type of individual who just accepted what the docs said, 4% chance to be around in 3 years (brain cancer like waht Ted Kennedy had) ...My Dad was dx with acute Leukemia and given 30 days to live, he made it 3 months, but really suffered, he never had a good day after dx (he showed up in the hospital with a 105' fever and was there for 10 days before they gave him the dx). Dad was super healthy for a 73 year old, he still walked 2 miles a day and ran his brokerage out of his home office.

It's just a question I have had ever since I was diagnosed with cancer. I am the type of person who loves to read up on anything and everthing. I asked a visiting onc one time during tx when my reg onc was out if the Erbitux actually kills the cancer cells, he said yes. I asked my reg onc one time if the Erbitux kilss the cancer cells, he said it sensitizes them to radiation ..and over the months I would sneak that question in and "walla" ..I would get multiple answers...that is the kind of stuff that drives my kind of brain crazy ...so I thought I would just ask you all

As you can see, we all kind of got different answers ...but that's okay....

My oldest son is going to be like me. ever asking and seeking answers. He asked me one day "Dad, who invented money"? I really could not answer his question to well, then he just matter of factly stated "Well, whoever did it, it was a dumb idea, because it sure does nothing but cause problems"! ...I just laughed so hard at that.

...this is the same boy that asked me one time when we were going camping if we could "catch a fish and eat it"? I explained to him that unfortunately your dad was never taken fishing when I was young and I am not sure I would know how to clean the fish to eat it...there was a long pause in the back seat of the truck and then he just blurted out "that's okay dad, we can just catch a clean fish"!!!

Best,

Tim

getting specific
sometimes the phrasing of the question determines the answers we get.

don't think you're gonna get a satisfactory answer for all "chemo" in general--since erbitux isn't much like platinum-based drugs, and vice versa.
and since the mechanisms are so complex, a yes-no answer doesn't always do justice.

reading the mechanism of action for erbitux seems pretty clear.

"In vitro assays and in vivo animal studies have shown that cetuximab inhibits the growth and survival of tumor cells that express the EGFR. No anti-tumor effects of cetuximab were observed in human tumor xenografts lacking EGFR expression. The addition of cetuximab to radiation therapy or irinotecan in human tumor xenograft models in mice resulted in an increase in anti-tumor effects compared to radiation therapy or chemotherapy alone."

they do claim that erbitux induces "apoptosis", which is programmed cell death.
BUT only for cells with the EGFR protein.
so to your original Q, seems safe to say "yes. erbitux alone kills cancer cells--with conditions."
but I'm no expert. and no idea about other types of chemo.

btw, an admirable trait, seeking answers. :-)

longtermsurvivor · October 2012

Skiffin16 said:
I Hear What You Are Saying...But...
Pat, and others...I hear what you say, but can only speak of my experience.

As you know I had nine weeks in cycles of cisplatin, taxotere and 5FU up front before another seven weeks of concurrent weekly carboplatin with daily rads.

Going in I had STGIII SCC Tonsils and a lymphnode on the same side as the affected tonsil (right).

They removed the tonsils (both), extra tissue scooped out on the right side. But left the tumor pending results of treatment.

The thinking was it would end up somewhere between being gone, shrinking and less envasive surgery, or dissection.

In my case the tumor (which did light up on it's own with the first PET), was completely gone after the nine weeks of Chemo...

This was confirmed with a CT before starting the additional seven weeks of chemo and rads.

Soooo....

Though if what you say is true, I presume that I could have still had cancer cells floating around. But the chemo zapped the tumor before I had rads...

Thoughts, opinions...?

JG

Hi John
in my case, too, there was no tumor visible to either PET or CT scan after a few months of chemo. This certainly does not imply that the tumor is gone, just that it has been reduced to the point that CT nor PET can discern it. For both, the limits of resolution are about one centimeter, and that is if the tumor is discretely circumscribed. If it is infiltrative, mthose size limits are pretty meaningless. The problem becomes one of tumor resistence to chemotherapy, which happens very routinely in SCC. It bears remarking again that, in this fashion SCC behaves differently than a number of the other cancers, which can and are cured by chemotherapy. Here is a reference which hints at the problem behind this topic. By the time you cytoreduce a tumor down to even one cm volume ( the lower limits of CT or PET discernment) you still are dealing with 100000000 cancer cells. One survivor is all it takes.

http://radiology.rsna.org/content/91/2/339.extract

best

Pat

luvofmylif · October 2012

longtermsurvivor said:
Hi John
in my case, too, there was no tumor visible to either PET or CT scan after a few months of chemo. This certainly does not imply that the tumor is gone, just that it has been reduced to the point that CT nor PET can discern it. For both, the limits of resolution are about one centimeter, and that is if the tumor is discretely circumscribed. If it is infiltrative, mthose size limits are pretty meaningless. The problem becomes one of tumor resistence to chemotherapy, which happens very routinely in SCC. It bears remarking again that, in this fashion SCC behaves differently than a number of the other cancers, which can and are cured by chemotherapy. Here is a reference which hints at the problem behind this topic. By the time you cytoreduce a tumor down to even one cm volume ( the lower limits of CT or PET discernment) you still are dealing with 100000000 cancer cells. One survivor is all it takes.

http://radiology.rsna.org/content/91/2/339.extract

best

Pat

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Does chemo alone kill the cancer cells?

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