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Intermittent Chemotherapy for Chemotherapy Responders - An Early Trial
(August 2003)
If a chemotherapy regimen fails to produce a response (or achieve an
acceptable disease stabilization) after a reasonable trial period,
physicians usually discontinue treatment and consider other options.
However, there is no consensus regarding the proper duration of treatment
for responders. Currently, treatment is continued until
relapse or until unacceptable toxicity develops. An abstract in the ASCO
Proceedings, June 2003, by Tomasz Beer and his Oregon colleagues (abst
1582) reported a trial of intermittent chemotherapy in metastatic androgen
independent cancer using the Taxotere/Calcitriol regimen developed by that
group (for analysis of that protocol see PCa Commentary, February 2003,
archived on the seattleprostate.com web site). The new trial addressed the
feasibility of intermittent treatment with the hope that benefit would not
be lost and quality of life would be improved - in a sense, treating the
disease as a chronic condition. Eleven of the thirty seven men (30%) in
the trial met the response criteria and were offered a treatment break.
Eight of them were suitable for analysis. The schema: if treatment led to
a fall of PSA to <4 ng/ml a break in treatment was offered; and the
"holiday" ended and treatment was resumed if the PSA rose by 50% (at least
by 1 ng/ml) or symptoms developed. The median duration of the "holiday"
for these men was 20 months (range 13 - 43 months). Four patients
responded again to treatment and three others achieved PSA stabilization
after restarting treatment. One is still on "holiday." These eight men
were at median follow-up of 20.4 months from the start of the trial at the
time of this report.
Many medical oncologists will informally utilize "treatment breaks" for a
variety of reasons, but this trial, small as it is, is the first reported
formal evaluation of this strategy in prostate cancer and establishes
feasibility and sets the stage for further evaluation of this commendable
idea.
Bottom Line: If supported by additional trials, this is a strategy
of merit.
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