Adjuvant Therapy - Concomitant or Concurrent Systemic Therapy

Concomitant or Concurrent Systemic Therapy

Finally, concomitant or concurrent systemic therapy refers to administering medical treatments at the same time as other therapies, such as radiation. Adjuvant hormonal therapy is given after prostate removal in prostate cancer, but there are concerns that the side effects, in particular the cardiovascular ones, may outweigh the risk of recurrence. In breast cancer, adjuvant therapy may consist of chemotherapy (doxorubicin, herceptin, paclitaxel, docetaxel, cyclophosphamide, fluorouracil, and methotrexate) and radiotherapy, especially after lumpectomy, and hormonal therapy (tamoxifen, femara). Adjuvant therapy in breast cancer is used in stage one and two breast cancer following lumpectomy, and in stage three breast cancer due to lymph node involvement. In glioblastoma multiforme, adjuvant chemoradiotherapy is critical in the case of a completely removed tumor, as with no other therapy, recurrence occurs in 1–3 months. Adjuvant therapy does not improve prognosis in stage I, II, and III renal cell carcinoma, with the possible exception of radiotherapy, which lowered the risk of local recurrence from 41% to 22% in one study.as a result of this resistance to chemotherapy, targeted therapies, including nexavar, sutent, rapamycin and interleukin 2 that are known to be effective in stage IV renal cell carcinoma have been studied in the adjuvant setting, without good results. In early stage one small cell lung carcinoma, adjuvant chemotherapy with gemzar, cisplatin, paclitaxel, docetaxel, and other chemotheraputic agents, and adjuvant radiotherapy is administered to either the lung, to prevent a local recurrence, or the brain to prevent metastases. In testicular cancer, adjuvant either radiotherapy or chemotherapy may be used following orchidectomy. Previously, mainly radiotherapy was used, as a full course of cytotoxic chemotherapy produced far more side effects then a course of external beam radiotherapy (EBRT) However, it has been found a single dose of carboplatin is as effective as EBRT in stage 11 testicular cancer, with only mild side effects (transeint myelosuppressive action vs severe and prolonged myelosuppressive neutropenic illness in normal chemotherapy, and much less vomiting, diarrhea, mucositis, and no alopecia in 90% of cases, according to cancerconsultants.com)Adjuvant therapy is particularly effective in certain types of cancer, including colorectal carcinoma, lung cancer, and medulloblastoma. In completely resected medulloblastoma, 5-year survival rate is 85% if adjuvant chemotherapy and/or craniospinal irradiation is performed, and just 10% if no adjuvant chemotherapy or craniospinal irradiation is used. Prophylatic cranial irradation for acute lymphoblastic leukemia (ALL) is technically adjuvant, and most experts agree that cranial irradation decreases risk of central nervous system (CNS) relapse in ALL and possibly acute myeloid leukemia (AML), but it can cause severe side effects, and adjuvant intrathecal methotrexate and hydrocortisone may be just as effective as cranial irraditon, without severe late effects, such as developmental disability, dementia, and increased risk for second malignancy.