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Chemotherapy (chemo) is the use of anti-cancer drugs that are injected into a vein or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment useful for some types of lung cancer that have spread to organs beyond the lungs.

Unfortunately, carcinoid tumors usually do not respond very well to chemo. It is mainly used for carcinoid tumors that have spread to other organs, are causing severe symptoms, have not responded to other medicines, or atypical carcinoids that are dividing quickly. Sometimes, it may be given after surgery.

Because chemo does not always shrink carcinoid tumors, it is important to ask your doctor about the chances of it helping and if the benefits are likely to outweigh the risk of side effects.

Some of the chemo drugs that may be used for advanced lung carcinoids include:

• Etoposide (VP-16)
• Cisplatin
• Carboplatin
• Temozolomide
• Oxaliplatin
• 5-fluorouracil (5-FU)
• Streptozocin

Chemo drugs can be used together or alone, and often along with other types of medicines. Frequently used chemo drugs/combinations include carboplatin/etoposide, cisplatin/etoposide, temozolomide, and oxaliplatin .

Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks, and initial treatment is typically 4 to 6 cycles. Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemo.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

These side effects usually go away after treatment is finished. There are often ways to avoid or lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Some drugs can have other side effects. For example, cisplatin can damage nerve endings (a condition called neuropathy). This may lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it may last a long time in some people. For more information, see Peripheral Neuropathy.

You should tell your medical team about any side effects or changes you notice while getting chemotherapy, so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep the effects from worsening.