SHARING EXPERTISE
Pharmacist Timothy Chiang talks about
Chemotherapy
Timothy Chiang is a pharmacist in the Upstate Cancer Center. PHOTO BY ROBERT MESCAVAGE
What is chemotherapy? Any medications that are used to treat fast-growing cells in the body, and typically this is referring to cancer cells. The goal is either to kill the cancer cells or to slow their growth.
Now it's commonly known as a drug called mechlorethamine. They first used it to treat a lymphoma patient in the 1940s, and that patient had great results with it and ended up in remission.
When did chemotherapy begin? The first chemotherapy drug was available back in the 1940s. It was derived from mustard gas, a chemical weapon that was used in World War I. A doctor was looking at some of the autopsy results for some of the soldiers from the First World War, and they noticed that the bone marrow in those patients was significantly altered by the mustard gas. They realized that they might be able to use this type of medication for cancer.
How has it evolved? Scientists are now using more targeted approaches to try to minimize some of the toxicities to patients. A lot of the new oral medications stop cell signaling, and some of the newer intravenous medications are looking at the same thing: They're targeting a specific molecule on the outside of a tumor and trying to minimize toxicity to our patients.
Some modifications were made to the mustard gas, and then it was made into an injectible product. At that point, it was called nitrogen mustard. 16
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We hope the medications have become less toxic. Unfortunately, there are still a lot of side effects even with some of these newer medications. By inhibiting a specific
molecular target, sometimes those targets still affect some normal cell function as well. And that's what leads to some of these side effects.
Why are some chemotherapies in pill form and some intravenous, through a needle? It depends on how the medication can be absorbed. Some medications can be absorbed orally, and when they go through the gut, they need to be converted by the liver. Some medications just aren't able to be absorbed that way. It also has to do with some of the toxicities of the medications, as well. What determines if a patient has to be hospitalized overnight for an infusion? Sometimes it has to do with certain risk factors for a particular patient. If they are at risk for having some type of reaction or have had a history of
