I Advise Prioritizing Proven, Well-Established Anti-Cancer Treatments

Cancer-related research advances day by day, new anti-cancer drugs emerge endlessly, and treatment options are diverse. When a doctor lays a host of options before the patient and family, how should they choose? This is a question I often face. On this question everyone who studies tumors may have their own answer, and these answers relate to personal experience and temperament. Ultimately, which option the patient and family choose also depends on their own knowledge and temperament.

Personally, I advocate prioritizing mature and well-established anti-cancer regimens. What does this mean? It means that if a cancer already has regimens proven to have high response rates, reliable efficacy, and tolerability for most patients, we should prioritize such regimens rather than trying the newest treatment ideas and drugs, because the latter carry great uncertainty.

Some doctors or medical institutions may encourage patients to join clinical trials of new drugs. Should patients enroll? For patients not yet proven refractory to standard treatments, I do not recommend enrolling. But for patients who have already tried standard regimens without effect, enrollment in such trials may be considered.

In short, I do not advocate that patients rashly skip mature, reliable regimens and directly try new ones. The efficacy and side effects of new regimens hold many unknowns; trying them may yield better results, but if they are ineffective and toxic, they will greatly worsen survival time and quality. Moreover, some new regimens have such severe side effects that once they fail, the patient has little chance of receiving other treatments.

Over the past decade-plus, of the patients I have seen who tried the newest regimens, few survived; the great majority had shorter survival than those who chose mature, reliable regimens. Of course, another possibility cannot be excluded: many of those enrolled in new-drug trials already had highly aggressive, treatment-insensitive tumors. But there were also those who, lacking sufficient medical knowledge, rashly abandoned mature regimens for the latest ones. Many clinical trials end in failure, and those regimens never become standard. Yet when first introduced, their theory and prospects were tantalizing.

I often tell consulting patients and families that fighting cancer is like gambling with your life; we should choose the option with the best odds. That gamble is most likely to yield the longest survival and best quality of life. When I myself now recommend treatments to patients, I follow this principle. This relates to my cautious, conservative temperament as well as to what I have seen.

For some irreversible, traumatic treatments, when alternatives exist, I advocate considering the alternative first. For example, before choosing castration therapy, one can first try endocrine therapy for a period and observe. After women have ovaries removed or men testes removed, there are many sequelae; and after removal, will sex hormones really cease? Not necessarily—some patients continue to secrete large amounts of sex hormones from the adrenal glands after castration, causing castration therapy to fail. Thus unless absolutely necessary, do not lightly try such irreversible options.

Every step of cancer treatment is full of risk and uncertainty; before making any choice, do some research and judge how best to proceed. Rashness and radicalism often cost lives.

Finally, I must stress: anti-cancer regimens are by no means the newer the better. Some new anti-cancer theories are unproven by practice, and their major flaws may not yet have been discovered; placing excessive hope in them is unwise. Choosing a mature, reliable regimen is not falling behind the times; it is a cautious and rational decision.