Adjuvant Therapy

What is adjuvant therapy?

If you’ve received cancer treatment, your cancer care team may recommend follow-up treatment, or adjuvant therapy. Adjuvant therapy, sometimes called helper therapy, targets cancer cells that may remain after you’ve had surgery to remove a tumor.

Learning that you may benefit from adjuvant therapy can feel confusing. This is especially the case if your oncologist told you that surgery removed all signs of cancer. If treatment worked, why would you need more of it?

The problem is that cancer cells are microscopic and good at hiding. Even sophisticated imaging tests, like MRIs, CT scans and PET scans, can’t always detect them. The goal of adjuvant therapy is to destroy any microscopic cells you may have. This reduces the chance the cancer comes back (recurs).

When would I need this treatment?

When recommending adjuvant therapy, healthcare providers consider:

• Cancer type. Adjuvant therapies often treat breast cancer, colon cancer, lung cancer and skin cancer. But they also treat other types.
• Cancer stage. Adjuvant therapy typically follows surgery to treat early-stage cancers so they don’t come back. Sometimes, it helps people with more advanced cancers live longer.
• Cancer cell features. Adjuvant therapy treats cancers that are likely to come back after surgery. Providers can tell how aggressive some cancers are by examining the cells beneath a microscope.

What happens during adjuvant therapy?

Adjuvant therapy involves getting more treatment after your primary treatment (usually, surgery). When you hear the word “adjuvant” think after. It’s different from neoadjuvant therapy, which involves treatment you get before surgery.

Here are the types and what’s involved:

• Radiation therapy uses high-powered X-rays to kill cancer cells. You may need it after surgery to destroy any cells that may remain. You may need it if your surgeon was unable to remove an entire tumor.
• Chemotherapy sends drugs throughout your body to kill cancer cells that may be hiding. Chemo following breast cancer surgery was the first ever use of adjuvant therapy.
• Hormone therapy blocks hormones that fuel tumor growth. Your provider may recommend it after surgery for hormone-sensitive cancers.
• Immunotherapy helps your immune system destroy cancer cells. Adjuvant immunotherapies are commonly used to treat early-stage non-small cell lung cancer (NSCLC), colon cancer and breast cancer.
• Targeted therapy blocks proteins cancer cells use to grow. A newer type of treatment, the first targeted therapy drugs for adjuvant therapy, were approved in the 2000s.

What drugs are used for adjuvant therapy?

Most adjuvant therapies use drugs to destroy cancer cells. They come in pill form, as a shot or an infusion (IV). Some common ones to know about are:

• Chemotherapy drugs, like alkylating agents, antimetabolites and taxanes
• Hormone therapy drugs, like tamoxifen and aromatase inhibitors
• Immunotherapy drugs, like monoclonal antibodies and checkpoint inhibitors
• Targeted therapy drugs, like PARP inhibitors and tyrosine kinase inhibitors

But there are many more.

What are the potential benefits and risks of this treatment?

There’s never a guarantee of a cure when it comes to cancer. But adjuvant therapy can reduce the chance that cancer in remission will come back. It can also help people with incurable cancer live longer. These reasons are enough for many people to get more treatment.

But adjuvant therapy can cause unpleasant side effects. It can disrupt your routine by adding more doctor visits to your schedule. And there’s no way to know whether you need it. It’s possible that surgery got rid of all the cancer.

It’s your choice to accept or decline adjuvant therapy. Your cancer care team will honor your decision. They can help you weigh the pros and cons. Questions to ask may include:

• What type of adjuvant therapy do you recommend?
• Why am I a good candidate?
• When should I start this treatment?
• How long will I need treatment?
• Are there any permanent or long-term side effects?
• How will adjuvant therapy affect my outcome (prognosis)?

How long will it take for me to feel better?

Everyone’s experience is different. Adjuvant therapy may offer you the peace of mind that you’re doing everything you can to stay cancer-free. But sometimes, the benefits get overshadowed by the chance of a longer recovery.

Your cancer care team can guide you through the decision-making process. They can explain how adjuvant therapy will impact your recovery.