Cancer treatments

Chemotherapy is a cancer treatment that uses anti-cancer drugs to stop cancer cells from dividing and spreading. Although there are many different types of chemotherapy drugs, they generally work in a similar way by targeting rapidly dividing cells.

At CUH, chemotherapy may be given in several ways:

• It can be administered into a vein (intravenous chemotherapy), usually in hospital through a tube placed in a vein in the hand, arm or chest
• It may be taken as tablets (oral chemotherapy), which are typically taken at home with regular hospital check-ups
• It can be given alone, combined with different chemotherapy drugs, or used alongside other treatments such as immunotherapy or radiotherapy.

Chemotherapy may be used before surgery (neoadjuvant treatment) to shrink tumours or after surgery (adjuvant treatment) to reduce the risk of cancer returning. It remains one of the most common systemic cancer treatments, particularly for cancers of the breast, lung, bowel and blood. In some cases, it may also be used to help control symptoms when a cure is not possible. Chemotherapy is usually given in cycles, allowing healthy cells time to recover between treatments.

Hormone therapy is a treatment used for cancers that rely on hormones to grow (hormone-sensitive or hormone-dependent cancers). It works by lowering hormone levels in the body or blocking hormones from helping cancer cells grow and divide. By doing this, hormone therapy can slow down or stop the growth of certain cancers.

It is most commonly used to treat hormone-sensitive breast cancer and prostate cancer, and may also be used for womb (uterine or endometrial) cancer. In rare cases, it can be used for ovarian cancer. Hormone therapy does not work for all cancers.

There are several types of hormone therapy. Treatment may be given as tablets or injections and is often an important part of long-term cancer management.

Targeted therapy is a type of cancer treatment that uses drugs or other substances to identify and attack specific features of cancer cells. These treatments focus on the genetic changes or mutations that cause healthy cells to become cancer cells. By targeting these changes, targeted therapy can destroy or control cancer cells while causing less harm to healthy cells.

Cancer develops when the genetic instructions inside normal cells are altered, causing them to grow and divide uncontrollably. To use targeted therapy effectively, oncologists first identify the specific genetic mutation or abnormal process driving the cancer. They then select treatments designed to target particular parts of the cancer cell, such as proteins on the cell surface or substances inside the cell that help it grow and survive. The targeted drug may kill the cancer cells directly or block the signals that allow them to multiply.

There are several types of targeted therapy, which are classified according to how they work. These include:

• Small-molecule drugs that act inside cancer cells to disrupt their growth
• Immunotherapy-based treatments such as monoclonal antibodies, bispecific antibodies and CAR T-cell therapy
• Antibody–drug conjugates that deliver cancer-killing drugs directly to the tumour cells

Targeted therapy is used to treat many types of cancer including melanoma, kidney cancer, lung cancer and certain types of leukaemia. It may be used on its own or combined with other treatments such as chemotherapy, surgery or radiotherapy.

Immunotherapy is a type of cancer treatment that helps the body’s immune system recognise and attack cancer cells. It is increasingly used for many types of cancer, including melanoma, lung cancer, head and neck cancers, and bladder cancer.

There are several types of immunotherapy, each working in a different way to strengthen or guide the immune system. These can include:

• Immune checkpoint inhibitors, which help the immune system recognise cancer cells and boost immune response
• Monoclonal antibodies, which are laboratory-made proteins designed to attach to specific targets on cancer cells
• Cancer vaccines and immune modulators that enhance the immune response
• CAR T-cell therapy, which modifies certain white blood cells so they can better find and destroy cancer cells

Immunotherapy may be given on its own or combined with other treatments such as chemotherapy, a combination called chemoimmunotherapy. It is usually given intravenously (through a vein) or sometimes as an injection into skin or muscle, or sometimes directly into the tumour. Treatment may be administered daily, weekly, monthly, or intermittently, with rest periods between treatments to allow the body time to recover and produce healthy cells.

Cellular therapy is a treatment that uses the body’s own immune cells to fight disease. Although the processes involved are complex, these therapies have the potential to treat a range of conditions, including cancer and some autoimmune diseases.

There are several types of cellular therapy:

• CAR T-cell therapy, which is a highly specialised form of immunotherapy used for certain blood cancers that have not responded to standard treatments. It works by modifying T cells, so they can more effectively recognise and attack cancer cells.
• Tumour infiltrating lymphocyte (TIL) therapy, which is a personalised treatment that uses immune cells taken directly from a patient’s tumour to help fight advanced cancers.
• Gene therapy, which is a highly targeted approach that involves modifying a patient’s DNA or immune cells so they can detect and destroy tumour cells while minimising damage to healthy tissue.
• Bone marrow (stem cell) transplantation, which is a procedure that replaces damaged or diseased bone marrow with healthy blood-forming stem cells.
• Autologous stem cell transplantation, where a patient’s own stem cells are collected, stored and later reinfused after high-dose chemotherapy or radiation to restore bone marrow function

In many cellular therapies, immune cells are collected from a patient’s blood, although in some cases they may be taken from tumour tissue during surgery. The cells are then grown or genetically modified in a laboratory so they can target cancer or other disease-causing cells. Before the modified cells are returned to the body, patients often receive chemotherapy to prepare the immune system. The cells are then infused back into the bloodstream, where they work to identify and attack the harmful cells.