Chemotherapy for Wilms tumour

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most children with Wilms tumour have chemotherapy. The healthcare team will consider your child’s personal needs to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.

Chemotherapy is given for different reasons. Your child may have chemotherapy to:

• shrink a tumour before surgery (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• destroy cancer cells in the body, relieve pain or control the symptoms of advanced Wilms tumour

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the kidney.

Chemotherapy drugs used to treat Wilms tumour are:

• vincristine (Oncovin)
• dactinomycin (Cosmegen, actinomycin-D)
• doxorubicin (Adriamycin)
• cyclophosphamide (Procytox)
• cisplatin
• carboplatin (Paraplatin, Paraplatin AQ)
• etoposide (Vepesid, VP-16)
• irinotecan (Camptosar)

The most common chemotherapy drug combinations used to treat Wilms tumour are:

• vincristine and dactinomycin
• vincristine, dactinomycin and doxorubicin
• vincristine, doxorubicin, etoposide and cyclophosphamide (with or without dactinomycin or carboplatin)

If Wilms tumour does not respond to drugs used in earlier treatments or if it comes back, the following drug combinations may be used:

• vincristine, doxorubicin and cyclophosphamide
• ifosfamide (Ifex), carboplatin and etoposide
• cyclophosphamide and etoposide alternating with carboplatin and etoposide

Cyclophosphamide can irritate the bladder. When this chemotherapy drug is used, mesna (Uromitexan) may also be given to protect the bladder.

Side effects can happen with any type of treatment for Wilms tumour, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child’s body seems to handle chemotherapy better than an adult’s body. Children usually have less severe side effects and will often recover from them faster than adults.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your child’s overall health. Some common side effects of chemotherapy drugs used for Wilms tumour are:

• low blood cell counts
• fatigue
• nausea and vomiting
• hair loss
• skin problems
• sore mouth and throat
• changes in taste
• loss of appetite
• diarrhea
• constipation
• bladder problems
• kidney problems
• liver problems
• muscle and joint pain
• peripheral nerve damage

Other side effects can develop months or years after treatment for Wilms tumour. Find out more about late effects of treatments for Wilms tumour.

Tell your child’s healthcare team if your child has these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for your child, ask the healthcare team questions about chemotherapy.