Chemotherapy literally means using chemicals to treat disease, but it usually refers to medications that fight cancer. Cytotoxic (also known as antineoplastic) chemotherapy halts cell division and kills rapidly growing cells. Unfortunately, it affects not only cancer cells but also fast-growing healthy cells, which can lead to side effects such as nausea, hair loss and susceptibility to infections.

In contrast to traditional chemotherapy, which has been used since the 1940s, a newer type of treatment known as targeted therapy works more specifically against cancer cells with certain gene mutations or other characteristics, while immunotherapy helps the immune system fight cancer. Chemotherapy is often tried first before targeted therapy or immunotherapy, but these types of treatment may also be used together.

How does chemotherapy work?

Chemotherapy works by interfering with cancer cell multiplication. Normal cells undergo a regular cycle of growth, division and resting phases, but cancer cells grow out of control. Some chemotherapy drugs only affect only actively dividing cells, while others are most effective during the resting phase.

Many chemotherapy drugs interfere with DNA, the cell’s genetic blueprint. Medications known as alkylating agents cause cross-links in DNA strands that prevent copying and repair of genetic material. These include drugs derived from mustard gas (for example, cyclophosphamide and mechlorethamine) and platinum (for example, cisplatin and carboplatin).

Drugs known as antimetabolites (for example, capecitabine and methotrexate) inhibit enzymes needed to produce DNA or RNA or act as defective DNA building blocks. Others interfere with microtubules, tiny structures that play a role in cell division. Several cancer medications (for example, vincristine and paclitaxel) are alkaloids derived from plants. Some antibiotics have antitumor activity (for example, doxorubicin and bleomycin). Certain steroids (for example, dexamethasone and prednisone) both have anticancer activity and are used to help manage side effects.

How is chemotherapy used?

Usually, the chemotherapy medications that have been shown to offer the best balance of effectiveness and tolerability are tried first, known as first-line therapy. If this doesn’t work or if the cancer becomes resistant or relapses, second-line drugs may be tried. Sometimes older and sicker patients start with less intense chemotherapy to minimize side effects.

Chemotherapy may be given as the first treatment to shrink cancer before surgery or radiation therapy. This is known as neoadjuvant chemotherapy. It may also be used after surgery to kill any remaining cancer cells and reduce the risk of recurrence. This is known as adjuvant chemotherapy. Chemotherapy that delays disease progression or shrinks tumors can help relieve symptoms even if it is not expected to lead to a cure or prolong survival. This is known as palliative therapy.

Often, a combination of chemotherapy drugs works better than a single medication used alone, and this can reduce the development of drug resistance. Sometimes additional medications are administered before, during or after chemotherapy to help prevent or manage side effects.

Chemotherapy may be given in a variety of ways, including pills, injections and intravenous (IV) infusions. Infusions are usually administered at a medical facility while pills can be taken at home. People who receive ongoing infusions may get a catheter inserted into a vein (such as a PICC line) or a port inserted under the skin to allow treatment to be administered without puncturing a vein each time. In some cases, chemotherapy drugs may be injected directly into a tumor or administered to a specific part of the body—for example, into the abdominal cavity or the fluid surrounding the brain and spinal cord. Some medications are topical, or applied to the skin.

Chemotherapy is typically given in cycles—for example, one week of treatment followed by three weeks off. The timing of cycles is based on cancer cell growth rates and other factors. This allows breaks from side effects and give normal cells a chance to recover. Chemotherapy is often given for a set period (for example, six months or a year), but sometimes it is continued as long as it is still working.

Chemotherapy Side Effects

Because chemotherapy harms rapidly dividing healthy cells along with cancer cells, it can cause side effects throughout the body. These include cells in the mouth lining, hair follicles and bone marrow, leading to side effects such as mouth sores, hair loss and low blood cell counts. Loss of germ-fighting white blood cells can leave you more susceptible to infections, and loss of platelets can lead to easy bleeding.

Other common chemotherapy side effects include fatigue, nausea and vomiting, loss of appetite, diarrhea, headaches, cognitive problems (chemo brain or brain fog), muscle or joint pain, heart damage and peripheral neuropathy (nerve damage in the hands and feet). Because some drugs can impair fertility, younger people may wish to discuss ways to preserve their reproductive options.

