How reducing cancer treatment doses can reduce side effects … but be just as effective

Sarah Hymas was in the shower when she felt the bulge under her right armpit and knew immediately that something was wrong.

Ultrasound quickly confirmed that it was a large 3 cm tumor, which further tests showed was a triple-negative breast cancer, which is a more difficult form of the disease because it does not have receptors for hormones such as estrogen (for which there are targeted therapies).

“It was a shock. I have always been very health-conscious, ”says Sarah, 58, a psychotherapist who is divorced from two adult children and lives in the Southwest. “Although I was diagnosed with triple-negative breast cancer, it was never found in my breast, only in the lymph nodes in my armpit – but the doctors were convinced it came from my breast.”

At the end of 2020, doctors gave her immunotherapeutic drugs for six weeks and chemotherapy for six months to kill the cancer.

Women with this form of breast cancer – which accounts for 15 per cent of the 55,000 new cases each year in the UK – then usually undergo surgery, in Sarah’s axillary lymph node dissection.

Finding smarter - better, shorter and less toxic or harmful - cancer treatments with better results, such as TAD, is now the holy grail of cancer research.

Finding smarter – better, shorter and less toxic or harmful – cancer treatments with better results, such as TAD, is now the holy grail of cancer research.

This involves removing most or all of the lymph nodes under the arm – these filter waste and toxins from the lymph fluid as it moves through the body – as a way to prevent the spread of cancer.

The procedure is often successful, but it can also cause unpleasant side effects such as lymphedema, where parts of the body such as the arms swell due to damage to the lymphatic system, causing tension and difficulty moving.

However, Sarah could benefit from a “kinder” version of the procedure called Targeted Axillary Dissection (TAD), which she underwent in June last year.

This involves surgical removal of only the abnormal lymph nodes, not all (the number a woman has varies, but can be up to 40) with conventional treatment – but with the same success.

Sarah was’ pleased ‘that only five lymph nodes had been removed instead of her 20.’ The procedure involved only an overnight stay, and I later found that the cancer had completely disappeared, which was amazing.

“Diagnosis and treatment really relieved me; I lost a lot of weight and sometimes I felt so sick. So I was really happy to avoid other side effects. Seven months after the operation, my hand still hurts a little, but I have full movement. “

Finding smarter – better, shorter and less toxic or harmful – cancer treatments with better results, such as TAD, is now the holy grail of cancer research.

The first real breakthrough in this “de-escalation” or “optimization” approach was a British study published in The Lancet in 2005, which found that a single dose of chemotherapy was just as effective – and less toxic – for treating early testicular cancer. after surgery as a three-week radiotherapy, treatment offered for almost 50 years.

That has changed the care of thousands of men, and similar benefits are now being sought for a variety of cancers, instead of “throwing the kitchen sink at the disease and trying to cure it,” says David Cameron, a professor of medical oncology at the University of Edinburgh.

Professor Cameron explains: “What we are doing is changing the focus of our research to see if we can achieve the same results with less treatment and to improve the experience of cancer patients so that they suffer fewer side effects, can maintain fertility or not.” breast cancer as a result of their treatment will not cause damage to the heart muscle. “

As well as reducing side effects, there are de-escalation studies to find more effective treatments for patients with less intervention.

Last year, researchers at the Cancer Research Institute and the University of Manchester found that people with bladder cancer that had spread to the surrounding muscle would receive a shorter, higher-dose radiotherapy regimen, reducing the risk of relapse.

A study published in The Lancet Oncology in February 2021 found that patients who had 20 high doses of radiotherapy in four weeks instead of the standard 32 doses in six and a half weeks had a 29 percent lower risk of cancer recurrence in five years.

Bladder cancer cells are thought to grow rapidly, after about four weeks – so killing them in less time with a higher dose of radiotherapy will give them less time to grow back.

The study authors called for this approach to be adopted by the NHS. Professor Robert Huddart, a urological oncology consultant at The Royal Marsden NHS Foundation Trust and one of the authors, said the findings were particularly important during the Covid era, when it was “necessary to keep patients out of hospitals.”

“Kinder” cancer treatment

From lower doses to fewer surgeries, here are some of the ways cancer treatment becomes more patient-friendly.

