November 29, 2023

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Chemotherapy Targeting Immunity: Greater Side Effects is good?



Chemotherapy Targeting Immunity: Greater Side Effects is good? Chemotherapy, targeting, immunity, the greater the adverse reaction, the better the effect?

Chemotherapy, targeting, immunity, the less side effects, the better? However, it is also said that the greater the adverse reaction, the better the effect. Right and wrong?

A doctor shared his experience:

A patient who was undergoing chemotherapy. He was very positive and optimistic at the beginning of the treatment, and then he became unhappy. After asking, I realized that the other party had a “knot”:


“The old grandson in the bed next door has nausea, vomiting, hair loss and decreased white blood cells after chemotherapy. But the doctor  didn’t have any reaction. It must be a bad effect.”

“Walking in the hospital, I ran into a fellow with targeted therapy. The skin of my hands and feet reacted, and the doctor said his targeted therapy was working… I was like a okay person after chemotherapy, so I was really worried about myself.”

“My colleague, Lao Wang, is more worried than me. He used immunotherapy. The doctor said that it took 3 months to work. The cost is relatively high. There is no side effect at present. He is worried that it will not work and take up the treatment time.”

The adverse reaction of cancer treatment is really “a few happy, a few sad”! Chemotherapy, targeting, immunity, the greater the adverse reaction, the better the effect?

Really cannot be generalized. The three have different onset principles, and the relationship between curative effect and adverse reactions has its own merits, and it needs to be clarified in the same way.


The greater the chemotherapy response, the better the effect?

Chemotherapy was called a “biochemical weapon” a long time ago. It lacks the ability to distinguish cancer cells from normal cells, so it is often eliminated indiscriminately, “killing one thousand enemies and destroying eight hundred.” Under normal circumstances, the increase in the dose of chemotherapy drugs will increase the adverse reactions. From this point of view, it seems that the greater the adverse reaction, the better the chemotherapy effect has a certain truth. Therefore, some patients take it for granted that the side effects of chemotherapy are positively related to the treatment effect.

This view is wrong.

There is actually no correlation between chemotherapy response and chemotherapy efficacy. The size of chemotherapy response is related to the patient’s physique, tolerance ability and the drugs used.

01 Physique, endurance

The worse the physique, the lower the tolerance to drug toxicity, the greater the chemotherapy response. During the first chemotherapy, the physique is relatively good, and there may not be any response. When the number of chemotherapy increases, and sufficient nutrition is not supplemented during the chemotherapy interval, the organ function may be restored in the future. At this time, the chemotherapy response may increase.

02 Drug related

Chemotherapy response is related to the drugs used. Some drugs, such as cisplatin, have greater gastrointestinal reactions and nausea and vomiting occur earlier. Some patients may occur within 2 hours of taking the drug. Some drugs, such as oxaliplatin, have mild gastrointestinal reactions and very little hair loss, mainly neurotoxic. In addition, when the drug dosage is very small, there may be no chemotherapy response. For example, during radiotherapy, small doses of chemotherapy drugs will be used to increase sensitization, which is usually called small chemotherapy. Small chemotherapy generally does not cause obvious chemotherapy response.

Some chemotherapy reactions are delayed, and there is no obvious manifestation during hospitalization, and severe bone marrow suppression, vomiting and even diarrhea may occur even 1-2 weeks after discharge.


How to evaluate whether chemotherapy is effective?

Whether chemotherapy is effective or not depends on the sensitivity of tumor cells to drugs. Generally, for 2-3 cycles of chemotherapy, doctors will recommend patients to review tumor indicators and imaging examinations, and conduct a before and after comparison to evaluate the efficacy. There is no basis for judging the effect of chemotherapy by chemotherapy response. If it all depends on the size of the reaction, the treatment effect is good for whichever is bigger, and there is no need to do so many checks to see which kind of drug is used for the big reaction.

Is the efficacy of targeted drugs actually related to side effects? Not absolutely!

There is indeed a medical phenomenon: the better the efficacy of some targeted drugs, the greater the side effects.

If the hand-foot skin reaction occurs within 28 days of oral administration of regorafenib, the survival period can be prolonged by nearly 5 months than the patient who did not occur;

If a hand-foot skin reaction occurs at any time during the entire course of oral regorafenib, the survival period can be extended by nearly 8 months compared with patients who did not appear (the extended time here is a statistical result).

