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Old 01-18-2006, 05:52 PM   #1
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Post Transcript from LBBC Publications

Chemo for Advanced Disease in Remission?

Speaker: Kathy D. Miller, M.D.

From the LBBC teleconference, "Living with Advanced Breast Cancer: Improving Your Quality of Life with Symptom and Side-Effect Management," on October 28, 2005.

QUESTION: I have gone to two excellent oncologists to tell me what my plan should be. One is recommending a low-dose regimen of chemotherapy to keep me where I am. The other is saying to me we don't give chemotherapy, because it's toxic, if you don't need it. I have been in complete remission for six months. How does a patient decide what to do when there are very well respected oncologists who are suggesting two different things?

DR. MILLER: Sometimes what they do is come see a third oncologist who gets to be the tiebreaker. I can tell you that even though they gave you two different recommendations, they both gave you very reasonable recommendations. So let me tell you what we know about your situation, because I think this will really come down to what these different things mean to you.

There actually has been a study looking at ladies who are in exactly your situation who had initial chemotherapy and achieved a complete remission of their metastatic disease.

The study asked a simple question, which is, are you better off if you got a maintenance plan of chemotherapy? And that maintenance plan was with slightly different chemotherapy at slightly lower doses and less intense than the chemotherapy women had gotten initially. Or are you better of taking a holiday and stopping all of the chemotherapy and only restarting something at whatever point the disease starts to progress?

The results of the study will let you make either conclusion depending on what's most important to you. If what's the most important endpoint is how long you're alive, they were absolutely the same. There was no difference with the maintenance low-dose chemotherapy or being completely off chemotherapy.

But if you looked at how long from that time you achieved a complete response until the disease started progressing, it was longer in the women who were on the maintenance chemotherapy. But that was at the expense of still having ongoing side effects, less than the higher dose chemotherapy, but still some side effects during that time.

That's what we know about maintenance chemotherapy. I think that's why people have given you two different recommendations, because they've probably focused on different parts of the results from that same study.

I've had this discussion with my own patients, and they've had all different opinions about this, partly depending on their own perception and their own life views, partly depending on what their experience with chemotherapy and the side effects of chemotherapy has been.
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