Duration of Chemotherapy in Stage IV
This is an editorial from the Journal of Clinical Oncology about a very important question: how long should chemotherapy last for women with Stage IV breast cancer? (Realize that this is a question that is either of intense or zero interest, depending on your personal situation) The standard of care has always been serial treatments, each one continuing for as long as it is useful. Practically, this has meant that women in this situation have been on one or another kind of treatment for the rest of their lives. In many cases, that may still be the right plan, but there is now debate about whether that needs always to be the system. Here is the introduction and then a link:
How Long Is Long Enough?
Andrew D. Seidman, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
Mrs. Smith, an otherwise healthy 58-year-old woman, is in your office to review the results of a computed tomography- guided needle biopsy of a suspicious lung nodule three years after she completed adjuvant chemotherapy for stage II breast cancer. You empathetically explain to her that the results confirm a diagnosis of metastatic breast cancer (MBC) which, like the primary tumor, lacks hormone and HER2 receptor overexpression. Mrs. Smith coughs a cough that has only developed after her computed tomography scan revealed numer- ous bilateral pulmonary nodules. You explain the role for cytotoxic chemotherapy in attempting to achieve a remission, improving cancer-related symptoms, and you hope, prolonging survival. You explain the laundry list of possible adverse effects from your planned chemotherapy regimen. Mrs. Smith then asks, "Doctor, how long will I need to be on this chemotherapy?"
Depending on who her medical oncologist is and, to some extent, on geography, Mrs. Smith may get different recommendations. For example, one oncologist might say, "We will treat you for 4 to 6 months and then stop and observe. We can always treat you again as the need arises." Another might say, "The duration of your chemo- therapy cannot be determined in advance; it will depend on how well your cancer responds to treatment and how well you tolerate it." Can both approaches be correct, or in fact, is there only one right answer?