What happens if chemotherapy does not work?

Signs that a person’s cancer is not responding to chemotherapy include:

• a tumor growing or not shrinking
• cancer spreading to other areas of the body, a process called metastasis
• cancer symptoms returning
• additional symptoms appearing

If any of these issues occur, the doctor may recommend other types of therapy.

A chemotherapy course usually lasts 3–6 months, although this can vary.

The timing depends on various factors, including the type and stage of cancer, the person’s overall health, and the type of chemotherapy drug that the doctor uses.

Doctors do tests at intervals to assess the effectiveness of chemotherapy.

If tests show that chemotherapy is not having enough of an impact, other options are available. Some include:

Radiation therapy

Radiation therapy involves using radiation to kill cancer cells and reduce the size of tumors.

It can be a primary treatment, but it also works well with other approaches, such as surgery.

Radiation therapy damages the DNA in cancer cells so that they can no longer repair themselves.

These damaged cells stop dividing and eventually die, at which point the body breaks them down and removes them.

There are two types of radiation therapy. The first, external beam radiation therapy, is a local treatment, which means that it targets a specific part of the body.

Administering it involves using a large machine to send radiation from several directions to the targeted area.

The second type, internal beam radiation therapy, involves implanting a radiation source inside the body near the tumor. This type affects a smaller area of the body than external radiation therapy.

The implants can either be permanent or temporary. Temporary implants are usually removed after a few minutes or days, and the person is considered radioactive until the removal. Permanent implants gradually stop giving off radiation over time.

Advantages of radiation therapy

Radiation therapy has several advantages. For example, it:

• causes only moderate pain
• involves minimal or no hair loss
• effectively kills large numbers of cancer cells in a tumor
• is relatively safe because it specifically targets the tumor
• causes minimal damage to organs near the tumor

However, it is important to note that the intensity of the pain varies from person to person. Also, the risk of damage to organs depends on the location of the tumor.

Disadvantages of radiation therapy

There are also several disadvantages. For example:

• Anyone who receives internal beam radiation therapy will be radioactive for a short period.
• There is the risk of damage to vital organs if they are particularly close to the tumor.
• The treatment may not kill all the cancer cells in a very large tumor.
• It can be inconvenient and time-consuming, as a person needs to have the treatment 5 days a week for up to 2 months.
• It can be expensive, though the exact cost depends on the type and amount of treatment.
• The skin around the site of radiation can become red and sore.
• There may be site-specific side effects — for example, treating cancer in the esophagus or gastrointestinal tract can cause nausea, with or without vomiting.

Immunotherapy

Some types of cancer do not respond well to radiation or chemotherapy, so a person may need to try immunotherapy.

This aims to help the immune system fight cancer in the same way that it fights infections.

Immunotherapies either stimulate the immune system in a general way or train it to attack cancer cells directly.

The main methods of delivering immunotherapy include:

• Monoclonal antibodies: These are synthetic antibodies that bind to specific proteins on cancer cells — marking the cells to help the immune system locate and destroy them.
• Checkpoint inhibitors: These are medications that stimulate the immune system’s T cells, which then identify and attack cancer cells more efficiently.
• Cancer vaccines: Vaccines stimulate the immune system to fight cancer. Some vaccines, such as that for the human papillomavirus (HPV), can have protective effects, as specific types of HPV are known to cause certain cancers.
• Adoptive cell transfer: This involves removing T cells from a tumor and modifying them in a laboratory. After about 2–8 weeks, doctors return the T cells to the body. The aim is to boost the ability of the T cells to detect and destroy cancer cells.

Advantages of immunotherapy

Immunotherapy may work when other treatments do not, and it can have other advantages. For example, it:

• can be effective against many types of cancer
• can improve the success of other treatments
• causes fewer side effects than treatments, such as chemotherapy, that target all the body’s cells

Also, after learning to target cancer cells, the immune system remembers this response if cancer reappears.

