Most people with incurable cancer eventually face decisions about whether to continue with chemotherapy. In a recent JAMA Oncology publication, Dr. Holly Prigerson, director of the Center for Research on End of Life Care at Weill Cornell Medical College, evaluated the association between chemotherapy use and quality of life in people with progressive, metastatic solid tumors. Contrary to guidelines, which suggest that palliative chemotherapy should be considered in solid tumor patients with good performance status, Dr. Prigerson’s group found no association between chemotherapy use and survival. Moreover, chemotherapy use was associated with reduced quality of life in people that started out with a good performance status.
Although Dr. Prigerson’s study focused primarily on solid tumors like lung cancer, colon cancer, and breast cancer, some important parallels exist in the lymphoma world. While most aggressive lymphomas are initially treated with curative intent, multiple studies have demonstrated that people with aggressive lymphomas that have not responded to two prior lines of chemotherapy may not benefit from further chemotherapy. To some degree, this is intuitive. If chemotherapy has already failed twice, why would it be successful on the third attempt? Similar to Dr. Prigerson’s findings, chemotherapy in the setting of chemo-refractory lymphoma may serve only to negatively impact quality of life.
Fortunately, our understanding of lymphoma biology has expanded rapidly in the recent past, and non-chemotherapy treatments are already in the clinic with others on the way. Investigators around the world, including at Weill Cornell Medical College, are leading the development of exciting, rational approaches that might circumvent chemotherapy resistance and offer new hope, often with lesser side effects than chemotherapy. Please talk with your doctor about clinical trials, or call us at 212-746-2919 to discuss new approaches available at WCMC.