The conclusion of the study:
"When chemotherapy is being given with curative intent, we believe that it is important to avoid reductions and delays in chemotherapy if the best possible outcome is to be achieved, although this is not possible for all patients."
I encourage anyone to read the study first and form their own opinions, before listening to my views.
My belief, is that the study may be controversial. No one wants to be told that their oncologist may have made a sub-optimal decision regarding their treatment. Basically, a dose reduction or a delayed dose results in a reduction in the relative dose intensity (RDI: percentage dose relative to the standard dose) of the regimen. The study looks, retroactively, at the survival results when a group of patients are 50% RDI or 70% RDI. The findings: There is a significant reduction in patient survival.
My belief, is that the study makes sense. Accordingly, I will always resist, to the best of my ability, and dose reduction or delayed treatment. Bring on the neupogen!
Note: I'm not saying that I resist having only 2 ICE treatments. I am saying, that if those two treatments were a month apart or at reduced doses, then I would have a problem.
6 comments:
Interesting study but I'm not sure it addresses the issue at hand here. It's more a question of not using up your chemo-tolerance on ICE, right? rather than not giving you a harsh-but-necessary regimen. Still, I agree with you on keeping the momentum going ...
It doesn't really apply to me right now because I am receiving the standard dose for Salvage ICE. Plus, even if I received less than optimal, there is the question of chemo-tolerance and what role that plays here. Of course, then there's the consideration of chemo-efficiency, which seems to be highest at the standard doses. In that case, my chemo-tolerance would increase the least for the most efficient chemo -- so reducing the dose, even in salvage chemo, may not be optimal.
Mostly, though, this is just something I've been thinking about with standard chemo.
At the top of my mind was always the question: "If my counts drop too much, will they reduce the amount I am given?" I was quite surprised to find that this reduction may be sub-optimal. That's why I wrote about it here.
Your doctor at Stanford will take you into BMT when your tumor reduction reaches 50%. That to me expresses a high confidence that the BMT can handle a tumor that size. Ok, so now let's assume you have a 50% reduction after 2 ICE treatments and can choose between immediate BMT or one more ICE to get another 15% reduction - which do you choose? Which would your doctor choose?
My concern has to do with the time elapsed between BMT and radiation. I feel that time needs to be as short as possible.
The other scenario one can consider is if you had 4 ICE and were lucky enough to get a CR. Then could you justify going directly to radiation and skip the BMT, saving it as a treatment for a relapse if one ever occurred? Based on your philosophy that would not be aggressive enough.
A choice between 15% more reduction and straight to BMT? I'd chose the BMT. But what about an additional 40% reduction? Hmm..
Also, the only reason I advocate going into a BMT with a CR is because my doctor said: "It's best to go into BMT with a CR."
The philosophy I presented here is mostly to do with standard treatment, not additional ICE cycles.
In that study, it showed graph of cell count changes for each cycle. The way it was drawn, there was no cell death between cycles, only cell growth. Your doctor implied that shrinkage may continue after treatment of Stanford V. It seems likely to me that both are true. After chemo, cell death continues for a certain time, then after that if there is not a CR then cell growth resumes. That crossover time is critical. You would want to start a new cycle before reaching it. But it probably varies from individual to individual.
Yeah, I agree -- that crossover time is critical. Only a trained oncologist would be able to dial-in that precise timing of treatments.
Post a Comment