GOLDBERG, MD: “The message was clear: Treat your patient as soon as you can, because outcomes are better with treatment started at four weeks compared with later.” “This would suggest that there may actually be some benefit to chemotherapy beyond that arbitrary three-month window,” he said. For example, his hypothetical patient had a 45% overall survival rate with no chemotherapy but a 50% overall survival with chemotherapy starting at 12 weeks. If one arbitrarily assumes that half of them are able to start adjuvant chemotherapy four weeks after surgery but instead were delayed to eight weeks, that would put 1,225 lives at risk at five years.ĭespite the drop in benefit with increased time between surgery and chemotherapy, there may be some remaining benefit for patients treated after three months, Dr. If one assumes that 35% of those cases were Stage III, then 49,000 individuals would be eligible for adjuvant chemotherapy. Looking at this at a population level, Dr Biagi noted that there were 140,000 new cases of colorectal cancer in the United States in 2009. If those estimates were based on receiving chemotherapy at four weeks, then the patient's estimated five-year survival rate would decrease to 55% if chemotherapy started at eight weeks and 50% if it started at 12 weeks. To illustrate the impact of that increased risk, the researchers modeled a hypothetical patient using Adjuvant! Online.įor a 65-year-old male in good general health with T3N2 disease, the estimated five-year overall survival rate would be 45% with no chemotherapy and 60% with fluorouracil-based chemotherapy. Modeled a Hypothetical Patient Using Adjuvant! Online Biagi and his colleagues estimated that there was a 15% increased risk of disease recurrence and a 12% increased risk of death at five years for every four weeks of treatment delay, beyond the initial four weeks after surgery. Based on a meta-analysis of those data, which included more than 14,000 patients, Dr. Biagi and colleagues performed a systematic literature review and meta-analysis to evaluate the true impact of chemotherapy timing.Įxamining both the published literature and abstract presentations, the team identified nine studies that examined the time between surgery and chemotherapy and treatment benefit. Biagi, MD, Associate Professor and Acting Head of Oncology at Queen's University Cancer Research Institute in Ontario.īecause these assumptions are unlikely to be tested in a randomized controlled trial, Dr. “Two common clinical assumptions are that chemotherapy should commence as soon as practical after surgical resection, and that chemotherapy offered beyond three months may not provide benefit,” said the study's lead author, James J. We think, based on these results, that clinicians and jurisdictions should make efforts to optimize logistics that minimize time to adjuvant chemotherapy.”Īlthough adjuvant chemotherapy is standard for patients with locally advanced or high-risk colorectal cancer, the importance of treatment timing has not been fully explored. BIAGI, MD: “We believe the level of evidence from our study, with the knowledge that this relationship will not be subjected to prospective assessment, provides sufficient proof of an adverse association.
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