Wednesday, October 13, 2010

Palliative Chemotherapy

by: Robert Killeen MD

Is there anyone amongst the readership that can direct me to a list, a compendium of purely "palliative" chemotherapy regimens? I'm looking specifically for any reference on regimens (ie singlets, doublets, etc +/- RT) designed for non-curative symptomatic treatment. I've scanned EPERC, AAHPM, and the Feinberg Palliative Oncology sites, among others, without much success.

The best definition of a palliative chemotherapy regimen I've found had been derived earlier this decade by a European panel (1). Though their focus was on breast cancer their directive seems applicable across the board. Their opinion was that the optimum palliative regimen should control the disease (ie the response rate, RR) in at least 20-30% of patients and increase the progression-free (PFS) and overall survivals (OS). The regimen's toxicities should, ideally, minimally affect performance status while maximally eliminating tumor symptomatology. Quality of life, not curative intent, was foremost in their consensus.

Those who have treated metastatic or recurrent solid tumors recall that, with the exception of testicular cancer, the course is typically that of a "running battle". There are repeated periods of tumor growth and subsequent treatment followed by periods of dormancy.

Because of comorbidities some patients may not be able to tolerate a full course or cycle of chemotherapy. Even with dose attenuation patients may still lose that personal 'physical reserve' that enables them to maintain long term treatment.

A compendium of palliative chemotherapy regimens can be just as useful for patient care as any tome of standard (neo)adjuvant protocols. If anyone knows of such a book or reference please comment.

Thanks,

Reference;
1) Crown J, Dieras V, Kaufmann M, etal. Chemotherapy for metastatic breast cancer - report of a European expert panel. The Lancet Oncology. 2002;3:719-727.

3 comments:

vandana said...

HELLO,
A VERY GOOD AND SAFE CHEMO WHICH CAN BE USED IN VARIOUS ADVANCED CANCERS(H&N, BREAST, LUNG, ETC),
INJ.METHOTREXATE 50 MG WEEKLY,I/V SLOW BOLUS,WITH CBC MONITORING.THIS CAN BE GIVEN FOR LONG PERIODS OF TIME, TO VERY OLD AND POOR GC PATEINTS.
DR.VANDANA WILLIAMS.ST.STEPHENS HOSPITAL,DELHI.

Anonymous said...

I don’t know if you already know of Betty Ferrell, RN, PhD who is a Research Scientist  at the City of Hope National Medical Center in Duarte, CA.  If such a compendium exists, she would know.  She is the editor of an amazing textbook on Palliative Nursing.  Good Luck!

Anonymous said...

You can't find a protocol because there is no such thing. Chemotherapy produces symptoms, usually more symptoms than it relieves.