Dose Dense Chemotherapy
Posted 2/9/2012
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As many of you know, Dose Dense (DD) chemotherapy refers to drugs that are administered every two weeks instead of the more traditional every three. This became possible with the availability of Neulasta and Neupogen, drugs that stimulate the bone marrow and insure that blood counts stay elevated. Without them, it takes the body three weeks to naturally process the dip and then recovery of blood counts so that chemotherapy can again be safely given. The early studies of DD chemo for adjuvant breast cancer treatment suggested a slight survival benefit, so it has become the almost standard calendar--although there have always been some exceptions and reasons why, for a particular woman, the every three week schedule might be better.
The non-doctor (meaning from my patient and social worker perspectives) view has been that the DD schedule means that the whole thing is over more quickly, that one does not have to worry about low counts and exposure and possible infections in the same way. It has also meant that some women/people have had to endure very painful bone aches from Neulasta (I was lucky and had no side effects), and that everyone has had the added inconvenience of arranging to have the injection 24 hours after chemotherapy.
As we have learned more and paid increasing attention to individualized medicine, it seems that the DD schedule is indeed helpful for some women (especially those with ER/PR negative tumors) but not necessarily for all. Here is an editorial from Journal of Clinical Oncology. I give you the introduction and a link:
Wiser Use of Dose-Dense Adjuvant Therapy in Breast Cancer
Bruce E. Hillner, The Massey Cancer Center of Virginia Commonwealth University, Richmond, VA Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
In the article that accompanies this editorial, Hershman et al1 report their analysis of Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare claims from 1998 to 2005 of women with early-stage breast cancer, focusing on the use and specific types of adjuvant chemotherapy and use patterns of hematopoietic colony- stimulating factors (CSFs) in support of chemotherapy. They assert that the abrupt increase in CSF use beginning in 2003 was a result of the reported benefits of dose-dense (DD) chemotherapy and the ease of administration of pegfilgrastim. In addition, they note that by 2010, there was good evidence of no benefit of DD chemotherapy in women with hormone-responsive (estrogen receptor [ER] positive) disease, and that Medicare could have saved $38 million in 2005 had pegfil- grastim not been given. Herein, we try to provide some perspective, discuss other relevant events during these years, and examine the implications of the authors' suggestion.
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