Chemotherapy Side Effects: TS-1 and Tarceva for Seniors

Q: Chemotherapy Side Effects: TS-1 and Tarceva for Seniors

Hello, regarding your questions：<br>1. <br>TS-1 is an oral chemotherapy drug that is taken daily for four weeks (28 days), followed by a two-week break. <br>The daily dosage is determined based on the patient's height and weight. <br>Tarceva, on the other hand, is also an oral ta

What are the side effects of chemotherapy?

Hello Dr.
Chen: Thank you for your detailed response the other day.
You mentioned that for older patients, chemotherapy is recommended to be done with oral medications, with TS-1 being the first choice (and if financially feasible, adding Tarceva, which costs about $1400 per pill per day).

1.
How long does a treatment cycle with TS-1 and Tarceva typically last?
2.
What kind of side effects can be expected?
3.
Is it manageable for elderly patients in terms of physical burden? Does it severely impact their quality of life?
Thank you for your assistance.

kk, 50~59 year old female. Ask Date: 2015/08/14

Dr. Chen Yunfang reply Oncology

Hello, regarding your questions:
1.
TS-1 is an oral chemotherapy drug that is taken daily for four weeks (28 days), followed by a two-week break.
The daily dosage is determined based on the patient's height and weight.
Tarceva, on the other hand, is also an oral targeted therapy medication, which is generally taken once daily in the morning without breaks.
2.
TS-1 is a new drug developed in Japan and has only been available in Taiwan for the past five years.
It is primarily used for gastric and pancreatic cancers, and currently, the National Health Insurance only covers its use for pancreatic cancer.
Compared to previous chemotherapy drugs, TS-1 is more convenient for patients due to its oral administration, and it has milder gastrointestinal side effects (such as oral mucositis and diarrhea).
Additionally, its efficacy in combating tumors is somewhat better than older treatments.
In my clinical practice, I rarely hear complaints of discomfort from patients taking it.
Tarceva, a targeted therapy that has been on the market for 15 years, is mainly used for treating lung adenocarcinoma, but it has also been studied for use in patients with advanced pancreatic cancer.
Large studies have indicated that it can have some control over the disease (though the efficacy is not particularly striking, extending survival by only 2-3 weeks, which is why it is not covered by insurance and must be paid for out-of-pocket).
Targeted therapies generally have minimal side effects, with the most common being acne, rashes, and palmar-plantar erythrodysesthesia.
3.
For elderly patients, you might not consider administering injectable chemotherapy, as the side effects of injections are significantly greater than those of oral medications.
Currently, the best and only oral medication covered by the National Health Insurance is TS-1.
How do you know if she can tolerate it unless you give it a try? It is just medication; there is no lighter treatment option available.
I hope this information is helpful to you.
Thank you.

Reply Date: 2015/08/14

More Info

When considering chemotherapy options for seniors, particularly with medications like TS-1 (Tegafur, Gimeracil, and Oteracil) and Tarceva (Erlotinib), it is essential to understand both the treatment duration and potential side effects, as well as how these factors may impact the quality of life for elderly patients.

1. Treatment Duration: The duration of treatment with TS-1 and Tarceva can vary based on the specific cancer being treated, the patient's overall health, and how well they tolerate the medications. Typically, TS-1 is administered in cycles, often lasting about four weeks, followed by a rest period. Tarceva is usually taken daily. The overall treatment plan may involve several cycles of TS-1, and Tarceva may be continued for a longer duration as long as the patient is responding well and tolerating the medication. It is crucial to have regular follow-ups with the healthcare provider to assess the effectiveness of the treatment and make any necessary adjustments.

2. Potential Side Effects: Both TS-1 and Tarceva can cause a range of side effects. Common side effects of TS-1 include nausea, vomiting, diarrhea, fatigue, and a decrease in blood cell counts, which can increase the risk of infections, anemia, and bleeding. Tarceva may lead to skin rashes, diarrhea, fatigue, and potential liver function abnormalities. In elderly patients, the risk of side effects may be heightened due to age-related changes in metabolism and organ function. Therefore, careful monitoring is essential.

3. Impact on Quality of Life: The side effects of chemotherapy can significantly affect an elderly patient's quality of life. Fatigue, in particular, can be debilitating, and gastrointestinal issues can lead to nutritional deficiencies if not managed properly. Additionally, skin reactions from Tarceva can be distressing and may require dermatological care. It is crucial for healthcare providers to discuss these potential impacts with patients and their families, ensuring they have a support system in place to manage side effects. Palliative care options should also be considered to help alleviate symptoms and improve the overall quality of life during treatment.

In conclusion, while TS-1 and Tarceva can be effective treatment options for certain cancers, it is vital to weigh the benefits against the potential side effects, especially in elderly patients. Regular communication with healthcare providers, monitoring for side effects, and supportive care can help mitigate some of the adverse effects and enhance the patient's quality of life during treatment. Always consult with a healthcare professional for personalized advice and treatment plans tailored to the individual's health status and needs.

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