Does chemotherapy fulfill its expectations in cancer treatment?

In 1949, Cornelius P. Rhoads, director of the Memorial Sloan-Kettering Cancer Center, made his famous report on the practical value of nitrogen mustard before the Committee on Growth of the National Research Council, a quasi-governmental agency which had accepted the responsibility for the clinical trial of this drug at the end of the war. Doctor Rhoads assigned to David A. Karnofsky the job of receiving reports from individual physicians and analyzing the results in each type of cancer. The conclusions, based on 2500 case reports, indicated that nitrogen mustard did not cure any form of cancer, but it was temporarily useful in chronic leukemias, Hodgkin's disease, malignant lymphomas, and lung cancer. The most valuable outcome of this report was the beginning of massive and direct attack on cancer in humans. Since that time, in fact, there was enthusiasm and interest in studying cancer; physicians have been educated, interested and motivated to treat the disease; investigators became engaged in the search of new growth-inhibiting compounds and research clinicians in the formulation of new treatment strategies. The result was a progressively growing list of tumors responding to drug treatment with increased complete remission, prolonged disease free and even total survival rates particularly in the early stages of given malignancies; patient care, the most important achievement in cancer medicine, has been drastically improved. Clinical chemotherapy of cancer has a long history of controversies. Though never advocated as panacea, this form of treatment has continuously fluctuated between excessive optimism and detraction. Recently, harsh criticism has pointed to the magnitude of the overall results achieved in terms of decreased national mortality statistics for the various malignancies. An impatient group of clinicians, biostatisticians and epidemiologists began to question whether medical oncology has reached a plateau in its control of cancer or whether the entire treatment strategy for the control of cancer is wrong. Since sweeping generalization cannot be supported for the results of treatment in each tumor subset require separate analysis, let us review the biological principles of cancer treatment, the main strategies utilized, and the results achieved in the major groups of malignancies. The paper will also outline the contributions of chemotherapy to the medical sciences and to the care of the patients with cancer during the last 40 years.