Adjuvant Chemotherapy

Preventative Chemotherapy- What is it?

Kate Middleton in her recent video address declared that she was receiving preventative chemotherapy. There was a little debate regarding what this might have meant but has broadly been taken to indicate adjuvant chemotherapy. This is a type of strategy, where chemotherapy for cancer is given in conjunction with another form of treatment such as radiotherapy or surgery in this case. The adjuvant therapy is often regarding as the secondary treatment as it may be less effective or less established than the primary treatment. The rational is to mop up any residual microscopic disease and reduce the risk of recurrence. Chemotherapy has been traditionally used in advanced diseases where surgery or radiotherapy may not be curative, however this is no longer the case and cancer treatment are often multimodal. If a combination of treatment is more effective than a single treatment, then their use may be justified if the benefits of additional survival outweigh any detrimental effects on quality of life.

There is plenty of research on adjuvant treatments. The progress in these areas have often outstripped developments made in surgery in recent years. Though surgery alone, by and large, remains the most effective treatment for cancer in many cases.

It is natural to want to trial and develop new compounds in the fight against cancer in addition to extending the application of existing chemotherapy regimens. Over the last few years an average of just under 5000 articles have been published on adjuvant chemotherapy.

There are many examples of adjuvant chemotherapy.

Here are a few:

Testicular Cancer,

Chemotherapy may be given after the removal of the testes in patients with testicular cancer and no signs of diseases outside of the testes, i.e. no remaining visible disease after surgery cisplatin may be given in combination with other drugs and this can reduce the chance of cancer reappearing in the lymph nodes in the abdomen after surgery.

Bladder Cancer,

Drugs may be instilled into the bladder which reduces the chance of bladder cancer reappearing in the bladder after successful treatment. Examples are mitomycin and BCG. These are localised treatments that generally have no widespread effect on the body.

Breast Cancer:

"Sequential Adjuvant Epirubicin-Based and Docetaxel Chemotherapy for Node-Positive Breast Cancer Patients: The FNCLCC PACS 01Trial" The PACS 01 trial demonstrated improved disease-free survival (DFS) and overall survival (OS) rates with sequential adjuvant epirubicin-based and docetaxel chemotherapy compared to conventional chemotherapy regimens. This regimen is now a standard of care for many breast cancer patients.

Colon Cancer:

"Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer" (The MOSAIC trial) The MOSAIC trial demonstrated that FOLFOX significantly improved disease-free survival compared to fluorouracil and leucovorin alone. This regimen is now a standard adjuvant treatment for stage III colon cancer.

Lung Cancer (Non-Small Cell):

Adjuvant Chemotherapy for Completely Resected Stage II andIII Non–Small-Cell Lung Cancer" (The LACE Meta-analysis). The LACE meta-analysis showed that adjuvant chemotherapy with cisplatin or carboplatin-based regimens improved overall survival in patients with completely resected stage II and III non-small-cell lung cancer.

Ovarian Cancer:

Adjuvant Chemotherapy in Ovarian Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" Meta-analyses have consistently shown that adjuvant chemotherapy with carboplatin and paclitaxel significantly improves progression-free survival and overall survival in patients with ovarian cancer.

Stomach Cancer (Gastric Cancer):

Adjuvant Chemotherapy for Gastric Cancer with S-1, an OralFluoropyrimidine" (The ACTS-GC trial) The ACTS-GC trial in Japan showed that adjuvant chemotherapy with S-1, an oral fluoropyrimidine, significantly improved overall survival compared to surgery alone in patients with stage II or III gastric cancer.

Prostate Cancer:

Docetaxel and Prednisone or Mitoxantrone and Prednisone for Advanced Prostate Cancer The CHAARTED trial demonstrated a significant improvement in overall survival with the addition of docetaxel to standard androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer.

These are just a few examples, and the choice of adjuvant chemotherapy can vary based on the specific characteristics of the cancer and the patient.