Adjuvant drug treatment

Adjuvant drug treatment is given after local therapy to patients who do not show evidence of macroscopic residual disease, but who are judged to be at high risk of having microscopic metastases and therefore risk of relapse, as indicated by adverse tumor characteristics. Experimental evidence based on... 

It is used for treating hypertension in patients who do not respond to thiazide diuretics. It can be nsed as an adjuvant drug in thiazide treatment for reaching an optimal level of blood pressnre. A synonym of this drag is hylorel. 

It is intended for symptomatic treatment of seasonal allergies and allergic reactions as well as an adjuvant drug in anaphylactic reaction therapy. Synonyms of this drag are arbid, timpil, histryl, hispril, and others. 

Sarcomas are tumors of mesenchymal origin, arising in skeletal tissues and extra-skeletal connective tissues including the nerves. They are very rare and mainly effect a younger population. Sarcomas of soft tissues are relatively insensitive to drug treatment and are therefore not discussed in detail in this chapter. A systematic review of fourteen trials of doxorubicin-based adjuvant chemotherapy for the treatment of soft tissue sarcomas involving 1568 patients concluded Doxorubicin-based adjuvant chemotherapy appears to significantly improve time to local and distant recurrence and overall recurrence-free survival in adults with localised resectable soft tissue sarcoma. There is some evidence of a trend towards improved overall survival (see Sarcoma Meta-analysis Collaboration, 1999). 

MTX is part of curative therapeutic schedules for acute lymphoblastic leukemias (ALL), Burkitt s lymphoma, and choriocarcinoma. It was also used in adjuvant therapy of breast cancer. High dose MTX with leucovorin rescue can induce about 30% remissions in patients with metastatic osteogenic sarcoma. MTX is one of the few antineoplastic drugs that can be safely administered intrathecally for the treatment of meningeal metastases and leukemic infiltrations (routine prophylaxis in ALL). In addition, MTX can be used as an immunosuppressive agent for the treatment of severe rheumatoid arthritis and psoriasis. 

Adjuvant chemotherapy involves the use of antineoplastic drugs when surgery or radiation therapy has eradicated the primary tumor but historical experience with similar patients indicates a high risk of relapse due to micrometastases. Adjuvant chemotherapy should employ drugs that are known to be effective in the treatment of advanced stages of the particular tumor being treated. Adjuvant chemotherapy has played a major role in the cure of several types of childhood cancers as well as breast cancer, colorectal cancer, and osteosarcoma in adults. 

Low doses (100-200 mg/d) of amiodarone are effective in maintaining normal sinus rhythm in patients with atrial fibrillation. The drug is effective in the prevention of recurrent ventricular tachycardia. It is not associated with an increase in mortality in patients with coronary artery disease or heart failure. In many centers, the implanted cardioverter-defibrillator (ICD) has succeeded drug therapy as the primary treatment modality for ventricular tachycardia, but amiodarone may be used for ventricular tachycardia as adjuvant therapy to decrease the frequency of uncomfortable cardioverter-defibrillator discharges. The drug increases the pacing and defibrillation threshold and these devices require retesting after a maintenance dose has been achieved. 

Preclinical and clinical results indicate that both entacapone and tolcapone are orally active, nontoxic and well-tolerated drugs. The adjuvant L- dopa therapy with DDC inhibitor + COMT-inhibitor (+ possible MAO inhibitor) may substitute for the present double therapy in the treatment of Parkinson s disease [27-40]. Together with the development of dopamine agonists and MAO inhibitors, the inhibition of COMT will constitute major progress in the treatment of Parkinson s disease in the near future. 

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