Corticosteroids for chemotherapy: Rheumatrex, Plaquenil, Zoatrix

Medically reviewed: 1, February 2024

Corticosteroids for chemotherapy, drugs against cancer: overview

Corticosteroids are a type of drugs that can reduce inflammation and suppress the immune system. They are often used in cancer treatment for various purposes, such as:

• Treating the cancer itself: Some cancers, such as lymphoma and multiple myeloma, are sensitive to the effects of corticosteroids, which can kill cancer cells or make them more vulnerable to other treatments.
• Reducing side effects of chemotherapy: Corticosteroids can help prevent or lessen nausea, vomiting, allergic reactions, and inflammation caused by chemotherapy drugs.
• Improving quality of life: Corticosteroids can help improve appetite, energy, mood, and pain control in cancer patients.

The history of corticosteroids in cancer treatment dates back to the 1940s, when they were first discovered to have anti-inflammatory and immunosuppressive properties. They were initially used to treat rheumatoid arthritis, but soon researchers found that they also had anti-cancer effects in some animal models and human patients.

In the 1950s and 1960s, corticosteroids were widely used in combination with other chemotherapy drugs, such as alkylating agents and antimetabolites, to treat various cancers, especially hematologic malignancies. Since then, corticosteroids have become an integral part of many cancer treatment regimens, either as primary or adjuvant therapy.

Types of corticosteroids against cancer

Corticosteroids can be given in different ways, depending on the type and stage of cancer, the goal of treatment, and the patient’s condition. They can be taken orally as tablets or liquid, injected into a vein or muscle, applied as a cream or ointment, or given as eye drops.

The dose and duration of corticosteroid treatment vary from person to person, and depend on factors such as the type and severity of cancer, the response to treatment, and the side effects experienced. Corticosteroids are usually given for short periods of time, such as a few days or weeks, but sometimes they may be needed for longer periods, such as months or years.

Corticosteroids effect on cancer

Corticosteroids can have many benefits for cancer patients, but they also have some risks and limitations. These medications may lead to a variety of potential side effects, which can manifest in different ways and impact various aspects of a person’s health and well-being.

• Increased risk of infection: Corticosteroids can weaken the immune system and make it harder to fight off bacteria, viruses, and fungi.
• Increased blood sugar levels: Corticosteroids can raise the level of glucose in the blood and cause or worsen diabetes.
• Increased blood pressure: Corticosteroids can cause the body to retain salt and water, which can increase the blood pressure and strain the heart and kidneys.
• Osteoporosis: Corticosteroids can reduce the amount of calcium and vitamin D in the body, which can lead to bone loss and fractures.
• Mood changes: Corticosteroids can affect the brain and cause anxiety, depression, insomnia, or psychosis.
• Weight gain: Corticosteroids can increase the appetite and cause the body to store more fat, especially in the face, neck, and abdomen.
• Skin problems: Corticosteroids can cause acne, bruising, thinning, or slow healing of the skin.
• Eye problems: Corticosteroids can cause cataracts, glaucoma, or infections in the eyes.

To minimize these side effects, corticosteroids should be used at the lowest effective dose and for the shortest possible time.

They should also be taken with food or milk to prevent stomach irritation. Patients should not stop taking corticosteroids abruptly, as this can cause withdrawal symptoms such as fatigue, weakness, nausea, or low blood pressure. They should follow the instructions of their doctor or pharmacist on how to taper off the dose gradually.

Patients should also monitor their blood sugar, blood pressure, weight, and bone density regularly, and report any signs of infection, mood changes, or eye problems to their doctor.

Patients should also take care of their skin, eyes, and oral hygiene, and avoid exposure to sunlight, tobacco, alcohol, and infections.

