Why combination chemotherapy

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Sometimes radiation therapy or drug therapy is given before surgery to shrink a tumor, thereby improving the opportunity for complete surgical removal this technique is called neoadjuvant therapy. The stage and type of the cancer often determines whether single therapy or combination therapy is needed.

For example, early-stage breast cancer may be treated with surgery alone or surgery combined with radiation therapy, drug therapy, or with all three treatments, depending on the size of the tumor and the risk of recurrence. Locally advanced breast cancer is usually treated with chemotherapy Chemotherapy Chemotherapy involves the use of drugs to destroy cancer cells.

Sometimes combination drug therapy is used not to cure but to reduce symptoms and prolong life. Combination drug therapy can be useful for people with advanced cancers that are not suitable for radiation therapy or surgical treatment for example, people with non—small cell lung cancer, esophageal cancer, or bladder cancer that cannot be completely removed by surgery.

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It is not known however whether giving more intensive chemotherapy regimens results in better health outcomes, when both survival and toxicity are considered, and whether better response rates and rates of progression free survival actually translate to better overall survival.

To compare single agent with combination chemotherapy for the treatment of metastatic breast cancer. Handsearching of recent conference proceedings was also undertaken. Randomised trials of single agent chemotherapy compared to combination therapy in metastatic breast cancer. Two authors independently assessed trials for eligibility and quality, and extracted data. Hazard ratios were derived for reported time-to-event outcomes.

Response rates were analysed as dichotomous variables. Toxicity and quality of life data were extracted where present. Forty three eligible trials 48 comparisons were identified. For overall survival there was a statistically significant difference in favour of the combination regimens with no heterogeneity HR 0.

Results were very similar when trials of first-line treatment were analysed, and for analyses where the single agent was also included in the combination regimen. Combination regimens showed a statistically significant advantage for survival over single agent taxane HR 0. Combination regimens were also associated with significantly better time to progression HR 0. Women receiving combination regimens experienced a statistically significant detrimental effect on white cell count, increased alopecia and nausea and vomiting.