Treatments

Treatments

After your first visit, the Initia Oncología team will develop a treatment plan especially adapted to your case. There are different treatments for cancer and the choice of one or another depends on many factors, such as the type of cancer, the patient’s characteristics, or the stage of the disease.

A single treatment is used in some cases, while a combination of several treatments (surgery, chemotherapy, targeted therapy, etc.) is preferred in others.

It is normal to feel confused and uneasy, but do not hesitate to talk to your oncologist about any questions you may have about your treatment. The medical team of Initia Oncología will recommend the treatment options best suited to your particular case, but the final decision will always be in your hands. Do not forget either that you are entitled to a second opinion.

Treatment Options.

Surgery.

Many of the most common cancers are potentially curable if diagnosed at a stage where complete surgical removal is possible.

However, surgery is not always the most appropriate treatment for a specific stage of a particular cancer or should not be considered as the only possible treatment.

Our Medical Oncology specialists will be able to advise you on the indications for surgery and possible alternative treatments, if any, or complementary treatments to this approach.

At Initia Oncología we are in contact with the best oncological surgeons in our field and will offer you guidance for you to contact them if necessary.

Similarly, the members of our Medical Oncology Unit regularly hold meetings (Tumour Committees) with specialists from other fields, such as the surgeons themselves, in order to unify criteria and establish common therapeutic strategies.

Radiotherapy.

Radiotherapy is a cancer treatment that uses high-energy radiation to kill tumour cells in order to shrink the tumour and eventually destroy it.

External radiotherapy is administered by machines called linear accelerators (LINAC) which emit high-energy x-ray beams that are directed at the tumour from different angles to concentrate a maximum dose of energy on the tumour area and a surrounding safety margin. Another way of administering radiotherapy is using radioactive implants that are placed in or near the tumour.

You must bear in mind certain aspects if you are receiving radiotherapy: do not expose yourself unnecessarily to sunlight for long periods of time; do not use abrasive products on the area to be irradiated; avoid scrubbing or rubbing the area to be treated; wear baggy clothes, preferably made of cotton; and do not use any product on the irradiated area that has not been recommended by your physician.

Chemotherapy.

Generically, chemotherapy is the term used to refer to all the drugs that are typically used for the treatment of cancer and that interfere with the tumour’s mechanisms of cell division, thus preventing or delaying its growth. These medications can be given intravenously or orally.

A chemotherapy treatment is usually given either cyclically over a period of time or chronically. A cycle of chemotherapy is the time elapsed between the administration of one dose of chemotherapy and the administration of the next one, including the rest interval between administrations. In some cases, these cycles may include several intermediate days of treatment administration.

One or more drugs may be given with each chemotherapy administration. Along with the strictly anti-tumour drugs, other drugs are often also administered to modulate the chemotherapy side effects, such as antiemetics used to prevent nausea and vomiting. Each administration may take several hours.

With a view to administer the most comfortable and safe form of chemotherapy treatment, your oncologist may recommend that you have a subcutaneous reservoir or port-a-cath placed. This reservoir constitutes a system that is placed under the skin below the collarbone in order to administer the drugs. This system is connected to a central vein that is thicker than those normally used to insert lines into the arm, and, therefore, not only avoids damage to the patient's peripheral veins, but also ensures the safe administration of prolonged perfusions of chemotherapy over several days, even at the patient's home.

Chemotherapy treatments are administered in the so-called Day Hospital, which is an area of the hospital specifically dedicated to the administration of these drugs. The Outpatient Hospital is equipped with the necessary infrastructure for patients to comfortably receive the treatment prescribed by their oncologist.

In Initia Oncología you will find nursing staff who are perfectly trained in the administration of chemotherapy and the identification of potential problems that may arise during the treatment.

Hormone Therapy.

In addition to the treatments described above, your oncologist may, in certain cases, resort to hormonal treatment. Breast cancer in women and prostate cancer in men are the tumours most frequently treated with hormone therapy.

Hormone therapy also interferes with the metabolism of the tumour cells and contributes to the destruction of the tumours or the reduction of the risk of relapse.

Inmunoterapia.

Immunotherapy in cancer refers to the set of treatments that aim to use the patient's own immune system, that is, the body’s natural defences, to achieve an anti-tumour effect. It is, therefore, a biological therapy based on the use of substances that are either produced by the body itself or synthesised in the laboratory, and which resemble or stimulate the body's natural defences.

There are several types of immunotherapy that use different mechanisms of action with the ultimate goal of stimulating the body's immune response against tumour cells.

The first immunotherapy used against cancer was the so-called BCG, or Bacillus Calmette-Guérin, a culture of live attenuated bacilli of the tuberculosis bacteria. BCG was first used in cancer patients in 1935, but it was not until 1966 that its effectiveness was demonstrated in patients with superficial bladder cancer. In cases of superficial bladder cancer, BCG is instilled directly into the urinary bladder, following the corresponding procedure. This instillation causes a delayed hypersensitivity reaction in the bladder wall that promotes the mass arrival of the body's own defence cells, such as monocytes, granulocytes, and mononuclear cells, to the area and the attack of the tumour cells that could potentially still remain after the surgical procedure.

