Chemotherapy before main cancer treatment: Advantages, drawbacks, and medications used
Neoadjuvant chemotherapy is a pre-surgery treatment option that has shown significant benefits for several types of cancers. This approach involves administering a series of drugs to shrink tumors before primary treatments such as surgery, aiming to improve surgical outcomes and enhance longer-term survival.
In advanced-stage ovarian cancer, for instance, neoadjuvant chemotherapy (NACT) has demonstrated a 74% reduction in 90-day postoperative mortality and a 4-month improvement in 5-year (60-month) survival compared to low-volume treatment centers.
Locally advanced cervical cancer patients have seen promising results with combination therapy of neoadjuvant chemotherapy and immune checkpoint inhibitors, such as tislelizumab, showing a pathologic complete response rate of 66.7% and an objective response rate of 90%.
Neoadjuvant chemotherapy has also shown survival benefits for gastric signet-ring cell carcinoma, although exact survival percentages after neoadjuvant treatment were not fully detailed in the summary.
While the benefits are modest, neoadjuvant chemotherapy regimens such as FOLFIRINOX have shown varied response rates (20–30% in advanced chemorefractory disease) for pancreatic ductal adenocarcinoma (PDAC). Ongoing studies aim to optimize treatment by tumor subtype and emerging targeted therapies (KRAS inhibitors) may further improve survival in the neoadjuvant setting.
For muscle-invasive bladder cancer, standard neoadjuvant therapies like dose-dense MVAC and gemcitabine-cisplatin have improved surgical outcomes and survival in patients eligible for radical cystectomy, especially when molecular targets such as FGFR alterations are identified.
While exact survival rates vary by study and cancer subtype, neoadjuvant chemotherapy generally improves surgical outcomes, reduces tumor burden, and enhances longer-term survival compared to surgery alone. The degree of benefit depends on the cancer’s biology, stage, and treatment center experience.
People can receive neoadjuvant chemotherapy in a doctor's office, in the hospital, or at home. The number of cycles for neoadjuvant chemotherapy may vary depending on the progression of the cancer and how well the individual responds to the medication. Anthracyclines, taxanes, 5-fluorouracil, cyclophosphamide, and carboplatin are some drugs used for neoadjuvant chemotherapy.
It is essential to discuss questions with a doctor before starting treatment, including which drugs would be recommended, how treatment would be administered, how frequently treatments would be, how long they would last, what possible side effects are, if any lifestyle changes would be needed, whether prior authorization from a health insurance provider would be required, and who would be responsible for obtaining this.
Possible side effects of chemotherapy include hair loss, nail or skin changes, appetite loss, weight changes, diarrhea or constipation, mouth sores, fatigue, and nausea or vomiting. It is crucial to seek support for the possible mental health effects of cancer and chemotherapy.
In conclusion, neoadjuvant chemotherapy is a valuable tool in the fight against cancer, offering improved surgical outcomes and enhanced survival rates for several types of cancers. Consulting with a healthcare professional is crucial to determine the best treatment plan and manage potential side effects.
- In the context of cancer treatment, neoadjuvant chemotherapy with anthracyclines, taxanes, 5-fluorouracil, cyclophosphamide, and carboplatin can help reduce tumor burden and potentially improve health-and-wellness outcomes, especially for muscle-invasive bladder cancer.
- Beyond cancer surgery, neoadjuvant chemotherapy has shown success in managing medical-conditions like ovarian and cervical cancer, offering a 74% reduction in 90-day postoperative mortality and a 4-month improvement in 5-year survival rates for ovarian cancer patients.
