Adjuvant therapy chemotherapy

Adjuvant tamoxifen therapy generally is initiated shortly after surgery or as soon as pathology results are known and the decision to administer tamoxifen as adjuvant therapy is made. The administration of tamoxifen should be limited to administration after completion of chemotherapy based on results from a study that randomized patients to receive chemotherapy for six cycles with concurrent tamoxifen, followed by continued tamoxifen for a total of 5 years, or chemotherapy with sequential tamoxifen for 5 years.39 After a median follow-up of 8.5 years, the administration of sequential tamoxifen resulted in an estimated DFS advantage of 18% [hazard ratio (HR) = 1.18] compared with the concurrent use of tamoxifen with chemotherapy.39 It is believed the growth-inhibitory effect of... 

Early breast cancer is resected completely with curative intent, and adjuvant chemotherapy and hormonal therapy are initiated to prevent recurrence. During adjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy. After completion of adjuvant therapy, patients are monitored every 3 months for the first few years after diagnosis, with intervals between exams extended as time from diagnosis lengthens. 

The term adjuvant therapy refers to the use of chemotherapy or radiotherapy following surgical resection of a tumor mass. The rationale behind adjuvant chemotherapy is to eradicate micrometastases or other tumor cells that may have been missed during removal of the primary tumor. The recent results of five relatively large prospective trials (n = 344—1867) suggest that there is benefit from adjuvant chemotherapy. The largest study, the International Adjuvant Lung Trial (IALT),24 has led to the... 

Adjuvant therapy consisting of 5-fluorouracil-based chemotherapy in combination with radiation therapy should be offered to patients with stage II or III cancer of the rectum. 

Survival in Adjuvant Therapy Trials Using Chemotherapy... 

Methotrexate is part of curative combination chemotherapy for acute lymphoblastic leukemias, Burkitt s lymphoma, and trophoblastic choriocarcinoma. It is also useful in adjuvant therapy of breast carcinoma in the palliation of metastatic breast, head, neck, cervical, and lung carcinomas and in mycosis fungoides. 

G. Other applications Leukine has been effective in producing increases in normally functioning neutrophils, eosinophils, and monocytes in AIDS patients and patients with leukopenia. Leukine may prolong survival when used as adjuvant therapy in patients with stage III or IV malignant melanoma. Leukine has also been effective in abrogating chemotherapy-related neutropenia in cancer patients, with a reduction in the severity and duration of chemotherapy-induced myelosuppression. 

Tamoxifen is beneficial in postmenopausal women when used alone or when combined with cytotoxic chemotherapy. The present recommendation is to administer tamoxifen for 5 years of continuous therapy after surgical resection. Longer durations of tamoxifen therapy do not appear to add additional clinical benefit. Results from several randomized trials for breast cancer have established that adjuvant chemotherapy for premenopausal women and adjuvant tamoxifen for postmenopausal women are of benefit to women with stage I (node-negative) breast cancer. While this group of patients has the lowest overall risk of recurrence after surgery alone (about 35-50% over 15 years), this risk can be further reduced with adjuvant therapy. 

There were some attempts to apply this model for substantiation of accessory (adjuvant) therapy of micro-metastases in the cases of considerable tumors. It is known that micro-metastases contain significantly larger amount of dividing cells in comparison with considerable metastases. Due to this reason if chemotherapy erases predominantly dividing cells, then the part of killed cells in micro-metastasis should be larger. However clinical investigations didn t confirm these suppositions. 

Adjuvant therapy differs for colon and rectal cancer because their natural history and recurrence patterns differ. Rectal cancer is more difficult to resect with wide margins, so local recurrences are more frequent than with colon cancer. Adjuvant RT plus chemotherapy is considered standard for stage 11 or 111 rectal cancer. Adjuvant chemotherapy is standard for stage 111 colon cancer and can be considered for high-risk stage II colon cancer. Adjuvant therapy is not indicated for stage I colorectal cancer because most patients are cured by surgical resection alone. 

Cytotoxic chemotherapy is more useful in younger women, with tamoxifen, increasingly, as adjuvant therapy. The optimum duration of dosing with tamoxifen is not yet established, but is likely to be for 5 years or more. 

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