Dose reduction of chemotherapy

According to research presented at the American Society of Clinical Oncology, lower doses of chemotherapy are just as effective in controlling advanced stomach or esophageal cancer in elderly or frail patients, leading to fewer side effects such as diarrhea and lethargy. in 2019.

There are three chemotherapeutics for these patients. However, when participants were given only two full-strength drugs, medium or low doses, researchers funded by Cancer Research UK found that medium and lower doses of just two drugs were as effective as the full dose of the three drugs. for cancer control. Taking into account the quality of life, the lowest dose came out best.

Professor Matt Seymour, co-investigator at Leeds Teaching Hospitals NHS Trust, said: ‘Physicians can confidently give people a lower dose of chemotherapy, saving them from side effects without having to worry about jeopardizing their chances of survival.’

Milder drug therapy

A groundbreaking study in 2018 identified “kinder” treatments for women with incurable triple negative breast cancer that have spread and who also have a defective BRCA gene.

Treatment options for these women are limited, and a study in the United Kingdom found that the chemotherapeutic drug carboplatin was “kinder” than current docetaxel treatment and was more successful in delaying disease progression – prolonging disease progression by 54 percent (6.8 months compared 4.4 months), according to results published in the journal Nature Medicine.

And almost twice as many women saw a reduction in tumors compared with those treated with docetaxel.

Shorter treatment

Treatment of women with ductal carcinoma in situ (DCIS) – abnormal cells in the breast milk ducts – with three weeks of radiotherapy is as good as treatment for five weeks, according to an international study published last year in Cancer Research. .

Meanwhile, halving the amount of time breast cancer patients take by taking Herceptin significantly reduces side effects – and it is just as effective, according to a large study from 2019.

Herceptin targets a protein called human epidermal growth factor receptor 2 (HER2) on the surface of cancer cells, stopping them from growing and dividing. However, it can affect the heart’s pumping ability (because there are also HER2 receptors in the heart muscle), which causes shortness of breath and palpitations – leading about one in ten women to stop using the drug.

In a study of more than 4,000 women with early-stage HER2-positive breast cancer, the six-month treatment was as effective as the standard 12-month treatment, The Lancet said, with significantly fewer heart problems, aches and pains and fatigue.

Fewer operations

Radical hysterectomy – removal of the uterus, cervix, nearby lymphatic tissue and upper vagina – is often recommended in early cervical cancer, which can cause long-term urinary incontinence problems and sex pain.

A large international study (including the Sheffield Teaching Hospitals NHS Foundation Trust) is examining whether patients could just as well cope with removing less tissue around the uterus. The results are expected in 2023.

TAD has now been used on its own three years after a number of studies have shown that it is as effective as major surgery in some women – and a review of 13 studies published in Cancers last year concluded that these procedures can be “safely replaced more radical surgery in women who responded well in advance [initial] drug treatment ’.

Yet many women do not benefit from these new approaches, says Professor Kefah Mokbel, a breast surgeon at Princess Grace Hospital in London, one of the team that conducted the latest review and who treated Sarah privately.

“Updating national guidelines often lags behind research results by about five years.”

The secret of the body of the A-sheet

Lady Gaga's transparent purple dress at the recent premiere of her film House of Gucci showed her perfectly toned thighs.

Lady Gaga’s transparent purple dress at the recent premiere of her film House of Gucci showed her perfectly toned thighs.

This Week: Lady Gaga’s Thighs

Lady Gaga’s transparent purple robe showed off her perfectly toned thighs for the recent premiere of her film House of Gucci.

The 35-year-old singer and actress follows a detailed exercise program overseen by her coach. It includes high-intensity interval training (HIIT) on an exercise bike and 35-minute strength training five times a week.

But Lady Gaga accepts diversity: since 2004, she has been practicing hot yoga (where the room temperature is high, so you sweat), uses a pilates reformer, and swims regularly.

What to try: Start with your feet parallel and your feet a few inches apart. Put your hands on your hips and bend your knees. Lift your left leg to the side. When lifting, press the buttock muscles and outer thigh muscles. Repeat on the other side. This is one repetition. Continue for 60 seconds. Repeat four times. Do it five times a week.

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