PHOENIX — A Mayo
Clinic study involving
5,540 patients with metastatic colorectal cancer finds that maintenance
chemotherapy after initial treatment is more beneficial for patients whose disease
is under control, compared with more aggressive treatment.
A maintenance strategy with a fluoropyrimidine chemotherapy, such as 5-FU or capecitabine, is preferred, though observation with no chemotherapy is an acceptable option for some patients, according to the analysis of results from 12 randomized clinical trials. The study appears in JAMA Oncology.
“Based on these findings, switching to a lighter, maintenance regimen of chemotherapy or even taking a break in treatment for some patients is appropriate, with reintroduction of full chemotherapy when the disease progresses,” says Mohamad Sonbol, M.D., a Mayo Clinic oncologist.
Journalists: Broadcast-quality video with Dr. Sonbol is available in the downloads at the end of this post. Please “Courtesy: Mayo Clinic News Network.”
“The goal of
therapy in metastatic colorectal cancer is to prolong life while preserving or
improving quality of life. As most of these therapies are associated with side
effects, it’s important to use treatments that achieve a maximum benefit with
the fewest side effects,” says Dr. Sonbol, the study’s first author.
Colorectal cancer is the third most common cancer
in the U.S. At diagnosis, 1 in 4 patients will have cancer that already has
spread to other organs. Randomized controlled trials have tested different
strategies for continuing chemotherapy after initial treatment, compared with less-intensive
maintenance chemotherapy and observation without chemotherapy.
The results of
these trials have been inconsistent, making it challenging to draw conclusions.
The Mayo Clinic study used a network meta-analysis of findings from the 12
trials to compare the treatment strategies used and the outcomes.
The analysis showed
no benefit in continuing full chemotherapy until progression of the disease,
compared to the other strategies. Also, all maintenance strategies showed
significant improvement in disease control — progression-free survival —
compared with observation. The investigators further compared different
maintenance treatments used and found that the preferred regimen is fluoropyrimidine
with or without the addition of bevacizumab, a medication used in
combination with cancer-fighting drugs.
“Many chemotherapies that are used are initially beneficial in both shrinking and controlling the cancer,” says Tanios Bekaii-Saab, M.D., a Mayo Clinic gastrointestinal oncologist and the study’s senior author. “However, after a few months of therapy, the maximum benefit is usually achieved and the main focus should be on how to continue that benefit while minimizing side effects. This study confirms that switching to maintenance treatment is appropriate and beneficial, with introduction of full chemotherapy later upon progression of the disease.”
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