To help prepare for chemotherapy, ask your doctor or nurse about the kinds of side effects you can expect during and after treatment. But remember that people respond differently; side effects may range from mild to severe, and not everyone will experience all of them.

There are many steps you can take to lessen chemotherapy side effects. Sometimes symptoms can be managed by adjusting your dose or treatment schedule. Chilling the scalp or hands and feet during treatment can reduce hair loss and neuropathy. Additional medications (such as anti-nausea drugs) and complementary therapies (such as acupuncture) may be used to manage side effects. Management is often easier if started early, and this may help prevent long-term effects. Let your medical team know if you experience side effects so they can help you find ways to cope with them.

Below is a list of commonly used chemotherapy medications. They are used to treat a wide variety of cancer types and are often used in combination regimens (see next table).


Generic name: alitretinoin
Brand and other namesPanretin
Generic name: altretamine
Brand and other namesHexalen, hexamethylmelamine
Generic name: amifostine
Brand and other namesEthyol
Generic name: aminoglutethimide
Brand and other namesCytadren
Generic name: anagrelide
Brand and other namesAgrylin
Generic name: arsenic trioxide
Brand and other namesTrisenox
Generic name: asparaginase
Brand and other namesElspar, Erwinase, Kidrolase, erwinia L-asparaginase
Generic name: azacitidine
Brand and other namesVidaza, 5-azacitidine
Generic name: bendamustine
Brand and other namesTreanda, Bendeka
Generic name: bexarotene
Brand and other namesTargretin
Generic name: bleomycin
Brand and other namesBlenoxane
Generic name: busulfan
Brand and other namesBusulfex, Myleran
Generic name: cabazitaxel
Brand and other namesJevtana
Generic name: calaspargase pegol-mknl
Brand and other namesAsparlas
Generic name: capecitabine
Brand and other namesXeloda
Generic name: carboplatin
Brand and other namesParaplatin
Generic name: carmustine
Brand and other namesGliadel wafer implant, BiCNU
Generic name: chlorambucil
Brand and other namesLeukeran
Generic name: cisplatin
Brand and other namesPlatinol, Platinol-AQ, CDDP
Generic name: cladribine
Brand and other namesLeustatin, 2-chlorodeoxyadenosine, 2-CDA
Generic name: clofarabine
Brand and other namesClolar
Generic name: cyclophosphamide
Brand and other namesCytoxan, Neosar
Generic name: cytarabine
Brand and other namesAra-C, Cytosar-U, DepoCyt (liposomal), arabinosylcytosine
Generic name: dacarbazine
Brand and other namesDTIC, DTIC-Dome, imidazole carboxamide
Generic name: dactinomycin
Brand and other namesCosmegen, actinomycin-D
Generic name: daunorubicin
Brand and other namesCerubidine, DaunoXome (liposomal), daunomycin, rubidomycin hydrochloride
Generic name: decitabine
Brand and other namesDacogen
Generic name: dexamethasone
Brand and other namesDecadron, Dexasone, Diodex, Hexadrol, Maxidex
Generic name: dexrazoxane
Brand and other namesZinecard
Generic name: docetaxel
Brand and other namesTaxotere
Generic name: doxorubicin
Brand and other namesAdriamycin, Rubex, Doxil (liposomal), hydroxydaunomycin
Generic name: epirubicin
Brand and other namesEllence
Generic name: eribulin
Brand and other namesHalaven
Generic name: estramustine
Brand and other namesEmcyt
Generic name: etoposide
