Impact of Dose Delays, Decreases, Discontinuations on CIN Clinical Outcomes
Dr. Lyman: The impact of modifications in the chemotherapy dose and schedule of course vary with type of cancer, the stage of cancer, the data supporting the cancer therapies, the chemotherapy regimens for those cancers. So there is a variation across cancer types and regimens. However, again, when treating for curative intent, early stage disease, it’s very clear that the data that we and others have generated clearly shows that if you substantially, and I’m talking as little as perhaps 10%, 15% reduce the dose intensity of chemotherapy in those settings, you end up with a measurable and clinically significant increase in the risk of cancer recurrence.
I continue to emphasize to my trainees, again, you may start off and do what you think is a relatively minor reduction in the dose to alleviate the risk in some patients or delay treatment a week because of a holiday or something coming up. But when you look across the whole course of the therapy, those small, some appearing to be modest or minimal reductions in dose intensity, add up. By the end of the patient’s treatment course, you end up realizing, actually, I’ve really significantly reduced the dose intensity of that therapy.
You get one shot at this, generally. I mean, some—certainly some patients with responsive cancers can come back in and get second line therapy and still go on to do well. But the best chance for a treatable, responsive cancer to be cured is that first course of therapy. That’s where we put all this focus on optimally treating and dosing those patients. Because you don’t want that cancer to come back. Of course, you want to keep the patient comfortable, but most and foremost and with engagement of the patient in shared decision making and awareness, you do everything you can.
Most patients will work with you very much, because they have the same shared goal. They want to get rid of the cancer. Even in the COVID-19 era as I talk to patients going through cancer treatment, they still fear the cancer more than the COVID-19. So maintaining that dose intensity while protecting them from serious infection and reducing their exposure to the healthcare system, all that, I think, can come together with appropriate and aggressive use of supportive care. As our approach has become better and better and more effective, I think we’ll continue to do a better and better job of our overall goal of protecting and curing patients with cancer.
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