Fast Fact and Concept #099: Chemotherapy: response and survival data
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Title: Fast Fact and Concept #099: Chemotherapy: response and survival data
Author(s): Weissman, David E; von Gunten, Charles F
Key data in the decision process regarding chemotherapy includes the response rate, median duration of response and median survival, along with toxicity and quality of life information (see Fast Fact #14: Palliative Chemotherapy). The table below synthesized data for several common cancers. The data was derived by reviewing two standard oncology textbooks, along with a Medline search of recent relevant articles.
- All data is for metastatic or locally advanced cancer (not adjuvant, or neoadjuvant).
- All data is for first-line, commercially available oral or IV chemotherapy (immunotherapy, hormonal therapy, chemo-embolization, intra-arterial chemotherapy or combined chemo-radiation data is not included).
- Response Rate is defined as: percentage of complete and partial responders in a given trial, where Partial Response = > 50% reduction in measurable tumor for one month.
- Response is typically determined after 2 cycles of treatment (usually one cycle every 21-28 days); however, patients who progress after 1 cycle will continue progressing after two.
- The data reflects mid-point ranges derived from the available clinical trials; most of the data represents combination chemotherapy trials; Note: for certain cancers, the benefit of combination vs. single agent therapy is not proven (e.g. pancreas, biliary, liver).
- This data is not representative of all cancer patients. The data represents the ?best case? outcome, from a population of patients who were in good enough health to participate in a clinical trial, (e.g. ambulatory, good functional status). Actual responses and response durations for a non-clinical trial population will likely be poorer.
- Data for biliary, pancreas, esophagus and liver comes from many small trials (< 50 patients), thus the upper end figures are likely to be overestimated.
- Second-line chemotherapy, following disease progression from first-line treatment, can be expected to have a lower response rate and shorter duration of response.
||Median Duration of Response
||Median Survival (1)
|Lung - Non-Small Cell
|| 4-6 months
- Median survival data includes both responders and non-responders; Patients who respond to chemotherapy typically live longer than those who do not.
- Breast cancer is an extremely heterogeneous disease, thus the large response rate range
- Data from trials of 5FU/Leukovorin versus Irinotecan or Oxaliplatin
- Trials of Gemcitabine combination chemotherapy -- some of these trials use the term "objective response" which is a less rigorous term than the traditional "partial response", thus the benefit may be overstated.
Cancer Principles and Practice of Oncology. 6th Edition DeVita, et al. 2001 Lippincott Williams and Wilkins
Cancer Treatment. 5th edition Haskell CM 2001 WB Saunders
Schiller JH. Harrington D. Belani CP. et al. The Eastern Cooperative Oncology Group.
Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. New England Journal of Medicine. 346(2):92-8, 2002
Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman DE and von Gunten CF. Fast Facts and Concepts #99. Chemotherapy: response and survival data. October 2003. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
Creation Date: 10/2003
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
ACGME Competencies: Medical Knowledge, Patient Care
Keyword(s): Adult, Cancer, Radiation or chemotherapy
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