In the United Kingdom (UK) children and young people with cancer are all treated following standard protocols or regimens, where available. The term ‘regimen’ or ‘protocol’ means the plan for the entire treatment, including chemotherapy, surgery and radiotherapy if required.
Children and young people are treated according to their identified risk group. The site, stage and biology of the disease determine the risk group. Intensity of regimen used is determined by the risk group. Within the regimen there will be individual courses of treatment that could be surgery, radiotherapy,immunotherapy, chemotherapy, stem cell transplant or a combination of these. A number of courses of chemotherapy are normally given and these are referred to as ‘course 1’ or ‘cycle 2’ etc.
Oncology treatment regimens
For most oncology malignancies treatment is given on a cyclical basis. This may be, for example, on a three or six-weekly cycle with rest periods in between to allow the body to recover sufficiently for the next course of chemotherapy. For example, in a three-weekly cycle, the chemotherapy is given over 1-5 days at the beginning of the cycle as an inpatient or outpatient and followed by a period of rest until the beginning of the next cycle three weeks from the start of the previous cycle. Some cycles may have a weekly chemotherapy in the day care unit during the cycle.
Children and young people normally have weekly blood counts and contact with a designated health professional, so that supportive care may be given as required. The next course of chemotherapy does not start until specific criteria have been met, for example blood count recovery. On average an Oncology regimen may last 6-8 months with the “clock stopping” for any delay in treatment being given. Treatment may be delayed due to:
- Infection
- Slow blood count recovery
- Toxicities
Sometimes treatment may be moved forward or back by a day or two to meet families’ needs or service requirements.
Haematology treatment regimens
Most haematology patients are treated with chemotherapy alone. These regimens normally involve a number of drugs.
Common acute lymphoblastic leukaemia
There are three treatment regimens (Regimen A, B or C) for children and young people with acute lymphoblastic leukaemia (also known as common ALL). These last for just over two years for females and three years for males.
Within each regimen there are various named courses of chemotherapy and if patients is in a clinical trial, there will be various trial arms. After the first phase of treatment (induction), all other cycles may be potentially given as an outpatient.
Phases of treatment:
- Induction
- Consolidation
- Interim maintenance
- Delayed intensification
- Maintenance
Lymphoma
Lymphoma treatment is generally shorter in duration and, again, is given in cycles. Some children and young people also need radiotherapy, determined by their response to treatment and the protocol used. In some cases, treatment follows a very similar protocol to that of common ALL.
Acute myeloid leukaemia
The treatment for acute myeloid leukaemia (AML) is also given in cycles but as an inpatient. It is shorter in duration than common ALL treatment, at around 6-8 months.
The family will be given information and a flowchart of the regimen the child or young person is on. If you would like someone to go over a specific child’s regimen with you please contact their Paediatric Oncology Outreach Nurse Specialist (POONS) or Consultant.
Drugs used in the treatment of children and young people with cancer
CCLG has produced a series of factsheets describing each of the drugs used to treat children and young people with cancer, including information about their use, safe handling and potential side effects.