Disadvantages of immunotherapy

The disadvantages of this type of treatment include:

• the risk of overstimulating the immune system and causing it to attack healthy organs
• subsequent severe complications in the lungs, intestines, kidneys, or other organs
• side effects, such as:
  • fatigue
  • a cough
  • nausea
  • a loss of appetite
  • a skin rash
  • flu-like symptoms

Hormone therapy

Hormone therapy can treat some types of cancer, including prostate cancer and breast cancer, by taking advantage of the disease’s dependence on hormones to grow.

Hormone therapy works by either stopping the body from producing hormones or interfering with how hormones affect the body.

Hormone therapy to treat breast cancer, or antiestrogen therapy, focuses on lowering estrogen levels. This may involve surgical procedures, such as the removal of the ovaries, or medications that interrupt signals from the pituitary gland, which stimulates estrogen production.

Hormone therapy to treat prostate cancer, or androgen-suppression therapy, lowers testosterone and dihydrotestosterone (DHT) production. Treatments include surgical procedures to remove one or both testicles and medications that prevent the production of testosterone and DHT.

Advantages of hormone therapy

Hormone therapy can prevent the spread of cancer to other parts of the body. It can also help reduce the risk of cancer returning after surgery.

Disadvantages of hormone therapy

There are some disadvantages to this type of treatment. For example, it:

• only works on cancers that require hormones to grow
• can cause headaches, hot flashes, weight gain, and vaginal dryness, in females
• can cause fatigue, hot flashes, breast sensitivity or enlargement, nausea, impotence, and reduced sexual desire, in males

Targeted therapy

This involves using medication that specifically targets cancer cells, destroying them from the inside.

Unlike chemotherapy, targeted therapy does not affect healthy cells. It targets cancer by identifying particular genetic abnormalities in cancer cells. Targeted therapy works best in combination with other treatments.

There are many types of targeted therapy, and they employ different methods. These therapies may fight cancer by:

• blocking or turning off chemical signals that stimulate cancer cell growth
• changing proteins inside cancer cells, causing cell death
• preventing cancer cells from stimulating the growth of new blood vessels
• triggering an immune response to destroy cancer cells
• delivering toxic substances to cancer cells to kill them without affecting other cells

Advantages of targeted therapy

Targeted therapy may be beneficial because it:

• specifically targets cancer cells
• is not toxic to healthy cells
• employs a wide array of methods, helping doctors tailor effective treatment plans for each individual

Disadvantages of targeted therapy

Targeted therapy has some disadvantages. For example:

• It only works for tumors with specific genetic mutations.
• Cancer cells may develop resistance to it.
• Side effects include diarrhea, a rash, issues with blood clotting, high blood pressure, and liver problems, such as hepatitis.

If tests suggest that chemotherapy does not work or has stopped working, the doctor may recommend other options.

Anyone with concerns that chemotherapy is not working should raise these with their cancer doctor, or oncologist.

Points to discuss with an oncologist include:

• how well and for how long the first-line treatment worked
• the current status of the cancer
• how a new treatment could affect the overall prognosis
• if the cancer has spread
• the success rates of any alternative treatments
• the possible side effects of other treatment options

A person may wish to stop chemotherapy for a while or altogether. This may be because of adverse side effects, because the treatment seems to be ineffective, or for other reasons.

Anyone who is considering stopping should speak with their doctor first. They will describe the possible next steps and help the person make the right decision.

Other options

If cancer does not respond to chemotherapy, radiation therapy, or other treatments, palliative care is still an option.

A person can receive palliative care with other treatments or on its own. The aim is to enhance the quality of life.

Palliative care includes:

• pain relief
• help with daily living
• counseling and other forms of mental health support

Also, if treatment is no longer effective or a person has late-stage cancer, they may benefit from hospice care.

A healthcare team will create a plan to help manage all aspects of the person’s care and help them remain comfortable.

Usually, alternative treatments are available if chemotherapy does not work. The range of options depends on the type of cancer and other factors.

After considering the options, some people decline further treatment. In this case, the oncologist focuses on improving the person’s quality of life, and they develop a plan to manage the cancer symptoms.

If chemotherapy stops working, discuss the other options with the oncologist, the rest of the healthcare team, and loved ones, including family members, before making a decision about treatment going forward.