CaroleHammett Posted August 8, 2008 Share Posted August 8, 2008 Numerous studies show that for lung cancer patients, the higher the Quality of Life, the longer the Survival Rate (see my postings in Healthy Living Forum), but the following article refers to a "meta-analysis" showing that while extending chemotherapy can also extend the Survival Rate, the extra cycles can likewise reduce Quality of Life. In my own case, I cannot know if the extended cycles reduced my QoL, but I do know that the attempt to extend my Survival Rate with the use of 2nd line maintenance during last 8 months definitely caused me to experience lower Quality of Life during that period with no reduction of my Survival Rate (See link to My Story below). Definitely food for thought here. Affectionately, Carole ---------------- http://www.oncologystat.com/home/news/More_Chemotherapy_Cycles_Delay_NSCLC_Progression_but_Reduce_Quality_of_Life__US.html More Chemotherapy Cycles Delay NSCLC Progression but Reduce Quality of Life Elsevier Global Medical News. 2008 Jul 29 F Lowry CHICAGO (EGMN) - The continuation of chemotherapy beyond three or four cycles results in a substantial 22% improvement in progression-free survival and a modest 6% gain in overall survival for patients with advanced non-small cell lung cancer, according to data from a meta-analysis of 13 randomized, controlled trials. These benefits, however, came at the cost of more adverse events and a reduced quality of life, the lead author of the Australian analysis reported at the annual meeting of the American Society of Clinical Oncology. "Our study supports the 2004 ASCO guidelines," said Yu Yang Soon of the Sydney Cancer Centre at the University of Sydney. Those guidelines state that the optimal duration of chemotherapy is a matter of debate. They recommend that first-line chemotherapy be limited to six cycles and stopped after four cycles in nonresponders. Published during 1989-2007, the trials in the meta-analysis included a total of 2,146 stage IIIB and IV NSCLC patients who were being treated with palliative intent. Mr. Soon and his coinvestigators classified them into three designs: - Trial design 1. Randomization to four chemotherapy cycles, or to continuation of chemotherapy until disease progression or prohibitive toxicity (two trials). - Trial design 2. Randomization to four or six cycles of chemotherapy (six trials). - Trial design 3. Induction therapy, followed by randomization to more chemotherapy or to observation only (five trials). Only two of the trials used non-platinum-based chemotherapy. Nine used chemotherapy regimens that included third-generation agents, such as paclitaxel (Taxol), vinorelbine (Navelbine), gemcitabine (Gemzar), and docetaxel (Taxotere), Mr. Soon said. Eight trials compared a defined number of chemotherapy cycles (that is, two to eight cycles) with an extended number of cycles (five cycles until disease progression or prohibitive toxicity). In these trials, the continuation of therapy beyond a defined number of cycles resulted in a statistically significant 22% reduction in the rate of progression (hazard ratio, 0.78; P less than .00001). The extension of chemotherapy had little effect on overall survival, however (HR 0.94; P = .10). Another subgroup analysis showed that the benefit of improved progression-free survival resulted from additional cycles of a third-generation chemotherapy agent rather than an older agent (HR, 0.73; P = .02). The majority of patients (1,524) received the newer agents, Mr. Soon reported. Toxicity was reported in 11 of the 13 trials, and all showed that standard duration of chemotherapy was safer, with fewer and less severe adverse events. Seven trials documented quality of life; of these, two trials favored standard chemotherapy and five found no difference between standard and extended chemotherapy, Mr. Soon reported. "Future trials should test extending treatment with more effective or better tolerated alternatives," he concluded. "Extension of adjuvant chemotherapy is also worthy of investigation." Mr. Soon reported no conflicts of interest. --------------------- Quote Link to comment Share on other sites More sharing options...
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