Thursday, August 26, 2010

More Chemo, Different Chemo

Marco sent me the information about the new chemo he will be taking. It's a combination treatment called Gemzar with Taxotere.

Here are some excerpts from the current studies on this combination chemo treatment. Some terminology to remember too about response rates and palliation:

Complete Response means:
All detectable cancer is now gone after treatment. There can still be cancer left, but too little to detect, so a Complete Response is not the same thing as a cure, although some patients with a Complete Response may be cured.

Partial Response means:
Roughly speaking, a decrease in the amount of cancer of at least 50%, but less than 100%. More precisely, a decrease in the total cross sectional area of all measurable tumors of at least 50% but less than 100%.

Objective Response Rate is:
The proportion of patients with defined tumour shrinkage; generally it is the sum of partial responses and complete responses

Palliative chemotherapy is:
A type of chemotherapy that is given specifically to address symptom management without expecting to significantly reduce the cancer.

Adjuvant chemotherapy is:
Chemotherapy given to destroy left-over (microscopic) cells that may be present after the known tumor is removed by surgery. Adjuvant chemotherapy is given to prevent a possible cancer reoccurrence.

Neoadjuvant chemotherapy is:
Chemotherapy given prior to the surgical procedure. Neoadjuvant chemotherapy may be given to attempt to shrink the cancer so that the surgical procedure may not need to be as extensive.

From current sarcoma articles:

"Treatment options for patients with advanced soft-tissue sarcoma remain limited. There are few agents that achieve high objective response rates and none that result in cure for even a minority of patients. Although doxorubicin with or without ifosfamide remains a mainstay of treatment for many histologic types of advanced soft-tissue sarcoma, the combination of gemcitabine and docetaxel (Marco's current treatment) has become an established treatment option for patients, perhaps particularly those with leiomyosarcoma. The clinical development of the gemcitabine–docetaxel regimen is outlined, and data demonstrating the efficacy of this regimen in soft-tissue sarcoma are reviewed.

...retrospective studies and some case reports have been published that provide additional information regarding the activity of fixed-dose-rate gemcitabine and docetaxel in soft-tissue sarcoma. In one retrospective study, 133 patients with any number of prior treatment regimens were treated with fixed-dose-rate gemcitabine and docetaxel. Thirty-eighty percent of patients had had two or more prior regimens; 57% of patients had leiomyosarcoma. Objective response was observed in 18.4% of 114 patients evaluable for response (three complete responses and 18 partial responses). Sixteen of the responses were among 66 patients with leiomyosarcoma (24.2%), and five were among patients with other soft-tissue sarcoma histologies...

In another retrospective study, 35 patients with any number of prior regimens received fixed-dose-rate gemcitabine. The objective response rate was 43% (five complete and 10 partial responses). Objective responses were seen in seven patients with leiomyosarcoma, one malignant fibrous histiocytoma / undifferentiated high-grade pleomorphic sarcoma, two osteosarcomas, three angiosarcomas, one malignant peripheral nerve sheath tumor, and one Ewing's sarcoma.

There have also been case reports of objective responses to gemcitabine and docetaxel in other unusual sarcomas. A patient with pulmonary angiosarcoma was reported to have achieved a complete radiographic response. In addition, a patient with locally advanced leiomyosarcoma of the bladder had a near-complete pathologic response to gemcitabine–docetaxel delivered as neoadjuvant therapy.

"Apart from the chemosensitive small round cell tumors such as Ewing’s sarcoma family of tumors (ESFT) and rhabdomyosarcomas (RMS), some of which are potentially curable even when metastatic, all other patients with metastatic soft tissue sarcomas (STSs) are destined to die from their disease however aggressive their management. There are some exceptions, including a proportion of patients with limited pulmonary disease who have a long survival after lung metastasectomy as well as a fraction of patients (30%) among those achieving complete response (CR) after chemotherapy (accounting for 1–3% of patients with metastatic disease). For the majority of patients, the goals of treatment include palliation of symptoms and prolongation of survival with improved quality of life. Given this fact, one needs to consider how aggressive the treatment should be in order to balance the hoped for benefit against the inevitable toxicity. One important question that remains open is whether combination chemotherapy is better (in terms of overall survival [OS]) than sequential administration of active single chemotherapy agents...

The key role of chemotherapy in the management of STS is in the palliation of advanced disease. Active agents include doxorubicin, often used as a single agent, and ifosfamide. The combination of these two agents may produce a more rapid response and an increased likelihood of tumor shrinkage, but it is not yet clear whether there is a definite advantage to the use of combination therapy in terms of survival. Adjuvant chemotherapy for STS remains controversial but may be advantageous in certain situations, for example, where optimal RT cannot be given and local control is vital. Individual disease types are now treated differently, for example, synovial sarcoma is particularly sensitive to ifosfamide, angiosarcoma to taxanes and leiomyosarcoma to gemcitabine or the combination of gemcitabine plus docetaxel..."

From: Update on gemcitabine and docetaxel combination therapy for primary and metastatic sarcomas. Hensley ML. Curr Opin Oncol. 2010 Jul;22(4):356-61.

Role of chemotherapy in the management of soft tissue sarcomas. Krikelis D, Judson I. Expert Rev Anticancer Ther. 2010 Feb;10(2):249-60


Karen said...

I had Gem and Tax twice, in 2007 and 2009, and would be happy to share some tips for dealing with side effects if you're interested. Like, I kept a popsicle or ice in my mouth during the Tax part and that reduced the dry mouth significantly for me.

I have leiomyosarcoma.

Anonymous said...

Leezy120 said...
Hello Marco
Always thinking of you and hoping you find the best ways to cope during your treatment.

Love you Leezy

Anonymous said...

Leezy120 forgot to say...
And please do let me know if you need help with any chores at home. Won't be naggy. I promise.