A World Without Cancer — the Story of Vitamin B-17 – Another Perspective
Eye on the Prize: Complete Cancer Eradication
The use of adjuvant therapy is relatively new; having first come into widespread use after a 1975 clinical trial demonstrated that patients with breast cancer who received a chemotherapy pill, called melphalan, had fewer distant cancer relapses than those who received no further treatment after surgery (the standard of care at that time). Before this study, doctors were powerless to prevent metastases from developing after surgery.
In the thirty years since that landmark study, remarkable progress has been made in the adjuvant treatment of many cancers, especially breast cancer. A number of new chemotherapy drugs have been discovered, such as Taxol and Taxotere, and combined with older drugs with greater effectiveness; these treatments are often referred to by their initials, suchas “A-C-T,” which stands for Adriamycin, Cytoxan, and Taxol; “T-C,” for Taxotere and Cytoxan; and “C-M-F,” for Cytoxan, Methotrexate, and 5-FU (5-fluorouracil). Many other adjuvant chemotherapy regimens to treat breast cancer are in use and under development.
In addition, breast cancer adjuvant therapy may include hormone therapies such as tamoxifen or an aromatase inhibitor (anastrazole, aromasin, letrozole) that may be recommended either following or instead of chemotherapy. Hundreds of thousands of women have bravely and generously participated in clinical research that has allowed the continued refinement of breast cancer adjuvant therapy. Such research will continue with even greater gusto as new biologic agents like Herceptin are tested in this setting.
Whether a patient receives chemotherapy, hormone therapy, a targeted agent, or combinations of these medicines after surgery, the goal remains the same: to cure the cancer by preventing the growth of micro metastases.
It is a powerful notion that in the day-to-day routine of swallowing a little pill such as tamoxifen or an aromatase inhibitor, breast cancer patients are helping to kill any cancer cells that may be present in their bodies and prevent a cancer relapse.
There has also been considerable progress in the adjuvant therapy of cancers other than those affecting the breast and lung. Treatment of stage III colon cancer (involving nearby lymph nodes) with chemotherapy after surgery has raised the five-year survival rate from 55 percent to nearly 80 percent, and new agents will likely push cure rates even higher. Adjuvant hormone therapy of high-risk prostate cancer after treatment with surgery or radiation leads to fewer cancer relapses and longer survivals. Either chemotherapy or radiation or both are commonly used after surgery for many cancers.
I wish to make two final important points about adjuvant therapy. First, the timing and dosages of the drugs should be maintained at their recommended schedules. Although cancer treatments can sometimes be adjusted to diminish their side effects, this practice should be avoided during adjuvant therapy because the goal is cure. Certainly, if severe side effects occur, the treatment regimen will be modified; the oncologist will make the necessary changes. Products that support the blood system during chemotherapy, such as Neupogen and Neulasta, may be necessary to ensure that full doses of chemotherapy are administered.
Second, it is impossible to determine the effectiveness of adjuvant treatment for any individual. It is natural for a patient to ask after cancer therapy, “How do I know if it worked?” In the case of adjuvant therapy, there are no tumors to measure. The simplest way to think of this is that if the cancer never returns, then the treatment accomplished its task (or metastases were never destined to develop). If the cancer does relapse, the treatment was not effective enough.
