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SMILE Chemotherapy Treatment



What a ridiculous name! I have made several requests that the name of the protocol is changed, but it was created in Japan, so I have little influence. There are 5 drugs that make up the protocol which give the acronym SMILE.


The drugs that Ryan is subjected to are as follows:

Steroid Dexamethasone, days 2-4: A steroid used as an anti-inflammatory, increase appetite, prevents reactions. 
Side effects: Muscle weakness, mood swings, insomnia.

Methotrexate, day 1:  A cytotoxic - Anti Cancer Antimetobolite drug that prevents cell division. 
Side effects: Neutropenia, Alopecia, Fertility.

Ifosfamide, days 2-4: A cytotoxic - Anti Cancer Alkylating Agent that changes cell DNA. 
Side effects: Neutropenia, Alopecia, Fertility.

L-asparaginaseday 8: A cytotoxic - Anti Cancer Pancreatitis Enzyme that breaks down asparagine in the body. Since the cancer cells cannot make more asparagine, they die.
Side effects: Anaphylaxis, Neurotoxicity, Liver function.

Etoposidedays 2-4: A cytotoxic - Anti Cancer Plant alkaloid that halts cell division.
Side effects: Neutropenia, Alopecia, Fertility. 

Ry also has to take all of these in addition to counteract some of the effects on the body. 

  • Sodium Lactate 500ml on day 1 for Electrolytes balance
  • Phenytoin 300mg days 1-6. Anti-neurotoxicity. Can cause muscle & bone pain.
  • Folinic Acid days 2-5. Assists in Methotrexate breakdown
  • Mesna days 2-4. Bladder protection
  • Filgrastim (GCSF) 300mg day 6-15. Assists bone marrow to make stem cells for neutrophils.
  • Cyclizine days 1-10. Anti sickness.
  • Ondansetron days 1-10. Anti sickness
  • Methylene blue prophylaxis for ifosfamide reaction. Ryan unfortunately had a grade 1 neurotoxic reaction to Ifosfamide in cycle 2.

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