Theoretical Considerations Regarding the Early Use of Adjuvant Chemotherapy

Abstract

There is now a large amount of information from both clinical and experimental studies that indicate that there is a strong inverse correlation between tumor mass and potential curability by drugs (Skipper 1978; DeVita 1983). All other things being equal small tumor burdens will be much more susceptible to drug-induced cure than will large. This has been shown for a wide variety of transplanted rodent tumors and, as well, the same inference can be clearly made from clinical observation. For those disseminated malignancies for which curative chemotherapy is available, there appear to be no exceptions to the general statement that patients presenting with a significantly lower tumor burden are much more likely to achieve cure than those patients with the same histological disease who present with very extensive tumor burdens (Frei 1982). The extension of these concepts into the area of the treatment of more refractory groups of malignancies yields the conclusion that it may be possible to achieve drug-induced cures in patients with microscopic tumor burdens whereas the same disease at an advanced stage would be incurable. It is this hypothesis which has now become the underlying rationale for the utilization of so-called adjuvant chemotherapy.