What is adjuvant therapy and neoadjuvant therapy? Know the difference, clinical uses, and side-effects

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Do you ever meet any cancer patient and raise questions about what is adjuvant therapy? Adjuvant therapy is now commonly known as chemotherapy but it has some more goals aims and functions. Another term that is associated with adjuvant therapy is neoadjuvant therapy with a slightly different function. In this article, you will get knowledge about what is adjuvant therapy? neoadjuvant therapy, clinical applications, and side effects.

What is adjuvant therapy?

Adjuvant therapy also is known as adjunctive therapy, add-on therapy, adjunct therapy, and adjuvant care. Adjunctive therapy can be defined as an additional therapy or initial therapy to enhance the effectiveness and therapeutic benefits of primary therapy. It can also be defined as “An additional treatment for the patients going through complicated surgeries or complex treatments regimens for example used in cancer therapy

The clinical agents used in adjuvant therapy are called adjuvant agents. The main purpose of the adjuvant agent is to modify the therapeutic and clinical effects of other agencies and that show adjuvant therapy modifies the other primary therapy 

What is neoadjuvant theraphy?

In contrast to adjuvant therapy, the therapy which is given before the main treatment is known as neoadjuvant therapy. It is mainly used in the treatment of cancer or tumors.  For example, the therapy given before the removal of the breast is termed neoadjuvant therapy. The main reason for adjuvant therapy is to reduce the sign of tumors for maximum effective surgery. The administration of neoadjuvant therapy before surgery can improve life quality and survival time in patients.

Difference between neoadjuvant and adjuvant therapy

Readers after going through the definitions of neoadjuvant and adjuvant therapy mostly ask that what is the difference between neoadjuvant and adjuvant therapy? Here you are on your way to the simple and clear answer about it:

  • Neoadjuvant therapy involves the treatment before primary cancer treatment whereas adjuvant therapy involves a regimen after primary treatment.
  • The main goal of neoadjuvant therapy is to shrink or reduce the size of the tumor before treatment. Whereas the main goal of adjuvant treatment is to extend survival time and minimize the risk and adverse effects.
  • The examples of neoadjuvant therapy adjuvant therapy are almost the same as radiation therapy, hormone therapy, etc depending upon when and why these procedures are being performed. 

Adjuvant chemotherapy

Adjuvant chemotherapy is an advanced step to fight against cancer. 

Adjuvant therapy is administered to patients after primary treatments, where there is a high risk of recurrence cancer. Another goal of adjuvant therapy is to eliminate the microscopic, undetectable cancer cells that may change its position or travel to other parts of the body. Adjuvant chemotherapy is useful for:

  • Breast cancer
  • Colon cancer
  • Ovarian cancer
  • Testicular cancer
  • Lung cancer
  • Pancreatic cancer
  • Lymphoma

Adjuvant chemotherapy is commonly used for breast cancer when there is the susceptibility of beginning within three to five weeks after the removal of cancer or tumor surgically. The duration of adjuvant chemotherapy varies according to the type of cancer, but mostly it is three to nine months. The success rate of adjuvant chemotherapy is difficult to measure in most cases because it is administered in the absence of detectable amounts of cancerous cells.

Clinical applications of Adjuvant therapy 

1. In malignant melanoma

Oncologists have previously debated the role of adjuvant therapy in malignant melanoma. There is no denying that adjuvant therapy is used to treat malignant melanoma but not enough scientific evidence has been collected to explain it scientifically. Still, a lot of research and study is explaining the correlation with more scientific evidence. The agents used in malignant melanoma are

  • Cisplatin
  • Dacarbazine
  • Temozolomide

2. In Colorectal cancer

Adjuvant therapy is reported for its effectiveness in preventing micrometastatic growth from colorectal cancer that has been previously removed surgically. Studies have reported fluorouracil as the most effective adjuvant agent among patients with either microsatellite instability or low microsatellite instability, i.e., a genetic condition due to impaired DNA mismatch repair (MMR). However, fluorouracil is not effective in patients with a high frequency of microsatellite instability.

3 In breast cancer

The use of adjuvant chemotherapy in patients with breast cancer is known for about 30 years to increase relapse-free survival. It is stated by the national consensus conference in 2001 at the US national institute of health panel that “ Adjuvant polychemotherapy improves survival; therefore, it should be recommended to women with localized breast cancer with or without the existence of lymph node or hormone receptor status. Agents used in this are 

  • Cyclophosphamide
  • Methotrexate
  • Fluorouracil
  • Doxorubicin
  • Docetaxel
  • Paclitaxel
  • Epirubicin

Combination chemotherapy regimens include the following 

  • Doxorubicin and cyclophosphamide
  • Docetaxel and cyclophosphamide
  • Cyclophoshamide, methotrexate and flourouracil
  • Cyclophoshamide, epirubicin, and fluorouracil

4. In ovarian cancer

It is roughly estimated that 15% of ovarian cancer is detected at an early stage with a five-year survival rate which is 92%.  It is reported that adjuvant therapy with cisplatin in females with ovarian cancer has worsened the condition more than females which left untreated. So the use of the adjuvant agents in ovarian cancer is still confused. But another fact that must be highlighted that in the majority of the cases ovarian cancer is diagnosed at an advanced stage with a minimum survival rate.

Another controversy related to the adjuvant chemotherapy seems to impart a negative rate on the fertility of women so it is another question raise for the preservation of fertility 

Side-effects of adjuvant therapy

Side effects are the undesirable effects that are associated with any medicinal agent or therapy. Unfortunately, no treatment or theraphy is totally free from side effects. there is always a risk of some sort of negative effects of therapeutic agents. Adjuvant therapy has more risk of side effects due to the high toxicity profile of chemotherapeutic agents. So chemotherapy-induced side-effects are 

  • Nausea
  • Vomiting
  • Alopecia
  • Mucositis
  • Neutropenia
  • Bladder damage
  • Constipation
  • Diarrhea
  • Hemorrhage

While side-effects of radiation theraphy to the brain may cause

  • Headache
  • Memory loss
  • Alopecia
  • Brain necrosis

Before you leave

Cancer treatment includes multiple treatment therapies include neoadjuvant and adjuvant therapy, to improve the survival rate of patients or to minimize the risk of recurrence of cancer. Of course, it is too lengthy, challenging, and demands patience and cooperation from patients and his family. Risk factors and side-effects associated with adjuvant chemotherapy are severe. However, this therapy is used to save the patient’s life and enhance his survival time as much as possible.