Fast Fact and Concept #099: Chemotherapy: Response and Survival Data

2nd Edition

Author(s): Weissman, David E; von Gunten, Charles F

Key data in the decision process regarding chemotherapy includes the response rate, median duration of response, and median survival, along with toxicity and quality of life information (see Fast Fact #14). The table below synthesizes data for several common cancers. The data was derived by reviewing standard oncology textbooks, along with a Medline search of recent relevant articles.

• All data are for patients receiving chemotherapy for metastatic or locally advanced cancer (not receiving adjuvant or neoadjuvant chemotherapy).
• All data is for first-line, commercially available oral or IV chemotherapy or biological therapy (such as monoclonal antibodies).
• Response Rate is defined as: percentage of complete and partial responders in a given trial, where Partial Response = > 50% reduction in measurable tumor for one month.
• Response is typically determined after 2 cycles of treatment (usually one cycle every 21-28 days); however, patients who progress after 1 cycle will generally continue progressing after two.
• The data reflects mid-point ranges derived from the available clinical trials; most of the data represents combination chemotherapy trials. Note: for certain cancers, the benefit of combination vs. single agent therapy is not proven (e.g. pancreas, biliary, liver).
• This data is not representative of all cancer patients. The data represents the ‘best case’ outcome, from a population of patients who were in good enough health to participate in a clinical trial (e.g. ambulatory, good functional status). Actual responses and response durations for a non-clinical trial population will likely be poorer.
• Data for biliary, pancreas, esophagus and liver comes from many small trials (< 50 patients), thus the upper end figures are likely to be overestimated.
• Second-line chemotherapy, following disease progression from first-line treatment, can be expected to have a lower response rate and shorter duration of response.

1. Median survival data includes both responders and non-responders; patients who respond to chemotherapy typically live longer than those who do not.

References

1. DeVita VT, et al, eds. Cancer: Principles and Practice of Oncology. 7 th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
2. Kufe DW, et al, eds. Holland-Frei Cancer Medicine. 7 th ed. Hamilton, Ontario: BC Decker; 2006.

Fast Facts are edited by Drew A. Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For comments/questions write to: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman DE, von Gunten CF. Fast Fact and Concept #99. Chemotherapy: Response and Survival Data. 2 nd Edition. November 2007. End-of-Life/Palliative Education Resource Center ( www.eperc.mcw.edu).

Disclaimer: Fast Facts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 1/2008

Purpose: Instructional Aid, Self-Study Guide, Teaching

Audience(s)

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): cancer

Specific Disease and Organ System Category(s): Cancer