Chemotherapy: What’s Old Is New Again

Today’s chemotherapy remains relevant in a targeted therapy world.

Chemotherapy is a foundational treatment that still plays a vital role in treating cancer. While the advent of targeted treatments and immunotherapy has excited the masses, chemotherapy is aiming to keep pace. More than one hundred chemotherapy treatments are in use today, many of them used in combination with other drugs or treatments.

In the last decade, researchers have been devising ways to increase the uptake and concentration of chemotherapy in the tumor as well as new ways of combining treatments in hopes of improving their effectiveness and limiting some side effects.

“Chemotherapy has dramatically improved in the last decade,” George R. Simon, MD, FACP, FCCP, director of thoracic oncology at the Fox Chase Cancer Center in Philadelphia, told WebMD. “There has been a dramatic change in our ability to minimize side effects over the last few decades. Modern chemotherapy drugs are more effective and generally less toxic.”

Since 1990, the cancer death rates have been declining yearly in the United States, meaning survival rates for cancer patients are better than they were three or four decades ago. Approximately half of this improvement is due to treatment progress, with a large portion of that due to chemotherapy being included in many regimens.

Decades ago, the discovery of chemotherapy changed the approach to cancer treatment. Whether it was a derivative of tree bark or a man-made chemical compound, chemotherapy was found primarily to prevent cells from multiplying by interfering with the DNA-copying process used by all replicating cells. Most chemotherapies developed before 1990 were not targeted toward the cancer itself and could therefore damage healthy cells in addition to cancer cells. Hair follicles, for example, are rapidly replicating cells, which is why patients undergoing chemotherapy often lose their hair.

Chemotherapy was initially used as a supplement to other methods of treatment, such as surgery to remove the tumor and radiation to kill it. But whereas surgery and radiation are localized treatments that affect small areas of the body, chemotherapy affects the entire body.

Over the last thirty years, many scientific advances have occurred that significantly enhanced our understanding of how cancer develops and how cancer cells differ from healthy cells, which has led to the identification of specific treatment targets. Newer therapies typically aim for targets that are specific to cancer cells and do not occur, or are rare, in healthy cells.

Recent advances in chemotherapy have made it more suitable for certain cancers. As chemotherapy continues to evolve, some of the newer iterations have succeeded where older chemotherapies have not.

Scientists are still working continuously to develop better treatment options—including more advanced forms of chemotherapy—to control cancer, with the ultimate goal of a cure. According to the American Cancer Society, recent research includes new classes of chemotherapy, novel combinations of chemotherapy medications, and new routes of administering treatment. Some of the more exciting approaches involve nanotechnology and liposomal therapy.

No matter the form, chemotherapy remains a crucial part of the treatment plan for thousands of patients with various early- and late-stage cancers. In the age of targeted therapies based on gene mutations, receptors on cancer cells or the body’s immune response, the role of chemotherapy is still pertinent. Chemotherapy can shrink tumors to make some patients eligible for other treatment options, such as surgery or radiation. For others, chemotherapy can be used when the effects of targeted treatments begin to wane. Whether used alone or in combination with next-generation treatments, chemotherapy will remain a mainstay of cancer therapy for the foreseeable future.