Although there is no shortage of such phenomena, it cannot prove that all targeted drugs are related to side effects. The possible adverse reactions of taking targeted drugs are individual differences, and cannot be used as a conclusive basis for judging whether targeted drugs are effective.

In clinical practice, some patients who take targeted drugs have no side effects after taking the medicine, but the therapeutic effects of the drugs are surprisingly good; and some patients have severe skin rashes or diarrhea many times a day, almost dehydrated after taking targeted drugs. However, the drug has no effect or the effect is very general; however, most patients have side effects and the drug treatment effect is also very good.

There is no absolute relationship between side effects and the effectiveness of targeted drugs. The efficacy of targeted drugs is related to whether there are gene mutation targets, the abundance of gene mutations, and even the dose of treatment.


How to judge that the target treatment has worked?

There are two best ways to judge whether a targeted drug is effective:

1. Judgment by image: After re-examination, it can be judged by image inspection to see whether the mass has shrunk or grown.

2. Judging by symptoms: If the patient’s symptoms are obvious, it can be intuitively judged based on whether the patient’s symptoms have improved, such as pain reduction, dyspnea disappearance, and tissue symptom disappearance.

Therefore, patients with tumors whose side effects are not obvious after taking targeted drugs should not worry about the poor efficacy. The size of the side effects is not the criterion for judging the efficacy. Moreover, if the medicine has an effect but the side effects are not obvious, wouldn’t the quality of life be better for cancer patients?

The greater the side effects of immunotherapy, the better the effect? It depends!

The most important feature of immunotherapy is that once effective, the curative effect can be maintained for a long time, and the patient may have a longer survival period; secondly, the toxicity of immunotherapy is relatively small, and there will be no obvious side effects such as hair loss, nausea and vomiting. . Third, the efficiency of single-agent immunotherapy is relatively low. For most cancers, only about 20% of patients can benefit. Combination therapy is the future trend. For example, combined chemotherapy, targeted, immunotherapy, etc., can be greatly improved Efficient. Of course, immunotherapy also has disadvantages. For example, the price is relatively expensive, most of them are not covered by medical insurance and need to pay for themselves. Generally speaking, patients’ acceptance of immunotherapy is relatively high.

Compared with traditional radiotherapy and chemotherapy and targeted therapy, a major advantage of immunotherapy is its small side effects. It has been reported that the greater the side effects of immunotherapy, the better the patient’s efficacy may be. This actually needs to be judged by circumstances.

There are indeed some immune adverse reactions, which may be related to the curative effect, such as skin reactions such as allergic purpura or vitiligo. It is believed that these side effects may be related to the curative effect. Some people even think that immune-related hepatitis is also related to the curative effect. Correlation.

In fact, the adverse reactions of immunity may be related to the curative effect to a certain extent, but it needs to be analyzed in detail. For example, because immune-related adverse reactions can cause damage to the body, if immune heart disease and immune-related pneumonia occur, the toxic side effects caused by its single drug are more threatening than tumors. Under the circumstances, there is no difference in survival time. Therefore, if there is an adverse reaction in the immune system, it is necessary to judge whether it will have a positive relationship with its curative effect according to the category. This is a balance point. The greater the toxicity, the less relevant it is to the curative effect. The less the toxicity, it may be The correlation with curative effect will be closer.


♦ How to judge whether tumor immunotherapy is effective?

The effects of tumor treatment can be simply divided into several types: one is tumor reduction, in which complete remission (CR) is not easy to achieve in advanced tumors, and partial remission (PR) means tumor reduction by more than 30%, which is also a comparison A good result. Another result is stable (SD), which refers to the range of tumor enlargement or reduction within a range that we allow. This result is actually considered effective. Of course, the third worst thing is that the tumor continues to increase after medication, and the increase exceeds a certain range (PD), so that we can truly evaluate that this treatment is ineffective.

In the process of immunotherapy, the efficacy evaluation is different from other treatments. The tumor may first become larger and then smaller, that is, false progress will occur. In fact, it is also effective for patients who are big first and then small, but if the tumor continues to grow, it is a reflection of ineffectiveness.

For pseudo-progression, the treatment must be continued for two cycles before evaluation. If the tumor continues to progress after two cycles of continued medication, this must not be a false progression. Therefore, it is necessary to correctly distinguish-whether it is true progress or false progress in order to confirm the effectiveness of immunotherapy.


Sum up

To judge whether a tumor is effective through adverse reactions/side effects, it is necessary to distinguish specific situations, and self-judgment is often not “reliable”.


(source:internet, reference only)

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