# What is chemotherapy? Chemotherapy (chemo) uses drugs to kill cancer cells. Chemotherapy works best on cells that are actively growing and dividing. Cancer cells tend to grow and divide quickly so this makes them good targets for chemotherapy. But chemotherapy can’t tell the difference between cancer cells and normal cells. Some normal cells, such as those in hair follicles and the lining of the digestive system, also tend to grow and divide quicker than other cells in the body. Chemotherapy can affect these cells as well. Source: [Chemotherapy | Canadian Cancer Society](https://cancer.ca/en/treatments/treatment-types/chemotherapy) ## My treatment program I will be on a 6 month chemo program, with oral capecitabine and IV oxaliplatin. This program is commonly referred to as XELOX or XelOx (pronounced "zell-ox"), and CAPOX or CapOx or CapeOx (pronounced "cape-ox"). It will be administered on the following schedule: Week 1: oxaliplatin IV over one 2.5 hour session + capecitabine pill 2x daily x 7 days Week 2: capecitabine pill 2x daily x 7 days Week 3: break ## Mitigating chemotherapy side effects ### Cachexia (muscle wasting) [Cancer Cachexia - Cancer Ireland](https://cancerireland.ie/before-you-start-treatment/cachexia-lymphedema-etc/) ### Capecitabibe & supplement interactions and side effects [Capecitabine – Health Information Library | PeaceHealth](https://www.peacehealth.org/medical-topics/id/hn-10000777) ### Oral cannabidiol (CBD) for prevention of acute and transient chemotherapy-induced peripheral neuropathy CAPOX patients treated with [CBD](../3.3%20%20Supplements/CBD.md) had significantly lower peak baseline-adjusted difference in three PRO items on cold sensitivity to touch, discomfort swallowing cold liquids, and throat discomfort. **Conclusion:** [CBD](../3.3%20%20Supplements/CBD.md) attenuated early symptoms of CIPN with no major safety concerns. Source: [Oral cannabidiol for prevention of acute and transient chemotherapy-induced peripheral neuropathy - PubMed](https://pubmed.ncbi.nlm.nih.gov/35933415/) ## Mitigating chemotherapy drug resistance >Acquired drug resistance represents a major clinical problem and one of the biggest limitations of chemotherapeutic regimens in colorectal cancer. Combination regimens using standard chemotherapeutic agents, together with bioactive natural compounds derived from diet or plants, may be one of the most valuable strategies to overcome drug resistance and re-sensitize chemoresistant cells. In this review, we highlight the effect of combined regimens based on conventional chemotherapeutics in conjunction with well-tolerated plant-derived bioactive compounds, mainly curcumin, resveratrol, and EGCG, with emphasis on the molecular mechanisms associated with the acquired drug resistance. >Source: [Plant-Derived Bioactive Compounds in Colorectal Cancer: Insights from Combined Regimens with Conventional Chemotherapy to Overcome Drug-Resistance](https://www.mdpi.com/2227-9059/10/8/1948/html) ## 3 month vs 6 month chemotherapy regimes >The study achieved its primary end point, showing that 3-month oxaliplatin-containing adjuvant chemotherapy is non-inferior to 6 months of the same regimen; 3-month treatment showed a better safety profile and cost less. >The 3-year disease-free survival rate in the 3-month treatment group was 76.7% and in the 6-month treatment group was 77.1%, equating to a hazard ratio of 1.006, confirming non-inferiority for 3-month adjuvant chemotherapy. >Frequent adverse events (alopecia, anaemia, anorexia, diarrhoea, fatigue, hand-foot syndrome, mucositis, sensory neuropathy, neutropenia, pain, rash, altered taste, thrombocytopenia and watery eye) showed a significant increase in grade with 6-month duration; the greatest difference was for sensory neuropathy (grade ≥ 3 was 4% for 3-month vs. 16% for 6-month duration), for which a higher rate of neuropathy was seen for the 6-month treatment group from month 4 to ≥ 5 years. > #Source [3-month versus 6-month adjuvant chemotherapy for patients with high-risk stage II and III colorectal cancer: 3-year follow-up of the SCOT non-inferiority RCT - PubMed](https://pubmed.ncbi.nlm.nih.gov/31852579/) >The 5-year relapse-free survival was 82.2% for the 3-month arm and 88.2% for the 6-month arm, with an estimated hazard ratio of 1.41 (95% CI, 1.05-1.89; P = .86 for noninferiority). For CAPOX, the 5-year relapse-free survival was similar in the 2 arms (difference, 0.76% favoring the 6-month arm. #Source [Assessment of Duration and Effects of 3 vs 6 Months of Adjuvant Chemotherapy in High-Risk Stage II Colorectal Cancer: A Subgroup Analysis of the TOSCA Randomized Clinical Trial - PubMed](https://pubmed.ncbi.nlm.nih.gov/32053133/) >The incidence of long-lasting PSN was significantly lower for 3 months than for 6 months of therapy, and significantly lower for treatment with the drug CAPOX than with mFOLFOX6. Since the shortened therapy duration did not compromise outcomes, a 3-month course of CAPOX may be the most appropriate treatment option, particularly for patients with low-risk disease. > #Source [Efficacy and Long-term Peripheral Sensory Neuropathy of 3 vs 6 Months of Oxaliplatin-Based Adjuvant Chemotherapy for Colon Cancer: The ACHIEVE Phase 3 Randomized Clinical Trial - PubMed](https://pubmed.ncbi.nlm.nih.gov/31513248/) ## Diet protocol for chemo IV cycles : | Protocol | Thu | Fri | Sat | Sun | Mon | ==Tue== | Wed | Thu | Fri | Sat | | | ---------- | --- | --- | --- | --- | --- | ------- | --- | --- | --- | --- | --- | | Cheat | | | | | | | | | | x | | | Low carb | x | | | | | | | | x | | | | Keto | | x | x | | | | | | | | | | Water fast | | | | x | x | x | 1/2 | | | | | | Re-feed | | | | | | | | x | | | | | | | | | | | | | | | | | Peripheral Neuropathy [8 Best Supplements for Neuropathy - Modern Neuropathy](https://modernneuropathy.com/8-best-supplements-for-neuropathy/)