Introduction:
Cancer is an extensive and severe disease that requires proper treatments to treat and cure. One of the severe complications of cancer is its recurrence. Various treatment approaches are utilized to cure cancer and avoid recurrence. Surgery is a primary cancer treatment that helps in cancer cure by removing it from the body completely.
However, in some instances, the surgery may not remove it completely, and there is a chance of recurrence. In order to overcome that, adjuvant therapy is carried out. Adjuvant therapy is an additional treatment modality to primary cancer treatment, which avoids cancer recurrence. It also improves the quality of life in patients by decreasing complications and maximizing the overall survival time.
The term adjuvant therapy was first coined in 1963 by Paul Carbone and his teammates at the National Cancer Institute. It is derived from the Latin word “adjuvare” (meaning help). The first use of adjuvant therapy was used in breast cancer cases where an adjuvant alkylating agent was used. It is given after primary radical mastectomy, where it showed a significant decrease in its recurrence rate in premenopausal women. Later in 1973, Gianni Bonadonna and his colleagues conducted a randomized trial. This trial used CMF (Cyclophosphamide Methotrexate Fluorouracil) after initial mastectomy that showed favorable survival outcomes.
What Is Adjuvant Therapy?
Adjuvant therapy is given as an addition to primary cancer treatments, which maximizes the effectiveness of primary cancer treatment and avoids cancer recurrence. It is referred to by other names like “augmentation therapy,” “adjunct therapy,” and “helper therapy.” It destroys the cancer cells that are either missed by primary cancer treatments or remain in the body after initial cancer treatments. Adjuvant therapy is utilized in various cancers like breast cancer, colon cancer, lung cancer, etc. The various cancer treatments used as adjuvant therapy include,
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Immunotherapy.
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Targeted therapy.
Even though adjuvant therapy is highly beneficial in cancer cure, it does produce some side effects also.
What Is the Difference Between Adjuvant Therapy and Neoadjuvant Therapy?
Neoadjuvant therapy is a treatment that is given before your first-line treatment. For example, neoadjuvant therapies like chemotherapy or radiation therapy are given before cancer surgery to shrink the size of the tumor. This facilitates the easy removal of the tumor without removing much of the healthy tissues. At the same time, adjuvant therapy is given after surgery to maximize the effectiveness of the treatment and to avoid cancer recurrence.
What Are the Different Adjuvant Therapies Used in Cancer?
The following are the different adjuvant therapies used as a part of cancer treatment. It includes;
Chemotherapy: Chemotherapy means killing cancer cells using anti-cancer drugs. Adjuvant chemotherapy is given after first-line treatments like surgery, radiation therapy, etc. It provides a valuable therapeutic effect in cancer, but it does produce some side effects in some instances. Some of the common adjuvant chemotherapeutic agents used as a part of cancer treatment include:
1. Adjuvant Chemotherapy in Breast Cancer:
Adjuvant chemo drugs used in breast cancer include;
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Cyclophosphamide (Cytoxan).
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Carboplatin (Paraplatin).
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5-Fluorouracil (5-FU).
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Anthracyclines like Doxorubicin (Adriamycin) and Epirubicin (Ellence).
2. Adjuvant Chemotherapy in Colon Cancer:
Adjuvant chemo drugs like Fluoropyrimidine combined with Oxaliplatin decrease the risk of colon cancer recurrence and mortality in stage 3 colon cancer patients.
3. Adjuvant Chemotherapy in Lung Cancer:
Some of the common adjuvant chemo drugs used in lung cancer include:
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Cisplatin.
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Etoposide (VP-16).
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Docetaxel (Taxotere).
Radiation Therapy: Adjuvant radiation therapy uses high-energy X-rays to kill cancer cells. Adjuvant radiotherapy is used in cases where patients underwent breast-conserving therapy or in postmastectomy patients with tumors size greater than 5 cm or with involvement of more than four lymph nodes. It helps in the control of the disease, yet some locoregional toxicities are seen as side effects in certain cases.
Immunotherapy: Adjuvant immunotherapy uses drugs to stimulate the immune system to fight against cancer. For example, immunotherapy drugs like Atezolizumab (Tecentriq) are approved by FDA (Food and Drug Administration) for adjuvant therapy after surgery in non-small cell lung cancer (NSCLC).
Adjuvant immunotherapy is used to avoid recurrence in melanoma cases. Checkpoint inhibitors (a form of immunotherapy) like Ipilimumab, Nivolumab, and Pembrolizumab are given as adjuvant therapy in melanoma to avoid its recurrence.
Hormonal Therapy: Adjuvant hormonal therapy is a type of systemic treatment. For example, adjuvant endocrine therapy is used in hormone-receptor-positive breast cancer cases to reduce the recurrence and death rate in breast cancer patients.
Targeted Therapy: Targeted therapy is used as an alternative to overcome the drawbacks of traditional chemotherapy. Traditional chemotherapy kills cancer cells and normal cells due to its low specificity. Whereas targeted therapy targets and kills specifically the cancer cells without affecting normal cells. It can be used as adjuvant therapy in some cancers. For example, Olaparib is given as targeted therapy in breast cancer cases. It is used to reduce recurrence in metastatic, HER2- negative breast cancer with BRCA mutation.
What Are the Risks and Benefits of Adjuvant Therapy?
The benefits of adjuvant therapy are that it maximizes the treatment effect and avoids recurrence rate in cancer patients after first-line treatments like surgery. It destroys the cancer cells, which are missed by the first-line cancer treatments. It improves the quality of life of cancer patients and increases the survival rate of cancer. Adjuvant therapy shows promising results in breast, colon, and non-small cell lung cancers, etc.
Even though adjuvant therapy is highly effective in cancer treatment, there are always side effects seen in association with it. Some of the common side effects seen in different therapies include:
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Fatigue.
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Pain.
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Flu-like symptoms.
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Skin changes, etc.
Is Adjuvant Therapy Recommended in All Cancer Patients?
Adjuvant therapy is not recommended in all cancer patients. This is due to the following reasons:
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Some cancers show no promising evidence supporting the use of adjuvant therapy.
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It is not recommended in cases where there will be a low risk of cancer recurrence.
On What Basis Does Your Healthcare Provider May Recommend You Adjuvant Therapy?
Your healthcare provider may decide whether adjuvant therapy is appropriate for you on the following basis:
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Type of Cancer: Adjuvant therapies are not used in certain types of cancer as there is no proven evidence in certain cancers where it is beneficial. It is also not recommended in cases where cancers show a low risk of recurrence.
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Stage of Cancer: Adjuvant therapy is not used in the initial stage of cancer. This is because cancer has not progressed, and there are low chances of recurrence. In such cases, the therapy may be ineffective.
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Lymph Node Involvement: The more lymph node involvement, the higher the chance of cancer recurrence. If multiple lymph node involvements are seen in cancer, then adjuvant therapy may show beneficiary effects in reducing cancer recurrence.
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Hormone Receptivity: Hormonal therapy is ineffective in cases where the cancer is not hormonally sensitive. So it is not recommended in tumors (cancer) with no hormonal sensitivity.
Conclusion:
Adjuvant therapy is given after first-line cancer treatment like surgery to further maximize the treatment effectiveness and mainly to avoid cancer recurrence. Adjuvant therapy does not guarantee that cancer will not recur. However, it can aid in reducing the risk of cancer recurrence. Do discuss with your doctor to know whether adjuvant therapy is appropriate for you or not.