Cancer vaccination consists in introducing proteins or fractions of a tumour into the body that are then recognised by the body's immune system, thus triggering an immune reaction against them. The vaccination of a patient against a virus that can facilitate the development of a certain type of cancer (such as the case of the human papillomavirus in cervical cancer or hepatitis B in hepatocarcinoma) can prevent the appearance of that specific cancer.

A patient may also be vaccinated against a tumour that is already affecting him/her. This is the case with the sipuleucel-T vaccine for prostate cancer.

In other cases, so-called oncolytic viruses are used to fight the tumour cells. These are viruses that, when infused into a tumour, destroy some of its cells. The fragments of the tumour cell destroyed by the virus generate an immune reaction in the patient that contributes to the destruction of the rest of the tumour cells.

Another form of immunotherapy is represented by the use of monoclonal antibodies. These antibodies, which are actually proteins that fight foreign elements that enter our bodies, can be manufactured in a laboratory nowadays. Their mechanism of action is twofold: the antibodies sometimes attach to a certain protein or fraction of the tumour cell and mark it so that the patient's immune cells subsequently attack and destroy it, or, in other cases, the monoclonal antibodies act by “releasing the brakes” that the immune system itself has set into motion to control its own activity and which are used by the tumour cells as escape routes from the immune response. Thus, antibodies such as pembrolizumab or nivolumab block “immune checkpoints” and inhibit molecular pathways such as PD1, PDL-1, or CTLA-4.

Cytokines, or non-specific immunotherapies, comprise another form of immunotherapy.

Interferons are proteins produced by cells infected by viruses or attacked by any other antigen such as bacteria, tumour cells, or parasites. In addition to activating the cells of the immune system (macrophages, natural killer cells, etc.), interferons increase the presentation of antigens to the T lymphocytes, which are the cells responsible for destroying them. In doing so, they increase the recognition of the tumour cells by these defence cells and their subsequent destruction.

Interleukins are also proteins produced by leukocytes that help trigger, maintain, and regulate the intensity of the immune response against infectious agents or tumour cells.

Lymphocyte immunotherapy, also known as adoptive cell therapy, is an advanced form of immunotherapy in which the patient's lymphocytes (defence cells) are collected, grown in the laboratory to increase their number, and then reinfused into the patient to massively attack the tumour. These T lymphocytes can be modified in the laboratory by incorporating a tumour-specific receptor, the so-called chimeric antigen receptors (CAR), to generate a much stronger immune response against that particular tumour.

Tolerance to the different treatments based on the body’s immune response and the toxic effects derived from them are varied. Interferons and interleukins usually cause pseudo-flu syndromes in patients, with flu-like symptoms and signs such as fever, generalised malaise, muscle aches, etc. However, most immune-based therapies are well tolerated by patients and their side effects are acceptable. This allows them to be combined with other treatments such as chemotherapy or radiotherapy. Skin reactions, diarrhoea, the pseudo-flu syndromes described earlier, alterations in the liver enzymes (GOT and GPT) revealing an inflammation of the liver, pneumonitis (an inflammation of the lung tissue that can manifest with breathing difficulty or cough), and hormonal disorders are frequent side effects of this sort of therapies. However, an autoimmune reaction is perhaps the most striking and feared effect of this type of therapy. It consists in a disproportionate immune reaction of the body's defences against the patient's own tissues as a result of them being mistaken as foreign or tumoral by the immune therapy. This disproportionate reaction against the body's own cells can lead to the destruction of the patient's healthy cells in different tissues and result in severe problems. Similarly, the very disproportionate and exaggerated reaction of the patient's own immune system can lead to situations that require urgent care. Because of this, if you are receiving immunotherapy, you must contact your oncologist or visit the Emergency Room if you notice any of the above symptoms or any sudden discomfort.

Most of the side effects of the different immunotherapies are generally easily manageable and controllable. In fact, the latest immune-based therapies are better tolerated than any other anti-tumour drug and can be used in combination with them. In any case, our entire team will be at your disposal to advise and assist you if you receive any of these treatments.

Targeted Therapies.

Advances in the field of Oncology are enabling the achievement of a certain degree of personalisation in the treatment of tumours that was unthinkable just a decade ago.

Using information obtained from the biomolecular and/or genetic analysis of the tumour material obtained through a biopsy or the patient's own blood, it is possible to characterise the tumour in a comprehensive manner that allows for offering the patient the most suitable type of anti-tumour treatment available, whether it be classic chemotherapy, monoclonal antibodies, or immunotherapy.

The biomolecular and genetic profile of the tumour allows us to select those drugs that have demonstrated the greatest efficacy and to minimise the potential toxicities derived from their use.