Key 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.
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.