Adjuvant Therapy

What is Adjuvant Therapy

Adjuvant and Neoadjuvant therapy refers to any treatment for cancer before the main treatment to make the main treatment more likely to be successful.

As surgery is the main treatment for many cancers, neoadjuvant cancer therapy is any treatment administered before surgery. It is usually in the form of

systemic (drug) therapy, or
local therapy (radiation).

Cancer Stages

Early-stage cancer treatment involves a combination of local and systemic therapies, which can be delivered in various possible sequences.

Cancer treatment often involves surgical resection to remove the affected tissue and reduce the recurrence risk. However, cancer can still recur.

Cancer management has evolved from primarily surgical therapy to a multidisciplinary approach, including

surgery,
radiation therapy and
systemic therapy.

This shift is based on an increased understanding of invasive malignancy as a “systemic” disease and on the improved outcomes with the addition of adjuvant systemic therapy to local, and regional therapy.

System Therapy for Cancer Treatment

Systemic therapy refers to cancer treatment that targets the entire body and when given for non-metastatic invasive cancer, is primarily intended to reduce the risk of distant recurrence.

Systemic cancer therapy began as a postoperative or after surgical resection was undertaken. Systemic therapy is typically chemotherapy.

Adjuvant systemic therapy can reduce recurrence and improve survival by killing cells that may have escaped the primary tumour bed via lymphatics and blood vessels.

Research has shown that systemic therapy before surgery (neoadjuvant) might improve outcomes because it destroys undetectable microscopic circulating cells.

Local Neoadjuvant Cancer Treatment

Treat cancer cells in the affected area only and include the following:

Surgery and
Radiotherapy.

Cancer Surgery

Surgery involves removing any visible cancer in the affected areas.

Radiotherapy

Radiotherapy kills cancer cells in the area it is aimed at, and is similar to the x-rays used when you have a chest X-ray.

Systemic Neoadjuvant Cancer Treatment

Using drugs that can reach all parts of the body

Systemic therapies are drugs that spread throughout the body to treat any microscopic cancer cells, wherever they may be, and include

chemotherapy,
hormonal therapy,
targeted drugs, and
Immunotherapy.

Targeted Adjuvant Therapy

Targeted therapy, such as trastuzumab (Herceptin), targets the HER2 receptors on tumour cells, stopping the cells from dividing and growing.

They are usually given intravenously (through an IV drip) once every three weeks for a year, including any trastuzumab you might receive before surgery. Other HER2-targeted drugs, such as pertuzumab (Perjeta) may also be used.

What is Adjuvant Chemotherapy?

The primary, definitive treatment in many cancers is surgery to remove cancer.

Additional systemic treatment, such as chemotherapy or hormone therapy, is used before or after the primary therapy.

Extra treatment, in addition to surgery, given after primary therapy is referred to as adjuvant therapy (postop). In contrast, extra treatment before primary therapy is referred to as neoadjuvant therapy (preop).

Systemic therapy for non-metastatic invasive cancer, whether administered pre or post-op, is intended primarily to reduce the risk of distant recurrence.