Immediate versus delayed chemotherapy in patients with asymptomatic incurable metastatic cancer
Article first published online: 11 OCT 2007
Asia-Pacific Journal of Clinical Oncology
Volume 3, Issue 4, pages 187–198, December 2007
How to Cite
CARDEN, C. P. and ROSENTHAL, M. A. (2007), Immediate versus delayed chemotherapy in patients with asymptomatic incurable metastatic cancer. Asia-Pacific Journal of Clinical Oncology, 3: 187–198. doi: 10.1111/j.1743-7563.2007.00113.x
- Issue published online: 3 DEC 2007
- Article first published online: 11 OCT 2007
- Accepted for publication 2 September 2007.
Aim: To examine the evidence of benefit in initiating immediate chemotherapy in patients with newly diagnosed asymptomatic metastatic incurable cancer, compared with delaying chemotherapy until symptomatic progression.
Methods: Through an extensive review of published reports, we examined the biological, clinical, psychological and ethical background of the issue and reported on the available clinical trial evidence in a variety of tumor types.
Results: Only a limited number of clinical trials have directly examined the role of immediate versus delayed chemotherapy in patients with incurable asymptomatic metastatic cancer. Small studies in mesothelioma, colorectal cancer, breast cancer, myeloma, and low-grade lymphoma suggest no survival benefit for the immediate initiation of chemotherapy. However, there was no evidence in other tumor types.
Conclusion: The appropriate timing of chemotherapy initiation in an asymptomatic patient with metastatic cancer remains a substantial question in oncology. Many factors are likely to impact on the decision. However, little if any evidence demonstrates a clear advantage in the immediate initiation of chemotherapy in this setting.