Adjuvant therapy


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Related to Adjuvant therapy: Adjuvant chemotherapy

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 ?
The variables that were identified as significant in the univariate analysis, such as age (as a categorical variable), modus operandi, histological subtype, tumor grade, ascites, postoperative distant metastasis, and adjuvant therapy, were entered into a Cox model to define the independent factors that predict the postoperative survival time.
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.
Yet, in many cases, surgeons were unaware whether their patient was resistant to taking adjuvant therapy (56 percent of patients), understood the risks and benefits of adjuvant treatment (54 percent), or could not tolerate adjuvant treatment (52 percent).
The choice of the type of adjuvant therapy depends on many factors, such as whether the cancer cells contain hormone receptors (estrogen and progesterone), Her2 neu expression, the grade of tumor and the size of tumor and lymph nodes.
Adjuvant therapy is given to women with early-stage (localized) breast cancer who have had initial treatment -- surgery with or without radiation therapy -- with the goal of reducing the risk of cancer recurrence and/or the occurrence of metastatic disease.
Fall in mortality from breast cancer is due almost equally to screening and adjuvant therapy [News Roundup].
Adjuvant therapy was standardized, and the only variation was in the instrument used to remove the tonsils.
Accordingly, the three parties have launched a clinical study of immune cell therapy for postoperative adjuvant therapy in pancreatic cancer.
* Adjuvant therapy. Chemotherapy and/or radiation given after surgery to prevent cancer recurrence.