Adjuvant cancer therapies

Epidemiology and Biology of Colorectal Cancer Adjuvant Therapy of Colon Carcinoma Adjuvant Therapy of Rectal Carcinoma Future Trends in Combined Modality Therapy for Colorectal Carcinoma References... 

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. 

For additional information, reference may be made to the volume by Life Extension Foundation (2003). It should also be mentioned that this volume has the following chapter or section titles Cancer Overview of Protocols Cancer Adjuvant Therapies Cancer Chemotherapy Cancer Clinics Offering Alternative Therapies and Cancer Gene Therapies, Stem Cells, Telomeres, and Cytokines. There are also chapters or sections titled Cancer Prevention Cancer Radiation Therapy ... 

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. 

A number of potential prognostic factors have been identified for breast cancer. Prognostic factors are measurements available at diagnosis or time of surgery that in the absence of adjuvant therapy are associated with recurrence rate, death rate, or other clinical outcome. 

Cytotoxic drugs that have been used alone and in combination as adjuvant therapy in breast cancer include doxorubicin, epirubicin, cyclophosphamide, methotrexate, fluorouracil,... 

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. 

NIH Consensus Development Conference Statement. Adjuvant therapy for breast cancer, November 2000 1-3 17 1-23, www.nih.gov accessed June 23, 2006. 

Winer EP, Hudis C, Burstein HJ, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer Status report 2004. J Clin Oncol 2005 23 619-629. 

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. 

Hayes, D. F. Serum tumor markers for breast cancer. Proceedings 5th Annual Conference, Adjuvant Therapy in Primary Breast Cancer. In Senn, S. J. (ed) Recent results of cancer research. Heidelberg, Springer-Verlag, pp. 101-113 (1996). 

Dose-dense regimens may be considered as options for adjuvant therapy for node-positive breast cancer. 

Jordan VC, Fritz NF, Tormey DC (1987a) Long-term adjuvant therapy with tamoxifen effects on sex hormone binding globulin and antithrombin III. Cancer Res 47 4517-4519... 

Jordan VC, Fritz NF, Langan-Fahey S, Thompson M, Tormey DC (1991) Alterations of endocrine parameters in premenopausal women with breast cancer during long-term adjuvant therapy with tamoxifen as the single agent. J Natl Cancer Inst 83 1488-1491... 

Tamoxifen as Adjuvant Therapy in Early ER(+) Breast Cancer... 

Until recently tamoxifen has been the gold standard for adjuvant therapy in ER(+) early breast cancer. Recent information from controlled trials comparing tamoxifen to aromatase inhibitors has challenged this idea. More research is needed to establish the respective roles of the two families of substances in the hormonal management of breast cancer (Chlebowski et al. 2002). 

Takeda et al. (64) performed a phase I/II study consisting of low-dose CDDP (6-10 mg/m2/d) and UFT (600 mg/d) combined with radiotherapy (50 Gy/25 fractions) as postoperative adjuvant therapy following curative resection for patients with nonsmallcell lung cancer (NSCLC). The combined therapy was well tolerated and resulted in a disease-free survival rate of 78% at 2 yr. Another study in a small number of patients with unresectable stage III nonsmall-cell lung cancer, UFT (400 mg/m2 on d 1-52) and CDDP (80 mg/m2 on d 8,29, and 50) were administered with radiation therapy (total dose of 60.8 Gy in 38 fractions on d 1-52). Among 17 evaluable patients, 94% (16 patients) achieved partial responses with median time to tumor progression of 30 wk, and the... 

Dukes B2 and C rectal cancer GITSG No adjuvant therapy Radiation (40 14 Gy + 5-FU + semustine 35%b 55%b... 

O Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluoro uracil with radiation therapy after curative surgery. N Engl J Med 1994 331 502-507. 

Hermans J, et al. Adjuvant therapy after curative resection for gastric cancer meta- analysis of randomized trials. J Clin Oncol 1993 11(8) 1441-1447. 

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