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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2006The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 5630849&dopt=Abstract> Clin Oncol (R Coll Radiol). 2005 Jun;17(4):294. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Morgan G, Ward R, Barton M. Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia. gmorgan1@bigpond.net.au AIMS: The debate on the funding and availability of cytotoxic drugs raises questions about the contribution of curative or adjuvant cytotoxic chemotherapy to survival in adult cancer patients. MATERIALS AND METHODS: We undertook a literature search for randomised clinical trials reporting a 5-year survival benefit attributable solely to cytotoxic chemotherapy in adult malignancies. The total number of newly diagnosed cancer patients for 22 major adult malignancies was determined from cancer registry data in Australia and from the Surveillance Epidemiology and End Results data in the USA for 1998. For each malignancy, the absolute number to benefit was the product of (a) the total number of persons with that malignancy; (b) the proportion or subgroup(s) of that malignancy showing a benefit; and (c) the percentage increase in 5-year survival due solely to cytotoxic chemotherapy. The overall contribution was the sum total of the absolute numbers showing a 5-year survival benefit expressed as a percentage of the total number for the 22 malignancies. RESULTS: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. CONCLUSION: As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required. for every 100 cancers cured, radiation cures about 45........... And surgery about 52 > Clin Oncol (R Coll Radiol). 2005 Jun;17(4):294. > > The contribution of cytotoxic chemotherapy to 5-year survival in adult > malignancies. > (snip) > MATERIALS AND METHODS: We undertook a literature search for randomised > clinical trials reporting a 5-year survival benefit attributable solely to [quoted text clipped - 3 lines] > Epidemiology and End Results data in the USA for 1998. > (snip) It is 2006. The authors used USA data that was *seven years old* at the time of publication and probably about the same for the Australian data (they don’t say). > CONCLUSION: As the 5-year relative survival rate for cancer in Australia > is now over 60%, it is clear that cytotoxic chemotherapy only makes a [quoted text clipped - 3 lines] > urgently required. > This is dangerous thinking, having little or nothing to do with reality, IMO. QOL is for the patient to decide; cost effectiveness calculation is a beancounter’s playground. It just drives me bonkers (a short trip) when I encounter someone (not referring to J) mooing about tx results from many years in the past. It’s simply irrelevant to the present reality. Regards, Steve J "The thing is to expect nothing in particular, but be aware of the lack of enforceable guarantees or enforceable contracts with nature/god/entropy as to the condition or durability of our bodies." -- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate Problems Mailing List Thank you, Brian. > > Clin Oncol (R Coll Radiol). 2005 Jun;17(4):294. > > [quoted text clipped - 14 lines] > time of publication and probably about the same for the Australian data > (they dont say). Nothing much new has changed. Herceptin for certain patients with breast cancer. Older chemos have been tweaked for less side effects; marginal (month or few longer survival benefit). J On April 24, J replied to me: I wrote, in part: >> It is 2006. The authors used USA data that was *seven years old* at the >> time of publication and probably about the same for the Australian data >> (they don’t say). >> J responded: > Nothing much new has changed. Herceptin for certain patients with breast cancer. > > Older chemos have been tweaked for less side effects; marginal (month or few > longer survival benefit). > I’m sorry to observe that J is rather behind the times. Taxotere (docetaxel) was approved by the FDA in *2004*, and is the first chemotherapy drug to offer a substantial survival benefit. It is usually used with the steroid prednisone. The cohort of brave and selfless men who volunteered for the clinical tests were, as my oncologist bluntly puts it, on their last legs and had no hope. If a man is not so advanced (and more and more men are being treated early with Taxotere these days, often with adjuvant ADT), he can anticipate a substantial improvement on the average survival of the experimental subjects. As I said, those men were brave, selfless and also dedicated to helping their brothers. All honor to them. There should be a memorial. More can be found on the website of the Prostate Cancer Research Institute at: http://prostate-cancer.org/index.html And on WebMD: http://www.webmd.com/ As well as numerous other sources that will be found with a little basic searching. Regards, Steve J "What are the facts? Again and again and again -- what are the facts? Shun wishful thinking, ignore divine revelation, forget 'what the stars foretell,' avoid opinion, care not what the neighbors think, never mind the unguessable 'verdict of history' -- what are the facts, and to how many decimal places? You pilot always into an unknown future; facts are your single clue. Get the facts!" --Lazarus Long > On April 24, J replied to me: > [quoted text clipped - 14 lines] > chemotherapy drug to offer a substantial survival benefit. It is usually > used with the steroid prednisone. http://www.cancer.gov/clinicaltrials/results/prostate-and-docetaxel0604 Chemotherapy regimens that include the drug docetaxel extend median survival by two to three months in patients with advanced prostate cancer that is no longer responsive to hormone therapy, two large phase III studies have shown. These are the first clinical trials to show that chemotherapy can improve survival in advanced prostate cancer./quote. The rest of that page talks about median ~16-18.9 months - nothing new about that. > The cohort of brave and selfless men who volunteered for the clinical > tests were, as my oncologist bluntly puts it, on their last legs and had [quoted text clipped - 9 lines] > Institute at: > http://prostate-cancer.org/index.html Not sure why you're pointing me there, they're all "recruiting" or "not yet recruiting". I'd like to hear what Steph thinks taking chemo earlier will do vis-a-vis chemo resistance. Cross-posting. J J responded to me, in pertinent part: > http://www.cancer.gov/clinicaltrials/results/prostate-and-docetaxel0604 > Chemotherapy regimens that include the drug docetaxel extend median survival by two to [quoted text clipped - 4 lines] > The rest of that page talks