Adjuvant or precautionary chemotherapy is given to reduce the risk of recurrence associated with a certain type of cancer. In a recent social message, Princess of Wales Kate Middleton said that she started this type of treatment after she was diagnosed with an unspecified form of cancer. The oncologist Camillo Porta explains what it consists of and what it is used for.
Interview with Prof. Camillo Porta
Professor of Oncology at the Aldo Moro University of Bari
After months of silence, the Princess of Wales Kate Middleton he revealed in a official message posted on the royal family’s Instagram account that they discovered they had a cancer immediately after theabdominal surgery immediately in January. The princess did not provide further details about the type of cancer she was diagnosed with, but she tried to reassure the English (and not only), saying that he is taking care of himself and is gathering all his strength to better face this period of his life.
Specifically, Middleton said that after surgery at the London Clinic, thanks to which doctors detected the presence of tumor cells, started undergoing “preventive chemotherapy”. The correct medical term is “adjuvant chemotherapy” o “precautionary” and consists of the administration of anticancer drugs usually used in chemotherapy, but with one preventive purpose. At Fanpage.it he professor Camillo Portaprofessor of Oncology at theAldo Moro University of Bariexplained what this type of chemotherapy consists of, when it is used and what the benefits are differences compared to other possible uses of chemotherapy drugs.
What does adjuvant or precautionary chemotherapy mean?
What is the preventive chemotherapy that Kate Middleton is undergoing and what are the effects
When we talk about adjuvant or precautionary therapy we mean a chemotherapy treatment administered after surgery with which the tumor mass has been radically removed and with the aim of preventing any recurrence, i.e. that the tumor reappears in the future. In reality, other forms of oncological therapies can also be applied for this purpose, such as immunotherapy, radiotherapy or hormone therapy.
What changes compared to non-preventive chemotherapy?
Compared to chemotherapy used not for preventive purposes, in adjuvant chemotherapy the treatment does not change, but the objectives are different: not to reduce symptoms or lengthen survival expectations, but to reduce the risk of recurrence and therefore contribute to treating the patient.
When should we proceed with precautionary chemotherapy?
The choice of whether or not to administer adjuvant chemotherapy depends on the evaluation of various factors and variables, primarily the risk of recurrence associated with the treated neoplasm. This includes several factors, such as the size of the tumor, the results of the histological examination and other specific characteristics of the disease being treated. Once these assessments have been made, in patients at high risk of recurrence, and for those tumors in which we know that chemotherapy administered as a precaution has been shown to reduce the possibility of the tumor returning, then we proceed with treatment.
So what are the concrete cases in which this treatment is used?
In summary, we can say that the prerequisites for resorting to precautionary chemotherapy are that the tumor has been surgically removed completely, that there is a high risk of recurrence based on a series of anatomical and biological parameters, and finally that there is proven evidence – i.e. supporting data – that the treatment is able to reduce this risk in the majority of patients.
So nothing changes in the methods of administration?
Exact. The drugs used are normally the same and also in the same dosages as those used in chemotherapy used not for precautionary purposes, or in the case of metastatic disease, which is the other typical case in which chemotherapy drugs are used, therefore also side effects possible are the same as those that would be observed in the case of administration not for preventive purposes. The only difference concerns the duration.
Does adjuvant chemotherapy last less?
On average, we can say that the duration of adjuvant chemotherapy compared to chemotherapy in metastatic patients is shorter.
How long can it last then?
There are pre-established schemes according to which precautionary therapies – not just chemotherapy – indicate their duration of practice: they can last for one year, five years or ten years. Depending on the type of tumor or the risk, more or less high, that the disease may result in a recurrence.
Is it suitable for all types of tumors?
The studies conducted so far and the data we have demonstrate that there are tumors for which the effectiveness of reducing the risk of recurrence associated with chemotherapy is very high, others in which it is present, but in a more modest way, and still others in which however, no preventive effects have been demonstrated. Therefore, in the presence of these tumors, preventive chemotherapy is not used, except in an experimental setting.
Today there are many tumors for which chemotherapy has proven to be suitable on average to prevent relapses. There are also various rather invasive neoplasms, such as breast, colorectal, lung, pancreas, kidney and bladder cancer.
And when are other adjuvant therapies recommended?
The premise for proposing adjuvant therapy to a patient is that there are data to support the effectiveness of the treatment considered in reducing, at least on average, cases of relapse. The choice of the type of treatment depends on many factors: the type of tumor, the stage of advancement, the organ involved, the size, lymph node involvement and other biological factors.