Brand and other namesEtopophos, Toposar, VePesid, etoposide phosphate, VP-16
Generic name: floxuridine
Brand and other namesFUDR
Generic name: fludarabine
Brand and other namesFludara
Generic name: fluorouracil
Brand and other namesAdrucil, Carac, Efudex, Fluoroplex, Tolak, 5-fluorouracil, 5-FU
Generic name: fluoxymesterone
Brand and other namesHalotestin
Generic name: gemcitabine
Brand and other namesGemzar
Generic name: hydroxyurea
Brand and other namesDroxia, Hydrea, Mylocel
Generic name: idarubicin
Brand and other namesIdamycin, Idamycin PFS
Generic name: ifosfamide
Brand and other namesIfex
Generic name: irinotecan
Brand and other namesCamptosar, Onivyde, camptothecin-11, CPT-11
Generic name: ixabepilone
Brand and other namesIxempra
Generic name: lanreotide
Brand and other namesSomatuline Depot
Generic name: lomustine
Brand and other namesCeeNu, Gleostine, CCNA
Generic name: mechlorethamine
Brand and other namesMustargen, Valchlor, mustine, nitrogen mustard, HN2
Generic name: melphalan
Brand and other namesAlkeran, L-PAM, L-sarcolysin, phenylalanine mustard
Generic name: mercaptopurine
Brand and other namesPurinethol, 6-mercaptopurine, 6-MP
Generic name: methotrexate
Brand and other namesOtrexup, Rasuvo, Rheumatrex, Trexall, amethopterin, MTX
Generic name: methylprednisolone
Brand and other namesDuralone, Medrol, Medralone, M-Prednisol, Solu-Medrol
Generic name: mitomycin
Brand and other namesMutamycin, mitomycin-C, MTC
Generic name: mitotane
Brand and other namesLysodren
Generic name: mitoxantrone
Brand and other namesNovantrone, DHAD
Generic name: nab-paclitaxel
Brand and other namesAbraxane, albumin-bound paclitaxel
Generic name: omacetaxine
Brand and other namesSynribo
Generic name: oxaliplatin
Brand and other namesEloxatin
Generic name: paclitaxel
Brand and other namesOnxal, Taxol
Generic name: pegaspargase
Brand and other namesOncaspar, PEG-L-asparaginase
Generic name: pemetrexed
Brand and other namesAlimta
Generic name: pentostatin
Brand and other namesNipent
Generic name: prednisone
Brand and other namesDeltasone, Meticorten, Orasone
Generic name: pralatrexate
Brand and other namesFolotyn
Generic name: procarbazine
Brand and other namesMatulane
Generic name: rasburicase
Brand and other namesElitek
Generic name: streptozocin
Brand and other namesZanosar
Generic name: temozolomide
Brand and other namesTemodar
Generic name: temsirolimus
Brand and other namesTorisel, CCI-779
Generic name: teniposide
Brand and other namesVumon, VM-26
Generic name: thalidomide
Brand and other namesThalomid
Generic name: thioguanine
Brand and other names6-thioguanine, 6-TG, 2-amino-6-mercaptopurine
Generic name: thiotepa
Brand and other namesThioplex, thiophosphoamide, TSPA
Generic name: topotecan
Brand and other namesHycamtin
Generic name: trabectedin
Brand and other namesYondelis
Generic name: tretinoin
Brand and other namesVesanoid, Atralin, ATRA
Generic name: trifluridine/tipiricil
Brand and other namesLonsurf
Generic name: valrubicin
Brand and other namesValstar
Generic name: vinblastine
Brand and other namesAlkaban-AQ, Velban, vincaleukoblastine
Generic name: vincristine
Brand and other namesOncovin, Vincasar PFS, Leurocristine, Marqibo (liposomal)
Generic name: vinorelbine
Brand and other namesNavelbine

Below is a list of acronyms for some combination chemotherapy regimens. It is not a complete list of all possible combinations.


