What is salvage therapy in cancer treatment?

Hearing the term “salvage therapy” applied to your cancer treatment might be a little alarming. It could make you think your prognosis is poor or that you’re running out of options.

Fortunately, neither of those scenarios is the case — and they couldn’t be further from the truth.

Keep reading to find out what salvage therapy actually means, which cancers it can be used to treat and which patients may benefit.

‘Salvage’ just means the first treatment didn’t work

While the word “salvage” can have a negative connotation, in the context of cancer treatment, it just means that the first thing your doctors tried — also known as “front-line” therapy — didn’t work.

Either the cancer didn’t respond to the treatment at all or it responded initially, but then stopped, and the disease advanced.

In either of those situations, the next step is called salvage therapy. Despite its name, though, salvage therapy is not considered a last resort. It is often a standard next step designed to help regain control of a disease and improve patient outcomes.

Salvage therapy can treat many different cancer types

Salvage therapy is often used to treat acute myeloid leukemia and prostate cancer. But this approach is not disease-specific, so it’s not just limited to those cancer types.

There’s also no particular treatment that is used exclusively for salvage therapy. It may involve chemotherapy, targeted therapy, immunotherapy, radiation therapy or whatever else your doctor deems appropriate.

Generally speaking, though, we do try to switch up the types of therapy we give you if you’ve relapsed. If the first approach failed, we obviously wouldn’t want to do essentially the same thing again.

Instead, we might try a combination of therapies, especially if it’s your first relapse. Because the more resistant — or refractory — a disease becomes to treatment, the more difficult it is to get you into remission. So, we want to be as aggressive and effective as we can early on, when the chances of success tend to be higher — to get you into remission and keep you there.

Salvage therapy can still sometimes offer a cure

One of the biggest misconceptions about salvage therapy is that it can extend your life only for a short while.

Fortunately, that’s not true either.

The goal of salvage therapy in a relapse setting can still be a cure — especially with acute leukemias. For many patients with acute myeloid leukemia and acute lymphocytic leukemia, for instance, we’re still aiming for a cure with salvage therapy — especially if it’s only your first or second relapse.

Every patient is different, of course. And some will have better prognoses than others. But we have three new classes of targeted therapy drugs to treat acute myeloid leukemia now. They are achieving high remission rates when used in combination with high- or low-intensity chemotherapy and followed by a stem cell transplant.

These drugs are:

• FLT3 inhibitors
• IDH inhibitors
• Menin inhibitors

The best candidates for salvage therapy

Technically, any patient could be eligible for salvage therapy if the disease:

• has progressed despite first-line treatment
• did not respond to first-line treatment
• responded only briefly to first-line treatment

So, many patients may qualify for it.

To identify the patients who are really best-suited for it, though, we consider other factors, such as disease-specific mutations, chromosomal changes or immune profiling, as well as age, organ function, overall health and any underlying conditions.

If you have kidney, heart or lung problems, for instance, a drug’s tolerability may become a factor. And, if you’re 90 years old and very frail, you might weigh the risks against the benefits and decide that’s not something you really want to go through.

Still, 80-90% of our leukemia patients here at UT MD Anderson opt to proceed with salvage therapy.

Determining if salvage therapy is right for you

Unless you have a unique molecular target to go after, the options available to give you lasting remission may become somewhat limited after your second relapse. So, you might want to start exploring the role of supportive care in cancer treatment at that point. The same applies if you live 10 hours away from UT MD Anderson, and there’s only a 10% to 20% chance of remission, even with salvage therapy.

But whether salvage therapy is right for you depends on many other factors, too, including the underlying disease biology, the tumor microenvironment, the types of prior therapy you might have had and your goals for treatment. If you’re determined to try every treatment option — even if the potential for response may be lower — we will take that into account and make our recommendations accordingly. We consider a lot of things.

Salvage therapy success rates

There’s no general figure I can cite for how successful salvage therapy is. Even among patients with one particular disease, the success rate could be anywhere between 10% and 90%.

Certain subsets of patients with acute myeloid leukemia have very low rates of response: as low as 10% to 20%. Others have very favorable rates, with up to 70% to 80% achieving full remission. So, it’s a pretty broad spectrum that’s heavily influenced by the specifics of the disease.

But salvage therapy is a very personalized field now, compared to where it was 25 years ago. So, it’s important not to generalize or try to guess if it might work for you, based on statistics you might read or hear that could well be outdated already. Your situation might also be totally different from those of the patients being discussed, so those figures may not necessarily apply to you.

That’s why it’s so important to talk to your care team about your specific situation. We take a lot of time to explain things, so you’ll know exactly what to expect and be able to determine if salvage therapy is right for you.

Naval Daver, M.D., is a leukemia specialist with a particular interest in molecular therapies.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.