Hormonal therapy (for selected cancers, eg, prostate, breast, endometrium)
Immune therapy including monoclonal antibodies, interferons, biologic response modifiers, tumor vaccines, and cell therapies (for many different types of cancer)
Differentiating drugs such as retinoids (for acute promyelocytic leukemia) and isocitrate dehydrogenase-2 (IDH2) inhibitors (for acute myeloid leukemia)
Targeted drugs that exploit the growing knowledge of genomics and cellular and molecular biology (eg, imatinib for chronic myeloid leukemia)

Often, modalities are combined to create a treatment program that is appropriate for the patient, based on patient and tumor characteristics as well as patient preferences. These modalities can be combined with the primary treatment at the same time or used before or after. The primary purpose of adjuvant therapy, which is given after, and neoadjuvant therapy, which is given beforehand, is to prevent cancer recurrence and increase survival.

Overall treatment should be coordinated among a radiation oncologist, surgeon, and medical oncologist, where appropriate. Choice of modalities constantly evolves, and numerous controlled research trials continue. When available and appropriate, clinical trial participation should be considered and discussed with patients.

Treatment decisions should weigh the likelihood of adverse effects against the likelihood of benefit; these decisions require frank communication and possibly the involvement of a multidisciplinary cancer team. Patient preferences for how to live out the end of life (see Advance Directives) should be established early in the course of cancer treatment despite the difficulties of discussing death at such a sensitive time.

Various terms are used to describe the response to treatment (see table Defining Response to Cancer Treatment). Disease-free or progression-free survival often serves as an indicator of cure and varies with cancer type. For example, lung, colon, bladder, large cell lymphomas, and testicular cancers are usually cured after 5 years of disease-free survival. However, breast and prostate cancers may recur long after 5 years, an event indicating tumor dormancy (now a major area of research); a 10-year disease-free interval is more indicative of cure in these cancers.

Defining Response to Cancer Treatment

Term	Definition
Cure	Long-term absence of symptoms or signs of a disease, although patients who appear to be cured may still have cancer cells that could eventually cause relapse
Complete remission (complete response)	No evidence of cancer
Partial response	Substantial (usually > 50%) reduction in size of a cancer
Stable disease	Neither improvement nor worsening
Disease-free survival	Interval between achieving a complete remission and relapse or death, whichever occurs first
Progression-free interval	Time from end of treatment to progression
Survival time	Time from diagnosis or the end of an intervention to death

Survival rates with the different modalities, alone and in combination, are listed for selected cancers (see table 5-Year Survival in Various Types of Cancer).

5-Year Survival in Various Types of Cancer

Type	5-year Survival (%)
Acute lymphocytic leukemia (children and adults)	68
Acute myeloid leukemia	26
Bladder	67
Bones and joints	67
Brain and other nervous system	33
Breast (female)	89
Cervix	68
Chronic lymphocytic leukemia	18
Chronic myeloid leukemia	90
Colon and rectum	69
Esophagus	18
Eye and orbit	82
Gallbladder	77
Hodgkin lymphoma	86
Kidney and renal pelvis	73
Larynx	61
Liver and intrahepatic bile duct	17
Lung and bronchus	17
Melanoma	92
Myeloma	47
Non-Hodgkin lymphoma	70
Oral cavity and pharynx	63
Ovary	46
Pancreas	7
Prostate	99
Soft tissue	65
Small intestine	66
Stomach	29
Testis	95
Thyroid	98
Uterus	82
Data from American Cancer Society: Cancer Treatment & Survivorship Facts & Figures 2016-2017. Atlanta, American Cancer Society; 2016.

Click here for Patient Education

NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Multiple Myeloma

Was This Page Helpful?

Surgery for Cancer

Overview of Intracranial Tumors

Systemic Cancer Therapy

Radiation Therapy for Cancer

Follow

Add to Any Platform

Merck and the Merck Manuals

Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Merck Manual was first published in 1899 as a service to the community. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. Learn more about our commitment to Global Medical Knowledge.