Targeted therapy as common as chemotherapy at end of life

Targeted therapies are used as often as chemotherapy at the end of advanced cancer patients' lives, according to study results using US data.

Given their frequent use, the findings raise the question whether targeted therapy, such as monoclonal antibodies, should be considered a negative quality-of-care indicator in addition to chemotherapy, suggest the researchers.

The results emerge from data for 816 individuals who died from advanced cancer (most commonly gastrointestinal and lung malignancies) in Houston, Texas, between September 2009 and February 2010. A total of 14% of these patients received a targeted therapy in the last 30 days of life, compared with 18% who received chemotherapy.

"Given the increasing number of targeted therapeutic options and the growing number of clinical trials, we expect a sustained rise in the use of targeted agents at the end of life," say David Hui (University of Texas MD Anderson Cancer Center) and colleagues in the Journal of Pain and Symptom Management.

The team also reports a higher rate of targeted therapy use during the last month of life among younger patients, as evidenced by a significant 2% decrease in their use per year of older age. This is consistent with previous research that shows this population is generally managed more aggressively than their older counterparts, note Hui et al.

They also observed a significant association between hematologic malignancies and targeted therapy use in the last 30 days of life, such that the 113 patients with this type of cancer were 6.1 times more likely than those with breast cancer (the reference group) to receive it.

The researchers highlight several reasons for caution in using targeted therapies, such as erlotinib, bevacizumab, rituximab, and sorafenib, in patients at the end of life, namely because these agents are associated with many unique adverse effects including rashes, endocrine abnormalities, and in more extreme cases, vascular catastrophes.

"Furthermore, the pursuit of life-prolonging therapy could potentially delay transition of care, diverting patients' precious time and energy to the pursuit of cancer treatments rather than planning ahead," conclude Hui and co-workers.

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