(p. A1) Doctors are coalescing around the ironic idea that for some cancer treatment, less can be better.
Some patients with cervical and pancreatic cancer can do as well with less invasive surgery, according to research presented at the American Society of Clinical Oncology conference in Chicago over the weekend. Other studies at the annual meeting showed some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation.
The findings expand a body of evidence doctors are using to design treatment plans that aim to reduce side effects and costs. They call the strategy de-escalation: cutting back on some therapies to improve a patient’s quality of life without hurting their odds of survival.
Newer treatments and tests are extending patients’ lives and moving cancer care away from a blunt, one-size-fits-all approach. On the strength of studies like those presented in Chicago, doctors are getting better at determining who needs the most aggressive care and who can get away with less treatment and less collateral damage.
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(p. A7) In another study presented at the conference of some 1,200 patients with rectal cancer that had spread to nearby tissue or lymph nodes, about half got standard chemotherapy and radiation before surgery. The others got more aggressive chemotherapy but no radiation, unless their tumors failed to shrink by at least 20%. About 10% of those patients needed the radiation, according to the study, which was published in the New England Journal of Medicine and the Journal of Clinical Oncology.
At five years, results from the protocols were similar, suggesting that many rectal cancer patients can safely skip radiation that increases risks of pelvic fractures, bowel and sexual dysfunction and infertility, researchers said.
“We can spare select patients,” said Dr. Pamela Kunz, director of the Center for Gastrointestinal Cancers at Yale Cancer Center. “This trial is really less is more.”
The patients who avoided radiation by undergoing more aggressive chemotherapy experienced more, different shorter-term side effects including appetite loss, fatigue and nervous-system damage. Some patients might still opt to get the radiation, researchers said.
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The Food and Drug Administration this year released draft guidance to cancer-drug developers on how to determine the best dose for new therapies. Doses were traditionally set at the highest tolerable amount, since the drugs were less precise and patients needed them quickly.
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(Note: the online version of the story was updated June 5, 2023, and has the same title as the print version. The wording in the last sentence quoted above follows the more nuanced online version of the sentence.)