Adjuvant therapy


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Related to Adjuvant therapy: Adjuvant chemotherapy

adjuvant therapy

the treatment of a disease with substances that enhance the action of drugs, especially drugs that promote the production of antibodies.

adjuvant therapy

Medspeak
Any therapy that increases a primary treatment’s efficacy; auxiliary therapy.
 
Oncology
A treatment­ used after failure of chemotherapy, radiotherapy or hormones as a primary treatment of a tumour to prevent metastases, or for residual malignancy after excision; AT is used after one or more of the conventional therapeutic arms has failed.

Adjuvant therapies
Breast cancer
Various combinations of cyclophosphamide, doxorubicin, docetaxel, 5-FU, MTX, paclitaxel and others have been used with some reduction in metastases.

Colorectal cancer
Adjuvant chemotherapy for colorectal cancer has not been highly successful; 5-FU might reduce micrometastases.
 
Melanoma
While interferon alpha 2b is FDA-approved, and various chemotherapeutics have been used against advanced melanoma, responses have been minimal and short-lived.
 
Adjuvant therapy for breast cancer
Recommended after breast-conserving surgery
• If Nottingham prognostic index (NPI) is > 3.0, ER +ve; possible chemotherapy if NPI > 4.4;
• ER -ve, recommend chemotherapy.

Not recommended if Nottingham prognostic index is < 3.0
ER+ hormonal therapy; ER- no hormonal therapy, but if NPI > 5.4 chemotherapy for > age 50, or > 4.4 if < age 50.

Adjuvant Therapy

Therapy that enhances a primary therapy; the addition of one or more therapeutic modalities to a primary or initial management strategy to improve survival, usually in the context of cancer care. For example, the first-line treatment for melanoma, colorectal and breast cancer is surgical, assuming that they are in early stages (ideally under stage 3), with radiotherapy and various forms of local or systemic therapy (chemotherapy, regional hyperthermia with chemotherapy, hormonal manipulation, immunotherapy—BCG, IL-2-stimulated lymphokine-activated killer cells, IFN-alpha and biological response modifiers) serving as adjuvants.
Adjuvant therapy is also defined as a treatment which is used:
• After failure of the primary therapeutic modality (chemotherapy, radiotherapy, immunotherapy hormones);
• Instead of the primary modality, based on unique tumour characteristics or patient preferences;
• To prevent metastases; or
• For residual malignancy after excision.
Fives “rules” of adjuvant therapy were published in the JAMA in 1990 (264:1444), and are still relevant:
(1) There may be occult, viable tumour cells in circulation—intravascular, intralymphatic, or intraperitoneal and/or established, microscopic foci of tumour cells locally, at distant sites, or both.
(2) Therapy is most effective when tumour burden is minimal and cell kinetics are optimal.
(3) Agents with proven effectiveness against the tumour must be used. 
(4) Cytotoxic therapy shows a dose-response relationship and therefore must be administered in maximally tolerated doses, and duration of therapy must be sufficient to eradicate all tumour cells.
(5) The risk-to-benefit ratio for therapy must be favourable for individuals who may remain asymptomatic for their natural life expectancy after tumour resection.
Examples, Adjuvant therapies
Breast cancer Various combinations of cyclophosphamide, doxorubicin, docetaxel, 5-FU, MTX, paclitaxel and other have been used with some reduction in metastases.
Colorectal cancer Aduvant chemotherapy for colorectal cancer has not been hugely successful; 5-FU might reduce micrometastases.
Melanoma While interferon alpha 2b is FDA-approved and various chemotherapeutics have been used for advanced melanoma, responses have been minimal and short-lived.

adjuvant therapy

Any therapy that ↑ a primary treatment's efficacy Oncology A treatment–eg, chemotherapy, RT, or hormone therapy, used after a primary treatment of a tumor, to prevent metastases, or for residual malignancy after excision; AT is used after one or more of the conventional therapeutic arms–surgery, chemotherapy, RT, has failed. See IL-2/LAK cells. Cf Adjuvant chemotherapy Therapeutics Therapy that enhances an primary therapy; auxiliary therapy.

Adjuvant therapy

A treatment done when there is no evidence of residual cancer in order to aid the primary treatment. Adjuvant treatments for endometrial cancer are radiation therapy, chemotherapy, and hormone therapy.
References in periodicals archive ?
As receipt of neoadjuvant therapy may impact decisions regarding adjuvant therapy, we excluded patients receiving neoadjuvant therapy (n = 62) (Giordano et al.
The long inclusion period of this cohort inadvertently causes differences in adjuvant treatment between patients diagnosed in 2002 versus 2008, the most important of which is the addition of oxaliplatin to adjuvant therapy in 2004.
Median age (range), yr 61 (30-79) Sex Male 23 Female 13 Primary Site Left lung 20 Right lung 16 Histologic properties Squamos cell 23 Adenocarcinoma 5 Non-small cell (undifferentiated) 7 Mixed (adenosquamous) 1 Stage IIIA 31 IIIB 5 Neoadjuvant therapy 18 Chemotherapy 2 Radiation 0 Chemoradiation 12 Adjuvant therapy 8 Chemotherapy 1 Radiation 1 Chemoradiation 6 Surgery Alone 10 Table 2: Postoperative complications in patients with stage III NSCLC.
However, there are several limitations in undertaking adjuvant therapy.
6 (3-16) Body areas affected, n (%) Oral lesions only 10 (29) Mucocutaneous 19 (54) Cutaneous only 6 (17) Trunk 19 (54) Face 18 (51) Scalp 11 (31) Arms 8 (23) Legs 7 (20) Other Generalized involvement 1 (11%) Genitalia 1 (11%) Number of deaths Number (%) of patients treated only with systemic 5 (14%) steroids Number (%) of patients treated with adjuvant therapy 1 (3%) only Number (%) of patients treated with adjuvant therapy and systemic steroids 29 (83%) Number (%) of hospitalized patients 18 (51%) Medications administered during hospitalization, n (%) Intravenous immunoglobulin 9 (50%) Prednisone 8 (44%) Intravenous antibiotics 1 (6%) Table 2.
Trastuzumab as adjuvant therapy for early breast cancer, the importance of accurate human epidermal growth factor receptor 2 testing.
11,15,28,29) Some authors suggest that massive choroidal invasion is a significant risk factor for extraocular relapse, warranting adjuvant therapy, (13,22,25,30-32) whereas others have reported that only small percentage of patients with choroidal invasion experience extraocular relapse, that survival is more than 95%, and that adjuvant therapy should be withheld in these cases.
Cohorts 2 and 3 consisted of 214 patients drawn from prospective randomized, controlled trials of adjuvant therapy with interferon alfa.
Because hydrocortisone therapy did not lead to better outcomes in patients with septic shock, it is not recommended that it be used as general adjuvant therapy for this condition.
Also, no adjuvant therapy would have improved the patient's prognosis with this rare cancer.
Chapter topics on evaluation and adjuvant therapy include neurologic presentation; radiographic, electrodiagnostic and metastatic evaluation; chemotherapy, external beam radiotherapy, and stereostatic radiosurgery.