blank StationeryKey data in the decision process regarding chemotherapy
includes the response rate, median duration of response and median survival,
along with toxicity and quality of life information (see Fast Fact #14).
The table below synthesized data for several common cancers. The data was
derived by reviewing two standard oncology textbooks, along with a Medline
search of recent relevant articles.
· All data is for metastatic or locally advanced cancer (not
adjuvant, or neoadjuvant).
· All data is for first-line, commercially available oral or IV
chemotherapy (immunotherapy, hormonal therapy, chemo-embolization,
intra-arterial chemotherapy or combined chemo-radiation data is not
included).
· Response Rate is defined as: percentage of complete and partial
responders in a given trial, where Partial Response = > 50% reduction in
measurable tumor for one month.
· Response is typically determined after 2 cycles of treatment
(usually one cycle every 21-28 days); however, patients who progress after 1
cycle will continue progressing after two.
· The data reflects mid-point ranges derived from the available
clinical trials; most of the data represents combination chemotherapy
trials; Note: for certain cancers, the benefit of combination vs. single
agent therapy is not proven (e.g. pancreas, biliary, liver).
· This data is not representative of all cancer patients. The data
represents the ‘best case’ outcome, from a population of patients who were
in good enough health to participate in a clinical trial, (e.g. ambulatory,
good functional status). Actual responses and response durations for a
non-clinical trial population will likely be poorer.
· Data for biliary, pancreas, esophagus and liver comes from many
small trials (< 50 patients), thus the upper end figures are likely to be
overestimated.
· Second-line chemotherapy, following disease progression from
first-line treatment, can be expected to have a lower response rate and
shorter duration of response.
Response Rate
Median Duration of Response
Median Survival 1
Breast 2
25-55%
6-12 months
24-36 months
Colon 3
25-35%
6-8 months
12-18 months
Esophagus
30-50%
4-6 months
6-9 months
Lung - Non-Small Cell
20-30%
4-6 months
6-9 months
Stomach
20-30%
4-6 months
6-9 months
Melanoma
15-25%
4-6 months
6-9 months
Pancreas 4
15-25%
3-5 months
6-9 months
Liver (Hepatoma)
5-15%
2-4 months
6-9 months
Biliary (Cholangioca.)
5-15%
2-4 months
6-9 months
1 Median survival data includes both responders and non-responders; Patients
who respond to chemotherapy typically live longer than those who do not.
2 Breast cancer is an extremely heterogeneous disease, thus the large
response rate range
3 Data from trials of 5FU/Leukovorin versus Irinotecan or Oxaliplatin
4 Trials of Gemcitabine combination chemotherapy—some of these trials use
the term “objective response” which is a less rigorous term than the
traditional “partial response”, thus the benefit may be overstated.
References
Cancer Principles and Practice of Oncology. 6th Edition DeVita, et al. 2001
Lippincott Williams and Wilkins
Cancer Treatment. 5th edition Haskell CM 2001 WB Saunders
Schiller JH. Harrington D. Belani CP. et al. The Eastern Cooperative
Oncology Group. Comparison of four chemotherapy regimens for advanced
non-small-cell lung cancer. New England Journal of Medicine. 346(2):92-8,
2002
Copyright/Referencing Information: Users are free to download and distribute
Fast Facts for educational purposes only. Citation for referencing:
Weissman DE and von Gunten CF. Fast Facts and Concepts #99. Chemotherapy:
response and survival data. October 2003. End-of-Life Physician Education
Resource Center www.eperc.mcw.edu.
Edward E. Rylander,M.D.
Diplomat of the American Board of Family Practice
Diplomat of the American Board of Palliative Medicine
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