Adjuvant chemotherapy

The immunorestorative potential of inosiplex has been evaluated in several clinical conditions, including post-surgical trauma, cancer patients with concurrent viral infections, and cancer patients receiving radiotherapy or chemotherapy. For example, most (84%) of the surgery patients remained immunologicaHy depressed, but 56% of the inosiplex-treated surgery patients had complete restoration of normal skin test reactivity (probability level < 0.0005). The use of inosiplex as an adjuvant to chemotherapy or radiotherapy appears to be valuable in the prophylaxis against opportunistic infections. 

Adjuvant endocrine therapy reduces the rates of relapse and death in patients with hormone-receptor-positive early breast cancer tumors. Adjuvant chemotherapy reduces the rates of relapse and death in all patients with early-stage breast cancer. 

Neoadjuvant chemotherapy is appropriate for patients with locally advanced or inflammatory breast cancer, followed by local therapy and further adjuvant systemic therapy. 

The goal of adjuvant chemotherapy is curative, whereas the goal of chemotherapy in the metastatic setting is palliative. 

An NIH Consensus Development Conference Statement22 advises that adjuvant hormonal therapy should be recommended to women whose tumors contain hormone-receptor protein regardless of age, menopausal status, involvement of axillary lymph nodes, or tumor size. They also support a benefit of adjuvant chemotherapy for most women with lymph node metastases or with primary breast cancers larger than 1 cm in diameter (both node-negative and node-positive).22... 

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... 

Because most patients are given adjuvant chemotherapy, regimens chosen for first-line use in the metastatic setting often are... 

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. 

List the rationale, advantages, disadvantages, and place in therapy for adjuvant and neoadjuvant chemotherapy... 

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... 

Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. New Engl J Med 2004 350(4) 351—360. 

Adjuvant chemotherapy is not needed in patients with stage I colon cancer, is controversial in patients with stage II colon cancer, and is standard of care in patients with stage III colon cancer. 

Flurouracil-based chemotherapy is the standard regimen used in adjuvant treatment of colon cancer. It is usually given for 6 months with leucovorin, and based on recent clinical trials, oxaliplatin also may be added to the combination. 

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. 

There is currently no definitive role for adjuvant radiation in colon cancer. However, patients who receive surgery for rectal cancer receive radiation therapy to reduce local tumor recurrence. Adjuvant radiation plus chemotherapy is considered standard treatment for patients with stage II or III rectal cancer after the surgical procedure is complete.17 Preoperative radiation may be used to reduce the initial size of rectal cancers in order to make the surgical procedure easier. 

Adjuvant chemotherapy is administered after tumor resection to decrease relapse rates and improve survival in patients with colon cancer by eliminating micrometastatic disease that is undetected on imaging studies. Patients diagnosed with stage I colon or rectal cancer usually are cured by surgical resection, and adjuvant chemotherapy is not indicated in these patients.16 The role of adjuvant... 

Fluorouracil-based chemotherapy is the standard of care for the adjuvant treatment of colorectal cancer either as a single agent or, more commonly, in combination with other agents. 5-Fluorouracil (5-FU) alone results in a small improvement in survival that can vary based on the method of 5-FU administration. Studies suggest that protracted or continuous intravenous (IV) 5-FU infusion treatment schedules are more effective than bolus therapy.20... 

Capecitabine is an oral prodrug of 5-FU that also is effective in the adjuvant setting and is being evaluated as a replacement for 5-FU for patient convenience and safety reasons. Data suggest that capecitabine is at least equivalent to 5-FU and leucovorin in efficacy and is better tolerated by patients.24 Consequently, most practitioners feel that capecitabine is an acceptable alternative to IV 5-FU plus leucovorin. However, the role of capecitabine with additional chemotherapy agents such as oxaliplatin requires further study... 

Following resection of liver metastases, infusion of chemotherapy through the portal vein provides an additional adjuvant treatment approach. Historically 5-FU and floxuri-dine have been the agents used most commonly for hepatic portal vein infusion owing to their high metabolism in the liver. Although some studies demonstrate a decrease in recurrence rates, the value of portal vein infusion of chemotherapy for colon cancer remains to be determined.25 Table 88-4 summarizes adjuvant treatment recommendations for colon cancer. 

The histology of the disease is a prognostic factor. For instance, clear-cell and undifferentiated tumors do not respond as well to chemotherapy.2 The extent of residual disease and tumor grade are also predictive of response to chemotherapy and overall survival.2 There are other prognostic factors that may predict how well a patient will respond to adjuvant chemotherapy. 

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. 

Johnston PG, Fisher ER, Rockette HE, Fisher B, Wolmark N, Drake JC, Chabner BA, Allegra CJ. The role of thymidylate synthase expression in prognosis and outcome of adjuvant chemotherapy in patients with rectal cancer. 

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