[Protocols for the chemotherapy of solid tumors: should we increase or reduce?]

Contrary to the treatment of leukemia and lymphoma which is clearly defined, for most solid tumors the place, the type and the intensity of treatments remain under discussion. Experimental results are available to prove the benefit of various drug combinations in which doses, routes of treatment, schedule and number of cycles are carefully evaluated. However considering the difficulties in testing all the combinations which are possible and the lack of trust in the predictive value of experimental studies, it is generally according to clinical results that escalation or reduction of chemotherapy are decided, At the present time and for many solid tumors, escalation is predominating due to the low effectiveness of the current drugs we have at our disposal. It is only in the case of curable solid tumors (for example: carcinoma of the testis, choriocarcinoma) that a reduction phase is possible and this behaviour is justified in avoiding the iatrogenic effects of chemotherapy. Many examples of escalation and reduction are given in clinical cancer chemotherapy.