about median ~16-18.9 months - nothing new about that. > I‘m glad to see that J and I agree. The test subjects, heroes all, were in advanced stages of PCa. Their limited results should not be expected in pts whose tumors are not so advanced. Those latter pts should be able to anticipate better results, as I have indicated. Regards, Steve J "We must tailor the treatment to the nature of the disease. We must listen to the biology." -- Stephen B. Strum, MD | > On April 24, J replied to me: | > [quoted text clipped - 19 lines] | three months in patients with advanced prostate cancer that is no longer responsive to | hormone therapy, two large phase III studies have shown. (SNIP SNIP) Didn't see the first part... -----BEGIN PGP SIGNED MESSAGE----- As a cancer patient I would HAVE to ask what is the cost to benifit ratio, using docetaxel with a Chemo regiemen? I, myself, do not consider 2 to 3 months as a "substantial survival benefit", especially if it causes my survivors to be rendered insolvent by the grossly overcapitalised pharmaceutical companys, detail men, and those who would feed off the poor withered bodies of the terminally ill, and believe me, with 2 to 3 months, the patient is terminally ill. E. > | > On April 24, J replied to me: > | > [quoted text clipped - 43 lines] > > E. Fair enough. I would make the point that the two or three months is the median outcome. Some patients may do very much better than that and consider it very worthwhile. Some, of course, may do much worse, but chemotherapy is normally always given on a trial basis to those with advanced cancer and it can be stopped as soon as it is clear that no benefit is accruing or the patient says to. Another point is that many of these patients will have quite severe symptoms, and relief of those for even a few months may be valuable. However, quality of life and cost/benefit issues certainly have to be looked at, as you say. . Peter Moran www.cancerwatcher.com > ... > The cohort of brave and selfless men who volunteered for the clinical tests were, as my [quoted text clipped - 3 lines] > of the experimental subjects. > ... This seems to me to be an important point. We have at least some evidence that ADT is more effective when given early than late. The same may also be true of chemotherapy. There are trials underway now, with some members of our newsgroup participating, that will test this theory. Also, there are some novel approaches to chemotherapy that are just now in trials that may make a dramatic difference. Two that I can think of are: Combination of chemotherapy with phenoxodiol. Phenoxodiol is the drug developed in Australia that is in phase II trial now that halted disease progression for three out of the four men taking the largest dose for 18 months and counting. These men were all hormone refractory with metastatic cancer. I bring up phenoxodiol because it was used after chemotherapy on women with ovarian cancer who were no longer benefitting from chemo. The phenoxodiol had the effect of re-sensitizing the women to chemo so that repeated applications of much smaller doses of chemo had big effects on cancer again. The other thing I'm thinking about is targetted delivery of chemo using carriers (e.g., aptamers) that deliver the drug directly to the tumor cells, bypassing most other cells. > As I said, those men were brave, selfless and also dedicated to helping their brothers. > All honor to them. There should be a memorial. > ... Hear hear! Alan There's another issue regarding chemotherapy. Responses to chemotherapy vary from individual to individual. On average, a person gets a few months reprieve from them. But we don't yet know who will respond very well to the drugs and who won't respond at all. If insurance companies cut off access to chemotherapy drugs using the excuse that they aren't cost effective, some men who might have done very well on them will be denied treatment. Until we're able to test for sensitivity to various chemotherapies, the only way to find out whether the patient will benefit, or if the side effects will be too severe, is to try it. I'm not sure what I would want to do if I were at an end stage of cancer, but I'm inclined to think I'd want to try the drugs. From what I've read in this newsgroup, a group of relatively knowledgeable people, it appears that most of us would want to try. Alan On April 24, Alan Meyer wrote, in pertinent part: > There's another issue regarding chemotherapy. > > Responses to chemotherapy vary from individual to individual. On > average, a person gets a few months reprieve from them. I think that Alan has in mind the old tests using the subjects I have mentioned upthread. If a pt is not “on his last legs” he should be able to expect much more than a few months reprieve. Regards, Steve J > If a man is not so advanced (and more and more men are being > treated early with Taxotere these days, often with adjuvant ADT), he can > anticipate a substantial improvement on the average survival of the > experimental subjects. Is that a theory or are there clinical tiral results? J > If a man is not so advanced (and more and more men are being > treated early with Taxotere these days, often with adjuvant ADT), he can [quoted text clipped - 4 lines] > Is that a theory or are there clinical tiral results? > The regimen is, as I understand it, in its infancy. However, I do know as a matter of fact that my med onc offered this regimen last year, but as it turned out I did not need it. Moreover, a friend of mine is at this very time undergoing that tx regimen. Lastly, among many articles to be found by searching PubMed with the search term “prostate cancer AND chemotherapy AND hormone therapy” one can find (as of today) 24 articles on the general topic. One such is the Journal of Clinical Oncology November 10, 2005, article entitled, “High-risk localized prostate cancer, a case for early chemotherapy.” The last sentence of the abstract is, “With recent data confirming improved survival data with docetaxel chemotherapy in metastatic disease, future trials are now focusing on earlier combinations of chemohormonal or biologic therapies in high-risk patients.“ For anyone interested, the PMID is 16278471. And last and at least as important to me as any other consideration is the word of my brilliant medical oncologist. Beyond this point, with all due respect, I think that J would gain the most benefit if (s)he did his/her own homework. Regards, Steve J "There is NOWHERE in oncology where waiting for the tumor cell population to increase (and to mutate) is in the better interests of the patient.“ -- Stephen B. Strum, MD |
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