Chemotherapy and Targeted Cancer Therapy: Modern Approaches and Safety

Introduction to modern cancer treatment methods

Oncological diseases remain one of the leading causes of death worldwide, but thanks to the continuous development of medicine, new, more effective, and safer treatment methods are emerging. Modern oncology offers a comprehensive approach, including surgery, radiation therapy, chemotherapy, targeted therapy, and radiopharmaceutical therapy. The choice of treatment method depends on the type of cancer, its stage, the patient's general condition, and the presence of comorbidities.

The goal of these methods is to destroy cancer cells, slow tumor growth, prevent metastasis, and improve the quality of life for patients. However, like any powerful medical intervention, they can be accompanied by side effects that require careful monitoring and management.

Chemotherapy: principles and side effect management

Chemotherapy is a systemic treatment that uses drugs to kill rapidly dividing cells, including cancer cells. It can be used as a standalone method or in combination with other types of therapy, for example, with radiation therapy (chemoradiotherapy).

One example of a chemotherapeutic agent is oxaliplatin, which is used in treatment regimens for various types of cancer, including colorectal cancer. However, chemotherapy can cause serious side effects. For instance, in one case, a 73-year-old patient with rectal cancer who received postoperative chemotherapy using the XELOX regimen (which includes oxaliplatin) developed rhabdomyolysis — the breakdown of muscle tissue. Symptoms included involuntary muscle twitching, weakness in the lower extremities, decreased urine output, and dark urine. Laboratory tests showed a significant increase in creatine kinase levels [3]. This case highlights the need for careful monitoring of patients' conditions during chemotherapy and timely response to adverse reactions.

Combined chemoradiotherapy is also actively used. For example, in a study on the efficacy and safety of adjuvant apatinib therapy following concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma, chemoradiotherapy was the control treatment method [4].

Targeted therapy: focused impact on the tumor

Targeted therapy is a more modern approach aimed at specific molecular targets that play a key role in the growth and survival of cancer cells. This allows for more selective action, minimizing damage to healthy tissues compared to traditional chemotherapy.

An example of a targeted drug is apatinib, a vascular endothelial growth factor receptor (VEGFR) inhibitor. A multicenter, prospective phase 2 study investigated the efficacy and safety of adjuvant apatinib therapy (250 mg/day orally for up to six cycles) following concurrent chemoradiotherapy in patients with high-risk locally advanced nasopharyngeal carcinoma. The results showed that combination therapy with apatinib improved 3-year progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS) compared to chemoradiotherapy alone [4]. This demonstrates the potential of targeted therapy in improving long-term treatment outcomes.

Radiopharmaceutical therapy: an innovative approach

Radiopharmaceutical therapy (RPT) is an innovative treatment method in which radioactive isotopes are delivered directly to cancer cells using specific carrier molecules. This allows for internal irradiation of the tumor, minimizing the impact on surrounding healthy tissues.

One such method is ¹⁷⁷Lu-PSMA-617 therapy, which is an established treatment for metastatic castration-resistant prostate cancer. Since the radiopharmaceutical is excreted by the kidneys, the kidneys receive measurable radiation exposure. This requires routine monitoring of kidney function before each treatment cycle and after therapy. A study conducted between 2022 and 2025 showed that understanding the dynamics of kidney function, especially in patients with comorbidities (such as hypertension and diabetes) and pre-existing renal impairment, is of clinical importance for treatment planning and safety assessment. The study evaluated the stability of kidney function using longitudinal changes in estimated glomerular filtration rate (eGFR) and serum creatinine levels during and shortly after therapy in 56 patients who received at least two cycles of ¹⁷⁷Lu-PSMA-617 [1].

The importance of monitoring and treatment safety

Regardless of the chosen treatment method, careful monitoring of the patient's condition and management of side effects are critical aspects of oncological care. This includes:

• Regular laboratory tests: For example, monitoring kidney function (eGFR, creatinine) during ¹⁷⁷Lu-PSMA-617 radiopharmaceutical therapy [1] or creatine kinase levels when rhabdomyolysis is suspected during oxaliplatin chemotherapy [3].
• General condition assessment: Observing for the appearance of new symptoms, such as muscle twitching or weakness [3].
• Efficacy assessment: Regular evaluation of progression-free survival, overall survival, and other indicators for targeted therapy [4].
• Management of comorbidities: Accounting for conditions such as hypertension and diabetes, which can affect treatment tolerance and organ function, such as the kidneys [1].

A comprehensive approach to monitoring allows for the timely detection and correction of adverse reactions, ensuring maximum efficacy and safety of the therapy.

Sources

1. Renal Function During and After ¹⁷⁷Lu-PSMA-617 Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/42481178/
2. Oxaliplatin-induced rhabdomyolysis in a postoperative rectal cancer patient: a case report and literature review. https://pubmed.ncbi.nlm.nih.gov/42712673/
3. Adjuvant apatinib therapy following concurrent chemoradiotherapy in patients with high-risk nasopharyngeal carcinoma: A multicenter, prospective phase 2 study. https://pubmed.ncbi.nlm.nih.gov/42551128/

Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional consultation, diagnosis, or treatment provided by a qualified medical professional. Always seek the advice of your physician or another qualified healthcare provider with any questions regarding your health or medical condition.