Chemotherapy & targeted therapies
Chemotherapy can feel daunting, but knowing what to expect can help you feel more prepared. Here's a practical guide.
What is chemotherapy?
Chemotherapy uses anti-cancer drugs to destroy cancer cells or stop them from growing. For bowel cancer, it may be given:
- •After surgery (adjuvant) – to reduce the risk of cancer coming back
- •Before surgery (neoadjuvant) – to shrink the tumour, especially for rectal cancer
- •As a main treatment – for advanced or metastatic bowel cancer
Common chemotherapy regimens
Your oncologist will choose a regimen based on your cancer's stage, location, and your overall health. Some of the most common regimens for bowel cancer include:
FOLFOX
A combination of fluorouracil (5-FU), leucovorin, and oxaliplatin. One of the most commonly used regimens for bowel cancer after surgery. Given as an infusion, usually every two weeks.
CAPOX (XELOX)
A combination of capecitabine (Xeloda) tablets and oxaliplatin infusion. Given every three weeks. The tablets are taken at home, making it a popular option for people who prefer fewer hospital visits.
5-FU / Capecitabine alone
Sometimes a single drug is used, especially for people who may not tolerate combination therapy. Capecitabine is taken as tablets at home.
FOLFIRI
A combination of fluorouracil, leucovorin, and irinotecan. Often used for advanced bowel cancer, sometimes as a second-line treatment.
Don't worry about memorising these names. Your oncologist will explain which regimen they recommend and why.
How treatment is given
Chemotherapy for bowel cancer is typically given in cycles – a period of treatment followed by a rest period to let your body recover. A full course usually lasts 3 to 6 months, depending on the regimen and your situation.
- •Infusion (IV) – given through a drip at a hospital or clinic. Some infusions take a few hours; others are given through a portable pump over 46 hours that you take home.
- •Tablets – some drugs like capecitabine are taken at home as tablets, which many people find more convenient.
- •Port or PICC line– if you're having IV treatment, you'll likely have a small device inserted under your skin to make infusions easier and more comfortable.
Side effects and managing them
Side effects vary depending on the drugs used and how your body responds. Not everyone gets every side effect. Your care team can help you manage them.
Fatigue
The most common side effect. Rest when you need to, but gentle activity like short walks can actually help.
Nausea and vomiting
Anti-nausea medication is very effective and is usually given alongside chemo. Let your team know if your nausea isn't controlled – they can adjust the medication.
Numbness or tingling (peripheral neuropathy)
Common with oxaliplatin. You may notice tingling in your hands and feet, or sensitivity to cold. Tell your oncologist if this happens – they may adjust your dose.
Diarrhoea or mouth sores
Some chemo drugs can affect your digestive system. Your team will give you medication and advice to manage this.
Low blood counts
Chemo can temporarily lower your white blood cells, making you more susceptible to infection. Blood tests before each cycle will monitor this. Contact your team immediately if you develop a fever.
Important:If you have a temperature of 38°C or above during treatment, contact your hospital team immediately. Fever during chemo needs to be checked urgently.
Targeted therapies
Targeted therapies are newer drugs that attack specific features of cancer cells. They're often used alongside chemotherapy for advanced bowel cancer.
Bevacizumab (Avastin)
Blocks the growth of blood vessels that feed the tumour. Given as an infusion alongside chemotherapy. Funded by PHARMAC for some situations.
Cetuximab (Erbitux)
Targets a protein called EGFR on the surface of cancer cells. Only works for cancers that are RAS wild-type (your oncologist will test for this). Given as an infusion.
Panitumumab (Vectibix)
Similar to cetuximab – also targets EGFR and is only effective for RAS wild-type cancers. Given as an infusion.
Your oncologist will test your tumour's genetic features (biomarkers) to determine which targeted therapies, if any, may work for you.
Practical tips for treatment days
Here are some things that people who've been through chemo suggest:
- •Bring something to pass the time – a book, podcast, or downloaded shows
- •Wear comfortable, loose clothing with easy access to your arm or chest for the IV
- •Bring snacks and water – treatment sessions can be long
- •Arrange a ride home. You may feel tired or unwell after treatment
- •Keep a diary of side effects to share with your team at your next visit
- •Avoid very cold drinks or foods if you're on oxaliplatin – cold can trigger tingling or pain
- •Accept help when it's offered – meals, rides, company
Next steps
Learn about other aspects of treatment, or connect with people who understand:
Need help understanding your treatment?
Our nurse support line can talk you through what to expect and help you prepare. Call 0800 226 968 – it's free and confidential.