Why Selena Gomez Underwent Chemotherapy for Lupus

Since her diagnosis in 2014, Selena Gomez has been open about her journey with lupus. In addition to a kidney transplant in 2017, the 29-year-old singer and actress has shared she's undergone chemotherapy to treat her autoimmune disease—and that the treatment's taken a toll on her career and mental health.

"My lupus, my kidney transplant, chemotherapy, having a mental illness, going through very public heartbreaks—these were all things that honestly should have taken me down," Golez told Elle magazine.

Back in 2015, Gomez shared with Billboard that her treatments forced her out of the spotlight and even sparked rumors of addiction. "I was diagnosed with lupus, and I've been through chemotherapy. That's what my break was really about," Gomez told the magazine.

What Is Lupus?

Systemic lupus erythematosus (SLE), also called lupus, is a chronic autoimmune disease that occurs when the immune system attacks its own tissues and organs, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Because it's a systemic condition, lupus can affect many parts of the body, such as the skin, joints, heart and lungs, kidneys, and the brain. Lupus treatment ultimately depends on a person's symptoms and their severity, but in some cases—including Gomez's—healthcare providers use chemotherapy drugs to suppress the autoimmune response responsible for the disease.

Here's what to know about how chemotherapy works for lupus as well as other treatment options for lupus.

How and Why Is Chemotherapy Used To Treat Lupus?

Chemotherapy is a type of drug that kills the body's cells, and it's most commonly known as a drug to treat cancer, says the National Cancer Institute (NCI). But healthcare providers also use chemotherapy for other diseases, including blood disorders and autoimmune diseases like rheumatoid arthritis and lupus.

While healthcare providers may use the same types of drugs to treat cancer and lupus, the two diseases are different and unrelated. According to Andrew Wang, MD, PhD, Yale Medicine rheumatologist and assistant professor of medicine at Yale School of Medicine, cancer occurs when cells abnormally divide, grow larger, and damage other cells and organs. Autoimmune diseases, on the other hand, happen when the body's cells attack its own tissues and organs.

Chemotherapy drugs used for cancer can help with lupus, Dr. Wang said, because autoimmunity also involves a similar process. Before cells can attack the body, they first divide. "The thought is, if you can stop the rapidly dividing phase, you can get rid of the autoimmunity," Dr. Wang told Health.

Because the two diseases work so differently, healthcare providers also use chemotherapy drugs differently for individuals with autoimmune diseases. According to Amr Sawalha, MD, chief of the division of pediatric rheumatology and director of the Comprehensive Lupus Center of Excellence at the University of Pittsburgh School of Medicine, chemotherapy for lupus is typically a much lower dose than cancer treatment.

"Rather than killing the immune cells, we suppress them enough that they stop attacking organs and tissues of the body," Dr. Sawalha told Health. For that reason, Dr. Sawalha said, providers usually call lupus-specific chemo treatment "immunotherapy treatment," rather than just "chemotherapy."

There are several chemotherapy drugs. The one which a healthcare provider prescribes depends on the specific symptoms a person with lupus is experiencing (and how severe they are). Some chemo drugs may be taken as pills, while others are given intravenously.

In either case, Dr. Sawalha said, the side effects are usually far milder than in cancer treatment. For example, immunosuppressants can cause hair thinning like with chemotherapy, but not as severe. And while some individuals with lupus experience gastrointestinal problems like vomiting or diarrhea, Dr. Wang said, those issues aren't nearly as bad in most people with lupus.

Even though side effects are generally milder, Dr. Sawalha said, chemotherapy drugs aren't without risks—so it's important that doctors monitor them closely through the process. "For example, we want to make sure we don't suppress the immune system too much and reduce the patient's white blood cell count," Dr. Sawalha said.

What Are Other Treatment Options for Lupus?

Chemotherapy is just one treatment option for those with lupus. "For lupus and autoimmunity generally, there are only a few drugs we share with cancer," Dr. Wang said. "The vast majority of drugs lupus patients would get are not used with cancer."

One such option is steroids, which work by suppressing the entire immune system to prevent autoimmunity. In reducing inflammation and immune response, steroids help to prevent damage to the tissues in your body, according to the Lupus Foundation of America. But because of the side effects—steroids weaken the immune response and can make people more susceptible to infection—healthcare providers use them cautiously.

"Our aim is to use steroids at the lowest dose possible for the shortest duration to minimize the long-term side effects," Dr. Sawalha said. Because they work faster than other medications, Dr. Sawalha added that steroids are especially helpful for acute flare-ups and that doctors often use them in conjunction with other treatments that take longer to work.

Biologics, another treatment option for lupus, work by targeting specific cells involved in creating autoimmune antibodies rather than the entire immune system, according to the United States Food and Drug Administration (FDA).

Currently, Dr. Sawalha said, there are two FDA-approved biologic drugs for treating lupus: Benlysta (benlimumab), which was first approved to treat SLE in 2011 and then active lupus nephritis (a kidney disease caused by lupus) in December 2020, and Saphnelo (anifrolumab-fnia), which was approved in August 2021.

For people with milder symptoms, Dr. Sawalha may prescribe an immunomodulator called hydroxychloroquine, along with steroids in a flare-up. For individuals with more severe lupus symptoms—such as kidney failure, like Gomez experienced—Dr. Sawalha would consider immunosuppressants. "If a patient's disease isn't controlled with other medications, we might scale up," Dr. Sawalha said.

Overall though, while all of these drugs can help people with lupus, every patient is unique, Dr. Sawalha said. And the best treatment methods will depend on the individual's specific situation and be prescribed at the discretion of the patient's entire medical team.