The preventive chemotherapy to which Princess Kate is undergoing is administered in cases of potentially curable tumors: it is a therapy that involves a certain toxicity but it is an “investment in the future” as it reduces the risks of recurrence to a minimum and, therefore, of reappearance of the disease. Massimo Di Maio, elected president of the Italian Association of Medical Oncology (Aiom) and director of University Medical Oncology 1 at the Molinette Hospital in Turin, explains it.
In general, chemotherapy can be classified into 4 categories: curative (to eliminate the tumor by inducing the death of cancer cells); neo-adjuvant (to reduce the volume of the tumor and make subsequent treatments such as surgery and radiotherapy more effective); palliative (to slow down progression when the tumor is in an advanced stage) and adjuvant.
Precisely the adjuvant, or preventive, chemo is the one administered to the princess: “It is carried out after surgery and/or radiotherapy – explains Di Maio – to destroy any tumor cells still in circulation but not detectable on the CT scan, and thus reduce the risk that the tumor recurs. The decision is made to have it done when there are particular risk factors. For example, in colon cancer a risk factor is the involvement of the lymph nodes, in other tumors the risk factor is the initial stage of the disease.”
However, it is a therapeutic option that is often “difficult to communicate and make the patient accept”, states the oncologist: “The patient, in fact, knows that he has eliminated the tumor surgically and the treatment does not have an immediate advantage because the patient does not has symptoms. It’s difficult to accept because you have to endure side effects but without immediate benefit. In reality, however, it is a long-term investment in the chance of recovery.” Side effects depend on the drugs used and the type of tumor: neuropathic effects, fatigue, nausea, or hair loss can occur, especially with some adjuvant chemo schemes for ovarian cancer.
As for the duration of therapy, the expert clarifies, “it can vary: for example in colon cancer it was 6 months but for a few years there has been a tendency to reduce it to 3 months to safeguard a greater quality of life, but it depends on the individual cases; in ovarian cancer, however, the duration is on average 4 months, to name two types of tumors of the abdominal area”.
Chemotherapy, however, always uses drugs that act with a cytotoxic mechanism, that is to say, ‘poison’ the tumor cells: “Therefore, if in patients with advanced disease we use it to destroy the tumor in the case, for example, of metastases in various organs, in In the case of adjuvant therapy – he underlines – chemo is administered without knowing whether the patient actually still has tumor cells in the body, because they are not detectable. We therefore do it to destroy any microscopic residual disease but which could still lead to a recurrence”.
Obviously “there are no absolute guarantees but a toxic treatment is accepted to increase the chances of recovery. It’s a gamble – he concludes – but the positive message is that preventive chemo indicates a situation in which the tumor can be eliminated and the patient, therefore, potentially curable”.
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