termsTerm

De-escalation, escalation and response-adapted therapy

aka de-escalation, de-escalate, de-escalated, de-escalating, de-intensification, de-intensify, treatment de-escalation, treatment intensification, intensification, response-adapted, response-guided, risk-adapted, risk-adapted therapy, biomarker-guided, ctDNA-guided, MRD-guided, PET-adapted, omission of chemotherapy, chemotherapy omission, chemotherapy-free, chemo-free, less is more, treatment omission

Giving less treatment to patients who are doing well and more to those who are not, using a marker such as scan response, ctDNA or MRD to decide. The aim is to cure the same number of people with less harm.

Examples: omitting chemotherapy in low-risk HR-positive breast cancer by genomic assays (TAILORx, MINDACT) or in HER2-positive disease by PET response (PHERGain); shortening adjuvant FOLFOX to 3 months (IDEA); ctDNA-guided omission or escalation of adjuvant chemotherapy in colon cancer (DYNAMIC, CIRCULATE); PET-guided omission of radiotherapy or bleomycin in lymphoma; 12 versus 6 months of trastuzumab (PERSEPHONE); radiotherapy dose reduction in HPV-positive oropharynx cancer (which has repeatedly failed); and MRD-guided stopping in CLL and myeloma. De-escalation trials need non-inferiority designs and large numbers, and are rarely funded by industry. Escalation trials add drugs to non-responders (KEYNOTE-522 residual disease, CheckMate 577).

Connected

13top

Pages like this

not linked directly; found by shared links

De-escalation, escalation and response-adapted therapy

Connected

Pages like this

fronts

terms

trials