Disease-free survival

TABLE 86-4. Estimated Stage at Presentation and 5-Year Disease-Free Survival (DFS) Breast Cancer... 

Chronic lymphocytic leukemia (CLL) patients who receive fludarabine-based combination chemotherapy and rituximab may have long-term disease-free survival. 

Autologous transplant either as a single or double transplant offers younger patients with myeloma longer disease-free survival. 

Combination therapy may provide improvement in longterm disease-free survival. The combination of fludarabine, cyclophosphamide, and rituximab improves CR rates compared with fludarabine alone (70% versus 20%) but at the expense of increased infections.28,29 Combinations of fludarabine and alemtuzumab are also being investigated, with the hope of improving overall survival.21... 

The number of long-term HCT survivors is increasing as 5-year disease-free survival rates improve. Since nonmyeloablative preparative regimens were developed over the past decade, the... 

Disease-free survival Length of time after treatment during which no disease is found. 

Chemotherapy, hormonal therapy, or both result in improved disease-free survival and/or overall survival (OS) for all treated patients. 

The addition of taxanes, docetaxel and paditaxel, a newer class of agents, to adjuvant regimens comprised of the drugs listed above resulted in consistently and significantly improved disease-free survival and OS in node-positive breast cancer patients. 

Resection of discrete metastases in selected patients may extend disease-free survival. Resection of hepatic-limited metastases may result in cure. Adjuvant chemotherapy may be administered but the optimal regimen remains to be determined. 

CIV, continuous intravenous infusion DFS, disease-free survival. 

The DNA-interactive agent oxaliplatin had a slightly different trial design leading to accelerated approval and that was used as a comparator (oxaliplatin and fluorouracil + leucovorin vs. fluorouracil + leucovorinj. The approval was on the basis of response rate but additional studies clearly demonstrated that oxaliplatin improved survival and indeed in an adjuvant setting led to a significant increase in disease-free survival (78.2% disease-free survival at 3 years vs. 72.99%, p = 0.002). ... 

All data were evaluated and updated as of August 1, 2003. Endpoints of the analysis were transplant-related mortality (TRM), incidence and severity of acute GvHD, incidence and severity of chronic GvHD, incidence of relapse, disease-free survival (DFS) and overall survival (OS). Transplant-related mortality is defined from any cause other than recurrent malignancy. 

Kaplan-Meier disease-free survival at 5 years was 46% (95% Cl 38-54%) for patients of HLA-matched group and 52% (95% Cl 35-69%) in HLA-mismatched group.The following variables were associated with improved patient survival in univariate analysis patient age <20 years (p=0.002), nonmalignant disease vs all others (p=0.003), standard risk disease (p=0.0001), CMV seronegative patients (p=0.007). In multivariate analysis relative risks were determined as per Table 5. 

Vinca alkaloids are exceedingly important in both curative and palliative regimens. Curative regimens now exist that regularly allow long-term disease-free survival for a variety of adult and pediatric patients, even if treatment begins when the tumor is advanced. These allow treatment of... 

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... 

The initial combination modality clinical studies with cisplatin and fractionated radiation therapy was carried out in head and neck cancer with weekly cisplatin (120-160 mg/m2) and conventional single daily fraction radiation (95). In a follow-up intergroup study, patients were randomized to radiation therapy alone or to radiation therapy plus 20 mg/ m2/wk cisplatin (96). Both studies showed no major increase in normal tissue toxicity in the radiation field and showed an increase in response rate. There was no increase in complete response rate or in survival. Bachaud et al.(97) carried out a randomized study comparing radiation therapy alone with concurrent cisplatin (50 mg/m2) and radiation therapy in postoperative patients. This trial produced a significant reduction in local recurrence and improved disease-free survival with 59% of the patients receiving the full planned dose of cisplatin. 

The median follow-up was 23 mo for the 1073 evaluable patients. Patients that received hyperfractionated or accelerated radiation therapy with boost had increased locoregional control (p = 0.045 and p = 0.05, respectively) and a trend toward improved disease-free survival (DFS) (p = 0.067 and p = 0.054, respectively) in comparison to conventional radiation therapy. However, there was no improvement in overall survival(s). Patients given accelerated split-course fractionation had similar outcomes to those who had received conventional radiotherapy. Hyperfractionated radiation therapy is the method of choice for combined chemoradiotherapy in current investigative approaches for head and neck cancer. 

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