Chemotherapy for Wilms tumour

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Most children with Wilms tumour have chemotherapy. Your childʼs healthcare team will use what they know about the cancer and about your childʼs health to plan the drugs, doses and schedules.

In Canada, chemotherapy is usually given after surgery. This is called adjuvant chemotherapy. Adjuvant chemotherapy usually starts 7 to 14 days after surgery.

Sometimes chemotherapy is given before surgery to shrink tumours that canʼt be easily removed with surgery or if a partial nephrectomy is planned. This is called neoadjuvant chemotherapy.

Chemotherapy can also be given to relieve pain or control the symptoms of advanced Wilms tumour. This is called palliative chemotherapy.

Chemotherapy may affect how puberty develops in children. It can eventually affect their fertility, which is the ability to get pregnant or get someone pregnant. If possible, talk to the healthcare team about fertility options before treatment begins.

Chemotherapy drugs may be given by mouth (orally) or by a needle in a vein (intravenously, or by IV).

Usually a special device called a central venous catheter is used to safely give the drugs. Itʼs put in place at the start of chemotherapy and left until treatment is finished. Find out more about a central venous catheter.

High-dose chemotherapy may be used to treat recurrent Wilms tumour, although it is still being studied.

After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that are damaged or destroyed by the chemotherapy drugs. This is called a stem cell rescue. The stem cell transplant uses stem cells from your childʼs own blood (called an autologous stem cell transplant). The stem cells are collected from the blood before high-dose chemotherapy is given.

Find out more about a stem cell transplant.

The chemotherapy drugs used for Wilms tumour depend on:

• the type of Wilms tumour (whether it has a favourable or anaplastic histology)
• the stage of the cancer
• chromosome changes in the cancer cells
• the childʼs age
• how the cancer responded to chemotherapy given previously, if the cancer has come back (recurred)

The most common chemotherapy drug combinations used for Wilms tumour are:

• vincristine and dactinomycin
• vincristine, dactinomycin and doxorubicin
• vincristine, doxorubicin, etoposide, cyclophosphamide and carboplatin
• vincristine, doxorubicin, dactinomycin, cyclophosphamide and etoposide

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

• vincristine, doxorubicin and cyclophosphamide alternating with etoposide and cyclophosphamide
• ifosfamide, carboplatin and etoposide
• cyclophosphamide and etoposide alternating with carboplatin and etoposide

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

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your child’s overall health. Tell the healthcare team if your child has any side effects 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.

Common side effects of chemotherapy for Wilms tumour include:

• low blood cell counts
• fatigue
• nausea and vomiting
• hair loss
• skin problems
• sore mouth and throat
• taste changes
• 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.

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.

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