New success measures for late-stage cancer treatment evoke tough questions
Among 11 candidate biomarkers under study in the UK MRC FOCUS trial, the largest-yet trial of metastatic colorectal cancer, levels of topoisomerase-1 (Topo1) appears to be the only one that predicts response to irinotecan in combination with fluorouracil. Patients with a high response to Topo1 gained a median 5.3 months of survival.
In the other arm of the trial, Topo1’s predictive value for fluoruracil-oxaliplatin was suggestive but not significant, at p = 0.05.
Oncologists have been wondering aloud how to communicate with patients when (as in the study above), continuing chemotherapy offers only a few more months of life at the cost of adverse effects.
“When is enough enough?” ask the authors of an article in a recent issue of the Journal of the American Medical Association.
Another recent report, this one in the Journal of Clinical Oncology,assesses prognostic factors for 2-month survival among hospitalized patients with advanced solid tumors. A combination of factors proved most predictive:
* Karnofsky index
* Number of metastatic sites
* Low serum albumin, and
* LDH concentration
The patient’s desire to continue treatment was also associated with survival.
Evidence-based Articles
A recent article in BMJ Clinical Evidence by authors from the UK and Canada ponders whether adverse effects data from major trials like the one above can be relevant in community practice, and how to make them more so.
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