Your kidneys, liver, heart, lungs and cancer drugs

About the kidneys, liver, heart, lungs and cancer drugs

Doctors use many different types of drugs to treat cancer. Some drugs can cause changes in the way that your kidneys, liver, heart or lungs work.

The changes are usually temporary and stop when your treatment ends. But some drugs might cause permanent changes.

Some chemotherapy drugs, targeted cancer drugs and immunotherapies are most likely to cause these changes. Some hormonal therapies and bisphosphonates cause mild changes. They usually clear up once you have finished treatment.

Even if a drug can cause these effects, it may not affect you that way. Drugs affect people in different ways. It is not possible to tell in advance who will have side effects. It depends on:

• the drug or combination of drugs you are having

• the dose

• how you react to the drug

• how you reacted to drug treatment in the past

Before you start cancer treatment your doctor or specialist nurse will check if you have any other illnesses. They will also want to know if you are taking any other medicines or herbal remedies.

Find out more about your cancer drugs

Your kidneys

Some cancer drugs can change the way your kidneys work. The drugs most likely to cause these changes are some:

• chemotherapy drugs, such as cisplatin and ifosfamide

• targeted cancer drugs

• immunotherapies

• bisphosphonates

The effect can be mild and the kidney changes are picked up on blood tests. Some people might develop symptoms. But this can vary between the types of treatments. Other factors may also play a role. For example how much ifosfamide will affect your kidneys can depend on:

• the total amount of the drug you have had over time (cumulative dose)

• whether you had kidney problems before you started treatment

• whether you have it with another medicine that can affect the kidney such as cisplatin or

  NSAID

• your age

If you are having medicines that might affect your kidneys, you will have a blood test before each treatment. The test checks how well your kidneys are working.

Your doctor may prescribe medicines to protect your kidneys from the treatment. Sometimes they adjust the dose of the drug you are having.

You might have extra fluid through a drip (intravenous fluids) for several hours before and after you have the treatment. Your nurse may also ask you to drink plenty of fluids and to keep a record of how much you drink.

You might have to measure the amount of urine you pass and keep a record. Your nurse might also ask that you weigh yourself before and after treatment. This is to make sure you are not holding fluid.

Let your nurse or doctor know if you cannot drink as much as you have been asked to, for example, if you feel sick. Also, tell them if you’re passing less urine.

If you have kidney problems related to immunotherapy treatment your doctor may temporarily stop your treatment to give you steroids. If your kidney function improves, they may restart the treatment. If the kidneys do not respond to treatment or it gets worse they may stop this treatment.

Your liver

Some cancer drugs can change the way your liver works. These changes are most likely to happen with some:

• chemotherapy drugs

• targeted cancer drugs

• immunotherapies

• hormone therapies

The effect can be mild and liver changes can be picked up on blood tests. Some people might develop symptoms. But this can vary between the types of treatments. Your liver usually recovers when the treatment ends. Having a combination of drugs can have more of an effect on your liver.

When you are having drugs that could affect the liver, you will have a blood test before each treatment. The test checks how well your liver is working.

Your doctor or specialist nurse might change the dose of your treatment if it is affecting your liver. Or they might give you a different treatment.

If you are having immunotherapy treatment your doctor may temporarily stop your treatment. This is to let your liver recover. If it improves they can restart the treatment. If your liver function continues to get worse, you may have steroids and intravenous fluids.

Your heart

There are cancer drugs that can change the way your heart works. The drugs most likely to cause these changes are some:

• chemotherapy drugs

• targeted cancer drugs

• immunotherapies

• hormone therapies

The effect of these drugs may be temporary but can sometimes be permanent.

A group of chemotherapy drugs called anthracyclines are more likely to affect the heart. These are for example the drug doxorubicin. Anthracycline drugs might affect you more if you:

• had treatment with anthracycline drugs before (cumulative dose)

• are obese

• are older than 50

• have existing heart problems

• have high blood pressure

• smoke

• have high cholesterol

• are diabetic

Some cancer treatments might be combined, such as chemotherapy with targeted cancer drugs. The combination of drugs may also affect your heart more.

Immunotherapy treatment can cause heart changes, including inflammation of the heart muscle (myocarditis). If this happens your doctor may temporarily stop your treatment to give you steroids.

Your doctor or specialist nurse will check your heart regularly. They will make sure that all treatments are as safe as possible. They will adjust your treatment if necessary. You might have tests to see how well your heart is working. These can be:

• a blood test to check for a protein called troponin. Troponin is released into the bloodstream when the heart muscle is inflamed or injured

• an electrocardiogram (ECG)

• an echocardiogram (ECHO)

• a multi-gated acquisition (MUGA) scan

Your lungs

Some cancer drugs can change the way your lungs work. The cancer drugs most likely to cause these changes are some:

• chemotherapy drugs

• targeted cancer drugs

• immunotherapies

It is not always clear how exactly some cancer drugs affect the lungs. Some cause inflammation of the lung tissue. This is also called pneumonitis.

Sometimes the lung tissue can get thicker and less flexible and make it harder for you to breathe. This is called pulmonary fibrosis. It might happen gradually over months or years. You might have a cough, feel short of breath or tired.

Some cancer drugs might cause you to become breathless when resting or when being physically active such as walking.

Your doctor or specialist nurse will check your lungs to see if the drugs you are having might cause lung problems. They will do so during your treatment and afterwards.

In some situations, your doctor or specialist nurse might have to stop your treatment if the cancer drug causes you to have severe lung problems. To relieve symptoms, they might treat you with a combination of:

• oxygen

• drugs (bronchodilators) to open up your airways - you can have them as inhalers, tablets or through a mask called a nebuliser

• steroids

If your symptoms are related to immunotherapy treatment, and they do not respond to steroids you might other medicine such as tacrolimus.

Let your doctor or nurse know straightaway if you have breathing changes, feel breathless or develop a cough.

Read more about breathing problems with cancer