Adjuvant cancer treatment

Adjuvant chemotherapy Chemotherapy given after the primary cancer treatment, designed to eliminate any remaining cancer cells that are undetectable with the goal of improving survival. 

Perez E, Suman V, Davidson N, et al. HER2 testing by local, central, and reference laboratories in specimens from the North Central Cancer Treatment Group N983J Intergroup adjuvant trial. /. Clin. Oncol. 2006 24 3032-3038. 

Andersson M, Storm HH, Mouridsen HT (1992) Carcinogenic effects of adjuvant tamoxifen treatment and radiotherapy for early breast cancer. Acta Oncol 31 259-263... 

Jin, Y., Desta, Z., Stearns, V., et al. (2005) CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. J. Natl. Cancer Inst. 97, 30-39. 

Tamoxifen is an oestrogen-receptor antagonist indicated as adjuvant hormonal treatment in oestrogen-receptor-positive breast cancer in postmenopausal women. Common side-effects include alopecia and uterine fibroids. 

Liposomes are phospholipid vesicles that have been evaluated both as adjuvants and as vehicles for antigens and adjuvants (17). A liposomal hepatitis A (Hep A) vaccine (virosomes) has been extensively evaluated in the clinic and is currently licensed for a Hep A vaccine (18). Alternative adjuvants that have been used in a few products include L-tyrosine (allergy vaccine) and MPL (cancer treatment). The various adjuvants (mainly alum salts) used in vaccine formulations and their quantities per dose are listed in Table 1. 

Tamoxifen versus aromatase inhibitors While tamoxifen is still widely regarded as the standard adjuvant endocrine treatment for postmenopausal women with localized breast cancer, provided it is hormone receptor positive, there are problems with recurrence and adverse effects. Reservations have recently been expressed about the future place of tamoxifen, and the case has been made that it is time to move from tamoxifen to the oral aromatase inhibitors (19). 

Recently, there has been renewed interest in developing vaccines for use in cancer treatment. The main factors giving impetus to this therapeutic approach include a better understanding of the immune system, the identification of several T cell-specific tumor antigens, more effective adjuvants, and the ability to construct more immunogenic molecules using recombinant DNA techniques (Murray et al., 2000). Current vaccine strategies for the treatment of solid tumors tend to focus on the cellular arm of the immune response. 

Cancer chemotherapy is only one method of treating neoplastic disease. The other primary weapons in the anticancer arsenal are surgery and radiation treatment.18,61 The choice of one or more of these techniques depends primarily on the patient, the type of cancer, and the tumor location. In many situations, chemotherapy may be the primary or sole form of treatment in neoplastic disease, especially for certain advanced or inoperable tumors, or in widely disseminated forms of cancer, such as leukemia or lymphoma.6 In other situations, chemotherapy is used in combination with other techniques, such as an adjuvant to surgery and radiation treatment.18,27 Primary examples of adjuvant cancer chemotherapy include using anticancer drugs following a mastectomy or surgical removal of other carcinomas.19,54,43,61... 

Schroth W et al (2007) Breast cancer treatment outcome with adjuvant tamoxifen relative to patient CYP2D6 and CYP2C19 genotypes. J Clin Oncol 25 5187-5193... 

Ramon y Cajal T et al (2010) Impact of CYP2D6 polymorphisms in tamoxifen adjuvant breast cancer treatment. Breast Cancer Res Treat 119 33-38... 

Zoledronic acid has also been investigated in the prevention of cancer treatment-induced bone loss in 401 premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer in a randomised, open-label. Phase 111 clinical trial [76]. In this study, patients received tamoxifen and goserelin with or without zoledronic acid (4 mg i.v. every 6 months) versus anastrozole and goserelin with or without zoledronic acid (4 mg i.v. every 6 months) for 3 years. The combination of zoledronic acid with endocrine therapy was well tolerated and was not associated with changes in renal function in this patient population. Over 3 years, 2, 904 serum creatinine measurements were taken, the mean serum creatinine level was 0.78 + 0.17 mg/ dl, and no patient had serum creahnine levels that exceeded 1.5 times the upper limit of normal [76]. 

Breast cancer treatment or adjuvant therapy in ER-positive patients preventive therapy in women at high risk for breast cancer... 

Laurie JA, Moertel CG, Heming TR, et al. Surgical adjuvant therapy of large bowel carcinoma An evaluation of levamisole and combination of levamisole and 5-fluorouracil. The North Central Cancer Treatment Group and the Mayo Qinic. J Qin Oncol 1989 7 1447-1456. 

CRA has been detected in humans [34] and was the first RAR-RXR pan-agonist discovered [35-37] and may be classified as a retinoid/rexinoid. It is the only retinoic acid isomer not approved for the common dermatological diseases. However, it has recently been launched in the US as adjuvant topical treatment of AIDS-associated Kaposi s sarcoma [38-41]. This agent is the first RXR ligand to be approved for the treatment of a dermatological disease. In a randomized study with 268 AIDS-associated Kaposi s sarcoma patients, 35% treated with alitretinoin (0.1% gel) had a positive response, compared with 18% treated with vehicle gel irrespective of the number of concurrent antiretroviral therapies [41], 9-CRA is in clinical trials for the treatment of various cancers, including breast cancer [42], renal cell carcinoma [43,44] and squamous cell carcinoma [45—47]. 

Another cancer Web site is http //www.mgwater.com/cancer.shtml which has a contribution by Mildred S. Seelig, M.D., MPH, of the Department of Nutrition, School of Public Health, North Carolina University Medical Center. This contribution was published as Chapter 15 in Adjuvant Nutrition in Cancer Treatment,... 

Quillan, P. and Williams, R.M., Eds. 1993. Adjuvant Nutrition in Cancer Treatment. Cancer Treatment Research Eoundation. 

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