Resumen
Actualmente la quimioterapia representa la principal opción terapéutica en los pacientes con cáncer avanzado. Su finalidad es paliativa, por lo que adquiere relevancia establecer un balance entre sus efectos positivos sobre la supervivencia y calidad de vida y aquellos negativos en forma de toxicidad, frecuentación hospitalaria y coste económico. Desconocemos si es mejor continuar la quimioterapia hasta la progresión de la enfermedad o bien administrarla de forma intermitente. Por ello hemos revisado los ensayos comparativos publicados al respecto. En el cáncer de mama metastático el tratamiento prolongado parece ofrecer ventajas sobre la supervivencia. Aunque no existen estudios suficientes en otras neoplasias, dos ensayos recientes apoyan el empleo de la terapia intermitente en el cáncer colorrectal y broncopulmonar avanzados.
Abstract
Chemotherapy still represents the treatment of choice for patients with advanced cancer and is mainly palliative in intent. Thus, positive effects on survival and quality of life should be balanced against the negative impact of toxicity, hospital frequentation and economic costs. It is not well known if continued therapy (until disease progression) is better than intermittent administration. A review of randomized trials assessing this question has been performed. Continued treatment seems to offer some survival advantages in metastatic breast cancer. Although there are no sufficient studies in other malignancies, two recent trials support the use of intermittent therapy in advanced non-small cell lung cancer and colorectal carcinoma.
Bibliografía
Scheithauer W, Rosen H, Kornek GV, et al. Randomized comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. Br Med J 1993;306:752–5.
Powles TJ, Coombes RC, Smith IE, Jones JM, Ford HT, Gazet JC. Failure of chemotherapy to prolong survival in a group of patients with metastatic carcinoma of the breast. Lancet 1980;1:580–2.
Glimelius B, Hoffman K, Haglund U, et al. Cost-effectiveness of palliative chemotherapy in advanced gastrointestinal cancer. Ann Oncol 1995;6:267–74.
Burris HA III, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:2403–13.
Early Breast Cancer Trialists’ Collaborative Group. Polichemotherapy for early breast cancer: an overview of the randomised trials. Lancet 1998;351:930–42.
Pastan I, Gottesman M. Multiple-drug resistance in human cancer. N Engl J Med 1987;317:1388–93.
Fisher RI, De Vita VT, Hubbard SP, Simon R, Young RC. Prolonged disease-free survival in Hodgkin’s disease with MOPP reinduction after first relapse. Ann Intern Med 1979;90:761–3.
Harris AL, Cantwell BMJ, Carmichael J, et al. Comparison of short-term and continuous chemotherapy (mitozantrone) for advanced breast cancer. Lancet 1990;335:186–90.
Glaholm J, Mort C, Ashley S, Yarnold JR. Duration of chemotherapy in advanced breast carcinoma. Lancet 1990;335:1033–5.
Smalley RV, Murphy S, Huguley CM, Bartolucci AA. Combination versus sequential five-drug chemotherapy in metastatic carcinoma of the breast. Cancer Res 1976;36:3911–6.
Ahmann FR, Pugh R. Short-term chemotherapy of poor-prognosis metastatic breast cancer with three non-cross resistant chemotherapy regimens: a Southwest Oncology Group study. Cancer 1987;59:239–44.
Muss HB, Case LD, Richards F, et al. Interrupted versus continuous chemotherapy in patients with metastatic breast cancer. N Engl J Med 1991;325:1342–8.
Gregory RK, Powles TJ, Chang JC, Ashley S. A randomised trial of six versus twelve courses of chemotherapy in metastatic carcinoma of the breast. Eur J Cancer 1997;33:2194–7.
Coates A, Gebski V, Bishop JF, et al. Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. N Engl J Med 1987;317:1490–5.
Coates A, Byrne M, Bishop JF, Forbes JF. Intermittent versus continuous chemotherapy for breast cancer. N Engl J Med 1988;318:1468–73.
Ejlertsen B, Pfeiffer P, Pedersen D, et al. Decreased efficacy of cyclophosphamide, epirubicin and 5-fluorouracil in metastatic breast cancer when reducing treatment duration from 18 to 6 months. Eur J Cancer 1993;29A:527–31.
Stockler M, Wilcken N, Coates A. Chemotherapy for metastatic breast cancer -when is enough enough? Eur J Cancer 1997;33:2147–8.
Falkson G, Gelman RS, Pandya KJ, et al. Eastern Cooperative Oncology Group randomized trials of observation versus maintenance therapy for patients with metastatic breast cancer in complete remission following induction treatment. J Clin Oncol 1998;16:1669–76.
Peters WP, Jones RB, Vredenburgh J, et al. A large, prospective, randomized trial of high-dose combination alkylating agents (CPB) with autologous cellular support (ABMS) as consolidation for patients with metastatic breast cancer achieving complete remission after intensive doxorubicin-based induction therapy (AFM) (abstract). Proc Am Soc Clin Oncol 1996;15:121.
Dixon AR, Jackson L, Chan SY, Badley RA, Blamey RW. Continuous chemotherapy in responsive metastatic breast cancer: a role for tumour markers? Br J Cancer 1993;68:181–5.
Maughan T, James R, Kerr D, et al. Continuous vs intermittent chemotherapy for advanced colorectal cancer: preliminary results of the MRC Cr06b randomised trial (abstract 498). Proc Am Soc Clin Oncol 2001;20:125a.
Scheithauer W, Kornek GV, Raderer M, et al. Randomized multicenter phase II trial of oxaliplatin plus irinotecan versus raltitrexed as first-line treatment in advanced colorectal cancer. J Clin Oncol 2002;20:165–72.
Freeman JA, Chalmers TC, Smith H, Kuebler RR. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial: survey of 71 «negative trials». N Engl J Med 1978;299:690–4.
Altman DF, Bland JM. Absence of evidence is not evidence of absence. Br Med J 1995;311:485.
Hickish TF, Smith IE, Middleton G, et al. Patient preference for extended palliative chemotherapy for non-small cell lung cancer (letter). Lancet 1995;345:857–8.
Smith IE, O’Brien MER, Talbot DC, et al. Duration of chemotherapy in advanced non-small-cell lung cancer: a randomized trial of three versus six courses of mitomycin, vinblastine, and cisplatin. J Clin Oncol 2001;19:1336–43.
Plotkin D, Waugh WJ. Hypothesis: discontinuous chemotherapy for advanced breast cancer. Am J Clin Oncol 1983;6:375–9.
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Urtasun, J.A., Beveridge, R.D. ¿Cuál es la duración óptima de la quimioterapia paliativa en los pacientes con cáncer avanzado?. Rev Oncol 4, 471–475 (2002). https://doi.org/10.1007/BF02712824
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DOI: https://doi.org/10.1007/BF02712824