Preparing for Targeted Therapy

How to Prepare for Targeted Therapy

Targeted therapy is a potential treatment option for some cancers. It uses drugs that selectively target specific features or genetic changes in cancer cells. If it’s part of your treatment plan, you probably have questions and concerns.

Understanding how targeted therapy works, what to expect during and after treatment, and how to prepare will help you feel more confident in the days and weeks ahead.

Targeted Therapy as a Cancer Treatment

Cancer starts when healthy cells mutate and grow uncontrollably, forming a lump called a tumour. All cancer treatments aim to remove or shrink tumours and kill any remaining cancer cells, but they work in different ways.

Targeted therapies take aim at specific features of mutated cells that help them grow and spread. This treatment is often called precision medicine because, unlike chemotherapy, which affects all rapidly dividing cells, targeted therapy attacks mostly the cancer cells.

There are different types of targeted therapies, and they work in different ways to kill or slow the growth of cancer [1,2]:

• Monoclonal antibodies attach to cancer cells and cause them to die by damaging them, stopping them from making new blood vessels, or marking them so your immune system can find and kill them.
• Angiogenesis inhibitors stop tumours from developing the network of blood vessels they need to survive.
• Cancer growth blockers switch off the chemical signals that tell cancer cells to grow and divide.
• PARP inhibitors block an enzyme that helps damaged cells repair themselves, so they die instead.

Who is Eligible for Targeted Therapy?

Targeted treatments aren’t yet available for every type of cancer, but they might help treat some of these cancers [2]:

• Bladder and kidney
• Breast
• Blood cancers, like leukaemias and multiple myeloma
• Cervical and endometrial
• Colorectal
• Liver
• Lung
• Melanoma
• Oesophageal
• Ovarian
• Pancreatic
• Prostate
• Stomach
• Thyroid
• Head and neck cancers

Even within these cancers, eligibility depends on the cancer stage, response to other treatments, and whether your cancer has certain biomarkers that the treatments can target.

Determining the Right Type of Targeted Therapy

Biomarker testing helps your doctor determine which targeted therapy is most likely to work for you. These tests look for one or more genetic changes in cancer cells, specific receptors, or certain genetic material or cells that are shed by cancer.

Depending on your cancer, your doctor may collect and analyse a sample from:

• A biopsy (small tissue sample) of the tumour
• A sample of bone marrow
• A blood sample, also called a liquid biopsy 
• Other body fluids or cells, such as urine or saliva, or a cheek swab

Preparation for biomarker testing depends on the type of test you’ll have. Your doctor will give you specific instructions before your test and review how long the test results will take to come back.

General preparation may include:

• Fasting for a period of time if you’ll be sedated
• Hydrating well if you’ll have blood tests
• Following any instructions from your healthcare team about medications that may need to be adjusted before testing
• Arranging transportation to and from your appointment if you’ll be sedated

Results can take a few days up to several weeks. Your doctor will use them to plan your treatment.

Ways to Receive Targeted Therapy

Targeted therapy drugs can be given as:

• An IV infusion into your vein
• A pill
• A shot under your skin

Some targeted therapy drugs are given in cycles, daily or weekly, for a period of time, followed by a rest period. Others are given daily without a rest period. 

Side effects from these treatments can vary depending on the medications you’re getting and your overall health. Some people experience few, if any, side effects, while others might have [3]:

• Allergic reactions, like hives, itching, or mouth or tongue swelling
• Skin rashes
• Hair loss or loss of hair colour
• Bruising or bleeding
• High blood pressure
• Slow wound healing
• Nausea, vomiting, or diarrhoea
• Heart damage
• Fatigue
• Nail changes, including inflammation of the nail bed, or cracks in the skin near the nail
• Increased liver enzymes
• Lung inflammation

Your cancer specialists will personalise your treatment and schedule to make it as effective as possible while minimising side effects.

How can You prepare for the Different Types of Targeted Therapy?

Before you start targeted therapy, your doctor will make sure you’re medically ready by:

• Reviewing your medical history and current medications
• Examining your physical health
• Ordering bloodwork or other tests to check how well your organs and immune system are working
• Explaining the goals of your treatment and what will happen during and after targeted therapy treatments, including follow-up testing to see how it’s working

Your care team will give you specific information to help you prepare for your specific treatment, but there are also some general steps you can take to prepare for targeted therapy:

• Adjust your work schedule to accommodate treatment and medical follow-up appointments.
• Learn about possible side effects and reactions, and how to manage them.
• Plan for any changes to your eating and drinking. For example, if you’re taking pills, should you take them with food or on an empty stomach? If side effects may affect your eating, speak with your healthcare team or an oncology dietitian. They can help you plan simple, easy-to-manage meals and recommend oral nutritional supplements if needed to help you meet your nutritional needs.
• If necessary, arrange for transportation to and from infusion appointments.
• Learn how to take safety precautions at home to prevent others from coming in contact with body fluids or oral medications. This includes washing your hands after using the toilet or handling medications, cleaning the bathroom daily with bleach, washing soiled bedding or laundry separately in hot water, and keeping pill bottles in a secure location.
• Line up extra support at home for childcare, errands, grocery shopping, and meal prep.
• For any longer treatment appointments, pack a small bag with comfortable clothing, snacks (if allowed), and audiobooks, movies, or other entertainment.
• Prepare yourself emotionally by meditating, keeping a journal, or talking to a support counsellor to discuss your worries or feelings.
• Support your body by prioritising rest and sleep, good nutrition, and gentle exercise when possible.

Timeline: From Testing to Starting Therapy

The path from biomarker testing to starting therapy can vary and may depend on the cancer type and how urgently testing and treatment are needed.

It may take several weeks or months from testing and analysis to planning and treatment. Your doctor will walk you through your specific timeline.

Once you start treatments, the duration can also vary and may depend on:

• Your cancer type and stage
• The type of targeted therapy drugs you receive
• Whether you are receiving other treatments along with targeted therapies
• Whether you experience severe side effects or treatment reactions
• How your cancer responds to the treatment. Follow-up testing and scans will tell your doctors how well your treatment is working.

Your oncology team will monitor you closely throughout and adjust your treatment plan as needed. Don’t hesitate to ask them for updates and information.

Seek out Support from your Care Team

Targeted therapy is a promising treatment for many cancer types, but there’s much to know about it, and that can feel overwhelming. Understanding how it works and preparing yourself can put your mind at ease and lead to a smoother experience and a better outcome.

Stay in close contact with your medical team because they can guide you through every step of your treatment and provide the support you need.