Regimen: ABVD
Component drugsAdriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine
Regimen: ABVE
Component drugsAdriamycin (doxorubicin), bleomycin, vinblastine, etoposide
Regimen: ACE
Component drugsAdriamycin (doxorubicin), cyclophosphamide, etoposide
Regimen: ADE
Component drugsAra-C (cytarabine), daunorubicin, etoposide
Regimen: ADOC
Component drugscisplatin, doxorubicin (Adriamycin), Oncovin (vincristine), cyclophosphamide
Regimen: BEACOPP
Component drugsbleomycin, etoposide, Adriamycin (doxorubicin), cyclophosphamide, Oncovin (vincristine), procarbazine, prednisone
Regimen: CAF
Component drugscyclophosphamide, Adriamycin (doxorubicin), fluorouracil
Regimen: CEPP
Component drugscyclophosphamide, etoposide, procarbazine, prednisone
Regimen: CFAR
Component drugscyclophosphamide, fludarabine, alemtuzumab, rituximab
Regimen: CHOP
Component drugscyclophosphamide, hydroxydaunomycin (doxorubicin), Oncovin (vincristine), prednisone
Regimen: CLAG-M
Component drugscladribine, Ara-C (cytarabine), mitoxantrone
Regimen: COPDAC
Component drugscyclophosphamide, Oncovin (vincristine), prednisone, dacarbazine
Regimen: COPP
Component drugscyclophosphamide, Oncovin (vincristine), procarbazine, prednisone
Regimen: CVD
Component drugscisplatin, vinblastine, dacarbazine
Regimen: CVP
Component drugscyclophosphamide, vincristine, prednisone
Regimen: DHAP
Component drugsdexamethasone, high-dose Ara-C (cytarabine), Platinol (cisplatin)
Regimen: EOX
Component drugsepirubicin, oxaliplatin, Xeloda (capecitabine)
Regimen: EPOCH
Component drugsetoposide, prednisone, Oncovin (vincristine), cyclophosphamide, hydroxydaunomycin (doxorubicin)
Regimen: ESHAP
Component drugsetoposide, Solu-Medrol (methylprednisolone), Ara-C (cytarabine), Platinol (cisplatin)
Regimen: FAMTX
Component drugsfluorouracil, Adriamycin (doxorubicin), MTX (methotrexate)
Regimen: FLAG-IDA
Component drugsfludarabine, Ara-C (cytarabine), G-CSF (filgrastim), idarubicin
Regimen: FOLFIRI
Component drugsfolinic acid, fluorouracil, irinotecan
Regimen: FOLFIRINOX
Component drugsfolinic acid, fluorouracil, irinotecan, oxaliplatin
Regimen: FOLFOX
Component drugsfolinic acid, fluorouracil, oxaliplatin
Regimen: GEMOX
Component drugsgemcitabine, oxaliplatin
Regimen: Hyper-CVAD
Component drugscyclophosphamide, vincristine, Adriamycin (doxorubicin), dexamethasone
Regimen: ICE
Component drugsifosfamide, carboplatin, etoposide
Regimen: JEB
Component drugsJM8 (carboplatin), etoposide, bleomycin
Regimen: MAID
Component drugsmesna, Adriamycin (doxorubicin), ifosfamide, dacarbazine
Regimen: MINE
Component drugsmesna, ifosfamide, Novantrone (mitoxantrone), etoposide (Etopophos, Toposar, VePesid, etoposide phosphate, VP-16)
Regimen: MMM
Component drugsmitoxantrone, mitomycin, methotrexate
Regimen: MOPP
Component drugsmechlorethamine, Oncovin (vincristine), prednisone, procarbazine
Regimen: MVAC
Component drugsmethotrexate, vinblastine, Adriamycin (doxorubicin), cisplatin
Regimen: OPPA
Component drugsOncovin (vincristine), procarbazine, prednisone, Adriamycin (doxorubicin)
Regimen: PAC
Component drugsPlatinol (cisplatin), Adriamycin (doxorubicin), cyclophosphamide
Regimen: PCV
Component drugsprocarbazine, CCNU (lomustine), vincristine
Regimen: PEB
Component drugsPlatinol (cisplatin), etoposide, bleomycin
Regimen: TAC
Component drugsTaxotere (docetaxel), Adriamycin (doxorubicin), cyclophosphamide
Regimen: TIP
Component drugsTaxol (paclitaxel), ifosfamide, Platinol (cisplatin)
Regimen: VAD
Component drugsvincristine, Adriamycin (doxorubicin), dexamethasone
Regimen: VAMP
Component drugsvincristine, Adriamycin (doxorubicin), methotrexate, prednisone

The following resources offer more information about chemotherapy:

American Cancer Society

American Society of Clinical Oncology

Chemocare

National Cancer Institute

Last Reviewed: January 3, 2019