Expectations from cytotoxic chemotherapy

Cancer chemotherapy has expanded rapidly during the last 30 years and in some tumours there is clear evidence that even in advanced disease, chemotherapy combined with appropriate local treatment, may be curative. These encouraging results have led to great expectations from cytotoxic chemotherapy, particularly since evidence has accumulated that many common tumours frequently show tumour regression when patients are treated with aggressive combination chemotherapy regimens. In the last ten years, apart from testicular cancer in which the addition of Platinum to previously available drug regimens, has led to dramatic improvement in survival rates, there is little solid evidence to suggest that chemotherapy in other advanced adult tumours has had a major impact on survival. In this article, steps in the development of cytotoxic chemotherapy are reviewed, and realistic expectations for the 1980's are outlined. New approaches to the identification of new drugs have been introduced in the last few years and these may lead to the identification of new drugs with a greater range of antitumour effects and increased antitumour activity. The possibility of in vitro sensitivity testing is critically discussed, and its is suggested that this approach may in part replace traditional Phase II studies. Adjuvant chemotherapy, which has clearly improved survival in certain childhood cancers, is now being evaluated in many solid tumours in adults, and only time will tell whether a higher proportion of patients will survive, compared to the results of local treatment only.