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This is a groundbreaking article, as it safely increases the population who do not need to undergo chemotherapy, even by conventional guidelines. To reiterate what I have said in the past, conventional chemotherapy dosing probably adds the most benefit in the adjuvant setting, as opposed to metastatic disease, where it improves survival marginally.
Having said that, of course we do not want to use it in the adjuvant setting, if it does not improve progression-free or overall survival.
Bottom line: In the 50-75 year old age group, with ER+, Her-2 neg cancer and negative nodes, with an Oncotype Recurrence Score between 11 and 25, chemotherapy is NOT indicated. In women younger than 50, with Oncotype Recurrence Scores between 16 and 25, outcomes were only SLIGHTLY better in the chemotherapy group, so patients need to take that into consideration.

 

April 9th, 2019

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low dose chemo

“When Cancer Can’t Be Cured, Low-Dose Chemo Aims To Keep It In Check,” an article from CommonHealth, can be accessed here.

This article is interesting because it notes that an oncologist at Tufts Medical Center uses low dose metronomic chemotherapy. In addition, an oncologist at Mass. General Hospital believes it may potentiate the effectiveness of immunotherapy. And finally, Dr. Schilsky, the director of ASCO, says, “It’s an interesting theory. It’s supported to some extent by laboratory studies.”

Dr. Schilsky also stated “the highest quality trials that have been done so far have generally not proven low-dose chemo to be better than conventional chemo.” As stated in the article, there is no large study, which randomizes standard of care maximum tolerated dose chemotherapy against low dose metronomic chemotherapy.

Unfortunately, it is unlikely that a study like this will ever be done due to lack of funding. What I find extremely interesting is that Dr. Schilsky said that “the highest quality trials that have been done so far have generally not proven low-dose chemo to be better than conventional chemo.” I assume that when Dr. Schilsky uses the term “better,” he means affords the patient longer survival (although it is not clear what he actually means). But even if a trial were to be performed, and low dose chemotherapy did not allow patients to live longer than maximum tolerated dose, is it possible that the improved quality of life from low dose chemotherapy in fact makes it “better?”

December 6th, 2018

Posted In: cancer care

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