Rheumatrex (methotrexate)

If your joint disease takes an aggressive turn, and you are not responding all that well to NSAIDs, methotrexate is the next logical step. Its toxic effects appear to be lessened when it is given in low doses on a once-weekly basis. In most patients its benefits will outweigh its risks. People with RA are more likely to continue methotrexate than they are any of the other second-line drugs. But it can cause problems, including nausea, abdominal pain, diarea, and vomiting. Liver failure can occur in * very small percentage of patients, especially the very old and those who have been on the drug for long periods.

Plaquenil (hydroxychloroquine)

This drug, which is also used to treat malaria,used for people with slowly progressive RA it is less toxic than most of the other drugs used for RA and therefore is favored as and second-line agent.

Prednisone

Steroids, as they are usually called, reduce inflammation, swelling, and joint pain in people with RA. Their use is somewhat controversial, because they also have some very undesirable side effects when used for prolonged periods.

The way to maximize the benefits of steroids and reduce the toxic side effects is to have your doctor prescribe them at the lowest dose possible (5 to 10 mg per day). They are especially useful in older people, as an alternative to the even more toxic second-line drugs, and in younger people to help control flare-ups. Side effects include weight gain, bone wasting, cataracts, risk of infection, elevated blood pressure, ulcers, bleeding, and skin changes.

Azulfidine (sulfasalazine)

This drug has shown increasing promise for treatment of RA. In one study, when used in combination with methotrexate and hydroxychloroquine in patients who had shown a poor response to other medications, people with severe RA showed significant improvement.

Zoatrix (capsaicin)

This drug is made from a substance found in hot peppers. Many people have found that continued use of this cream can improve joint pain.

Aspirin

Aspirin was one of the original treatments for RA. I no longer recommend it because multiple daily doses are required, which can be very inconvenient for RA sufferers, who frequently have to take many other pills. In addition, the dose of aspirin required to reduce inflammation is high enough to cause stomach irritation and other gastrointestinal complications in a significant percentage of people. NSAIDs are preferred over aspirin.

Depen (penicillamine)

Depen is not as effective as the second-line drugs in “Optimal” and “Recommended/’ This medication can cause a rash, itching, altered taste sensations, and blood count problems.

AVOID IF POSSIBLE (Not Recommended)

Sandimmune (cyclosporine)

This drug should be avoided if possible. It can cause serious kidney problems and have toxic effects on the liver as well. Its use is experimental and should be reserved for people in whom all else has failed.

Myochrysine (gold sodium thiomalate)

Gold by injection should be avoided because of its toxic effects on the kidneys. Gold taken by mouth (orally) appears to be less toxic but is also less effective than the drugs mentioned in the “Optimal” and “Recommended” categories.

Imuran (azathioprine)

This cancer chemotherapy drug can affect the immune system and cause liver problems It may predispose people to getting a type of cancer called lymphoma.

Chlorambucil

This chemotherapy drug can compromise the immune system and lead to an increased nsk of infections and certain cancers.

Cyclophosphamide

This chemotherapy drug can compromise the immune system and lead to an increased nsk of infections and certain cancers.

Meclomen (meclofenamate)

This NSAID is much more likely to produce severe diarrhea than other drugs in this class, and therefore should be avoided.

Feldene (piroxicam)

This is one of the best pain relievers and antiinflammatory drugs among the NSAIDs. It has been embroiled in controversy over its relative risk for causing gastrointestinal bleeding in elderly people with chronic arthritis. No long-term study has convincingly pmven that piroxicam does produce a higher risk of bleeding. Some studies suggest it does, others say no. Geriatric experts tend to avoid this NSAID. Its use as a first-line drug was more attractive a few years ago, when it was the only once-daily NSAID available. Now that other options (Daypro and Relafen), with equal convenience, are approved, Feldene’s advantages are less convincing.

Corticosteroids are an important and widely used class of drugs in cancer treatment. They can help treat the cancer itself, reduce the side effects of chemotherapy, and improve the quality of life of cancer patients. However, they also have some risks and limitations, and should be used with caution and under medical supervision. Patients should be aware of the benefits and side effects of corticosteroids, and follow the advice of their doctor or pharmacist on how to use them safely and effectively.