There is a very prominent misunderstanding in the cancer prevention and treatment process in China, that is: overtreatment .
For example, small lung nodules, small thyroid nodules, and small breast nodules. Although the supervisor has repeatedly suggested that " nodules are very small, and it is very likely not cancer. You can consider regular follow-up examinations", there are still many Chinese people who are restless and unable to sleep or eat, and they finally chose surgical resection. A considerable number of patients finally cut them into benign nodules.
Although it cannot be said that "wasted in vain", many nodules will disappear automatically after a period of follow-up, which is somewhat overtreatment.
For example, after early cancer surgery, no treatment is required according to treatment standards. For example, most cancers with stage I have this situation.
But Chinese patients began to worry again:
"Doctor, will my tumor definitely not recur after it is removed?"
"This cannot be 100% guaranteed, there is still a certain recurrence rate, but the recurrence rate is very low." "This cannot be 100% guaranteed. It still has a certain recurrence rate, but the recurrence rate is very low." html l5
"Since it cannot guarantee 100% guaranteed no recurrence, can I take some medicine? Can I get chemotherapy? Can I do some radiotherapy? Can I get PD-1 antibody?"
"None is recommended, because these treatments have been proven to not reduce the risk of recurrence, and even the cure rate will decrease due to side effects."
"It's so scary, then I don't have chemotherapy, don't take medicine, or take PD-1 antibodies, but I still have the risk of recurrence and metastasis. I am still very anxious and scared. Can't you doctor think of a way?"
" Sorry, as of now, there is really no way to effectively reduce the risk of recurrence."
"A group of quack doctors" Some patients will curse in their hearts, then turn their heads and start taking Chinese medicine, looking for folk remedies, or can't help but find a hospital for chemotherapy, take targeted drugs, or receive PD-1 antibodies...
For example, patients with advanced cancer often have patients who "life is endless and treatment is endless". They will receive more than a dozen or even dozens of courses of chemotherapy. They feel worried about the combination of dual medicines and three medicines, and force the doctor or use four medicines, five medicines and six medicines to treat them in concealed.
In fact, in most advanced solid tumors, if the treatment is effective, chemotherapy will generally be performed for 4-8 courses; if the treatment is ineffective, 2-3 courses will be replaced after imaging review and judging the progress of the disease.
As for the maintenance treatment that some patients are keen on, in fact, most of the time it only extends the survival time without disease progression and cannot extend the overall survival time; some blind maintenance treatments cannot even extend the survival time without disease progression and cannot extend. The longer the medication is used, the higher the risk of side effects of and the greater the economic cost. Therefore, more and more experts are calling for and exploring "treatment holiday" (treatment holiday) .
Recently, a team led by Professor Timothy S. Maughan from Oxford University announced the final results of the FOCUS4-N study in the journal JCO. The clinical trial was enrolled in advanced bowel cancer patients who had not progressed after 16 weeks of standard first-line treatment of (4 months). They were divided into 1:1 groups, and one group received oral Hiroda further maintained treatment until toxicity is intolerable or disease progression. One group stopped the medication directly after 4 months of standard first-line treatment and had regular follow-up examinations. After long-term follow-up, it was found that there was no difference in the median overall survival time between the two groups; while the Hiroda maintenance treatment group caused diarrhea (23% vs 13%) , fatigue (25% vs 12%) , and the incidence of hand and foot syndrome (26% vs 3%) was significantly higher.
In fact, since 2015, thousands of patients with advanced bowel cancer have been enrolled. No matter what kind of maintenance treatment plan is, it cannot prolong the patient's overall survival time, but all of them have significantly increased the patient's side effects. Therefore, more and more experts now prefer to encourage patients to choose timely discontinuation of medication and actively follow-up after the first-line treatment is effective.
Domestic lung cancer tycoon, Professor Wu Yilong recently proposed the "treatment holiday" under the guidance of accurate and active ctDNA monitoring. Patients with advanced lung cancer who receive standard targeted drugs have a long-term and stable efficacy, tumor marker is normal, and oncogene cannot be detected in peripheral ctDNA, the patient can choose to stop the drug under the conditions of informed consent and enter the "vacation period" (of course, actively follow up) .
A total of 34 Warriors challenged, and 5 patients had brain metastases at baseline. As of this year's World Lung Cancer Conference, 19 patients are still in the "dumping holiday". Another 15 patients have once again detected oncogenes or imaging during follow-up and surveillance, and have returned to drug treatment. The median disease-free survival time after the drug is 6.3 months (that is, the Warriors who chose to stop the drug can enjoy about half a year of drug withdrawal holidays) . Among the patients with tumor rebound in
, 8 patients took the return drug, and 100% took effect again. , and most of these patients with tumor rebound, except for those with brain metastases, discovered tumor rebound in time through peripheral blood monitoring. After resumed the medication, it soon reached the goal of zeroing oncogenes in peripheral blood again.
This research in Professor Wu’s team is an amazing feat. If further optimization and improvement, will give more and more patients a safe and reliable treatment break. What is more important is that it will greatly break the wrong concepts in the minds of the majority of Chinese people (think that the more tumor treatment, the better, think that the treatment cannot be stopped, and it will be better to endure it until the end) .
References:
[1]. Capecitabine Versus Active Monitoring in Stable or Responding Metastatic Colorectal Cancer After 16 Weeks of First-Line Therapy: Results of the Randomized FOCUS4-N Trial. DOI: 10.1200/JCO.21.01436
[2]. Drug holiday based on molecular residual disease status after local consolidative therapy following TKI treatment for patients with advanced NSCLC. 2021 WCLC.
[3]. Molecular and cellular dynamics of drug tolerant persister (DTP) cells during osimertinib therapy in EGFR mutant lung adenocarcinoma. 2021 WCLC.
