A cancer treatment that uses drugs to stop the growth of cancer cells
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).
When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Chemoembolisation of the hepatic artery may be used to treat cancer that has spread to the liver. This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver's arteries then deliver the drugs throughout the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the hepatic portal vein, which carries blood from the stomach and intestine.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
If your oncologist believes you will benefit from chemotherapy, they will discuss the best treatment plan options with you. You may be prescribed one drug or a combination of drugs.
Depending on the stage of your bowel cancer, you may also be recommended treatment with targeted therapies.
The chemotherapy drugs licensed for treatment of bowel cancer in Australia are:
- 5-FU (5-fluorouracil)
- Capecitabine (Xeloda)
- Oxaliplatin (Eloxatin)
- Irinotecan (Camptosar)
A combination of two or more drugs is common, for example:
- FOLFOX (5-FU + Oxaliplatin)
- FOLFIRI (5-FU + Irinotecan)
- FOLFOXIRI (5-FU + Oxaliplatin + Irinotecan)
- XELOX (Capecitabine + Oxaliplatin)
Each drug dose is calculated initially according to your body surface area.
Each drug has certain characteristic side-effects to be aware of. These side-effects can be 'risk assessed' for likelihood by your oncologist, and dosages can be altered to suit your own circumstances.
These standard drugs are considered to have a moderate risk for developing common side-effects associated with bowel cancer chemotherapy, including nausea and vomiting, diarrhoea and febrile neutropaenia.
Availability of Drugs
In Australia there are a number of government bodies responsible for the regulation and availability of bowel cancer treatments.
The Therapeutic Goods Act 1989, Regulations and Orders provide a national framework for the regulation of therapeutic goods in Australia to ensure quality, safety and effectiveness of medicines. They also set out the requirements for inclusion of therapeutic goods in the Australian Register of Therapeutic Goods (ARTG), including advertising, labelling and product appearance, for example.
The Therapeutic Goods Administration (TGA) is a unit of the Australia Government Department of Health. It carries out a range of assessment and monitoring activities to ensure therapeutic goods available in Australia are of an acceptable standard. At the same time the TGA aims to ensure that the Australian community has access, within a reasonable time, to therapeutic advances.
All treatments used to prevent, cure or alleviate bowel cancer must be entered on the ARTG before they can be supplied in Australia. Once approved and entered on the ARTG, they are available for human use and can be accessed privately.
Some treatments can then be recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) to be listed on the Pharmaceutical Benefits Scheme (PBS) as a subsidised treatment. The Scheme is available to all Australian residents who hold a current Medicare card.
The PBAC is an independent statutory body established to make recommendations and give advice to the Minister for Health about which treatments should be made available as pharmaceutical benefits.
No new treatment may be made available as a pharmaceutical benefit unless the Committee has so recommended.
The Committee is required by the National Health Act 1953 to consider the effectiveness and cost of a proposed benefit compared to alternative therapies. In making its recommendations the Committee, on the basis of community usage, recommends maximum quantities and repeats and may also recommend restrictions as to the indications where PBS subsidy is available.
When recommending listings, the Committee provides advice to the Pharmaceutical Benefits Pricing Authority (PBPA) regarding comparison with alternatives or their cost effectiveness.
Some treatments may not be recommended by the PBAC if they are deemed not cost-effective, even if they are clinically proven.
The issue of drug availability has received a lot of media attention and can be confusing and complicated. You should discuss all the options with your oncologist, and if a drug would be of benefit but it is not available via the PBS, you may consider accessing this privately or applying to a manufacturer to see if you are eligible to enter an access program or the drug made available on compassionate grounds. Also, ask about clinical trials.
A list of the applications for consideration at each PBAC meeting is published six weeks prior to each meeting. The sponsor of the submission will have already provided the PBAC with detailed clinical and economic data in support of the submission. However, you are welcome to provide comments from a personal (i.e. patient, carer, member of the public, health professional) or group perspective for consideration by the PBAC when the submission is considered.
Bowel Cancer Australia advocates for improved access to affordable treatment options and makes relevant submissions to the PBAC on behalf of the bowel cancer community. For more information on Bowel Cancer Australia's advocacy efforts and listing of new bowel cancer treatments, visit our Access to Treatments webpage.
Further details, including closing dates for submissions, can be found at the Pharmaceutical Benefits Advisory Committee webpage. The PBAC meets three times a year, usually in March, July and November.