Chemotherapy

Chemotherapy

The earliest successes with chemotherapy occurred in blood and lymphatic cancers. By the late 1970s, combinations of drugs helped to cure some patients with testicular and other "solid" tumors.

Since then, adjuvant chemotherapy – providing drugs after cancer surgery to help prevent cancer recurrence – has improved the outlook for patients with common early-stage cancers, including colon, breast and lung cancer. The use of neo-adjuvant chemotherapy – giving drugs before surgery to shrink tumors – is helping patients with cancers once considered inoperable.

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1999

Chemoradiation shown conclusively to benefit patients with advanced disease

Chemoradiation shown conclusively to benefit patients with advanced disease

A major clinical trial confirms the value of giving carboplatin chemotherapy and standard radiation therapy together to patients with advanced oropharynx cancer. While the approach, called concurrent chemotherapy, causes more side effects than radiation treatment alone, patients receiving the concurrent therapy lived almost twice as long as the patients receiving radiation alone.

Simultaneous chemotherapy and radiation proven most effective for stage III non-small cell lung cancer

Simultaneous chemotherapy and radiation proven most effective for stage III non-small cell lung cancer

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Researchers find that giving chemotherapy and radiation during the same treatment period, an approach known as concurrent chemoradiation, results in better survival for patients with stage III non-small cell lung cancer (disease with limited spread in the lungs and surrounding tissue) than the standard practice of waiting to give radiation therapy until after chemotherapy was completed. This finding echoes similar findings reported for small cell lung cancer in earlier years.

Intensive chemotherapy, with radiation and stem cell transplantation, improves neuroblastoma survival

Intensive chemotherapy, with radiation and stem cell transplantation, improves neuroblastoma survival

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An NCI study shows that treatment with intensive chemotherapy, together with radiation therapy and autologous stem cell transplantation, lowers the risk of recurrence and improves survival in children with high-risk neuroblastoma (a cancer of the nerve tissue). Adding stem cell transplantation to neuroblastoma therapy makes it possible for patients to recover from the intense chemotherapy needed to effectively fight the disease. In this approach, doctors harvest healthy stem cells from the patient's own bone marrow before chemotherapy and then re-implant them intravenously after treatment. The infusion of stem cells helps rebuild the patient's blood-production and immune system, which are both impaired by chemotherapy.

New oral chemotherapy drug, temozolomide, increases glioma survival

New oral chemotherapy drug, temozolomide, increases glioma survival

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The FDA grants accelerated approval to the oral chemotherapy drug temozolomide (Temodar) to treat anaplastic astrocytoma (a form of high-grade glioma) that recurs following other therapy. The approval is based on early-stage data suggesting that the drug shrinks tumors and is generally well tolerated. In 2005, temozolomide receives full approval for this and other high-grade gliomas, based on data showing that adding the drug to initial radiation therapy increases two-year survival by as much as 50 percent.

FDA approves liposomal doxorubicin for advanced ovarian cancer

FDA approves liposomal doxorubicin for advanced ovarian cancer

Liposomal doxorubicin (Doxil) receives accelerated FDA approval to treat advanced ovarian cancer that has progressed after prior treatment. The drug is unique because the active chemotherapy agent is encased in a microscopic fat bubble that releases the drug at the tumor site, delivering more of the chemotherapy directly to the tumor and less to other parts of the body, thereby limiting side effects. Full approval is granted in 2005 based on follow-up studies showing that the drug shrinks ovarian tumors and extends survival compared to standard topotecan (Hycamptin) chemotherapy. By the end of the 1990s, patients with advanced ovarian cancer have a growing number of chemotherapy options to select from.

1998

Chemotherapy before surgery helps more women benefit from breast-conserving treatment

Chemotherapy before surgery helps more women benefit from breast-conserving treatment

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A major trial reports that an approach called neoadjuvant chemotherapy – providing chemotherapy before surgery – allows more than two-thirds of women with large breast tumors to undergo breast-conserving surgery, called lumpectomy, instead of full mastectomy. The goal of neoadjuvant therapy is to shrink tumors so they can be removed surgically. Breast-conserving surgery, also called lumpectomy, is easier to recover from and results in far better cosmetic outcomes – without compromising survival – compared with mastectomy. Neoadjuvant therapy is later shown to benefit patients with rectal and other cancers.

NCI recommends chemotherapy-radiation combination for invasive cervical cancer

NCI recommends chemotherapy-radiation combination for invasive cervical cancer

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The National Cancer Institute issues an alert recommending that physicians consider adding chemotherapy to radiation therapy for women being treated for invasive cervical cancer (cancer that has spread within the cervix or pelvis). This updated approach is based on several randomized trials showing that women lived longer when treated with both radiation and chemotherapy, compared to those treated with the prior standard of radiation or surgery alone.

New chemotherapy regimen reduces side effects for children with Hodgkin lymphoma

New chemotherapy regimen reduces side effects for children with Hodgkin lymphoma

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A National Cancer Institute-funded study shows that a chemotherapy combination regimen known as ABVD (with the drugs doxorubicin, bleomycin, vinblastine and dacarbazine) can safely replace the previous standard treatment for patients with advanced Hodgkin lymphoma. This new combination dramatically lessens the side effects of cancer therapy for children with the disease, without affecting overall treatment outcomes.

Oral chemotherapy drug, capecitabine, approved for advanced breast cancer

Oral chemotherapy drug, capecitabine, approved for advanced breast cancer

Capecitabine (Xeloda) becomes an important treatment option for women whose breast cancer has progressed despite other commonly used forms of chemotherapy. The drug is approved by the FDA based on studies demonstrating the drug slows cancer progression. Unlike other traditional chemotherapies that are administered intravenously, capecitabine is administered orally – a convenient alternative that requires fewer doctor's visits for patients with advanced cancer.

1997

New chemo-radiation therapy offers alternative to surgery for advanced disease

New chemo-radiation therapy offers alternative to surgery for advanced disease

The introduction of combination therapy - using both radiation and cisplatin chemotherapy together – offers an important new treatment alternative for patients with advanced bladder cancer who are older or otherwise unable to undergo bladder surgery. The strategy provides tumor shrinkage, limits nearby cancer growth, and enables many patients to retain normal bladder function – a key quality of life benefit.

In 2012, a Phase III study confirms the benefits of this approach, using the chemotherapy drugs fluorouracil and mitomycin. Researchers demonstrate this regimen improves survival, with no significant increase in side effects.

Surgery found to cure some patients with advanced colorectal cancer

Surgery found to cure some patients with advanced colorectal cancer

In general, metastatic cancer is difficult or impossible to treat with surgery because tumor cells have spread throughout the body. But in a 1997 study, researchers find that some colon cancer patients with tumors that have spread to the liver alone can be cured with surgery. In a study of nearly 300 such patients who underwent surgery between 1960 and 1987, about one in four were still alive five years later, and nearly of all of these patients were found to have been essentially cured. A later study finds that use of positron emission tomography, or PET scanning, can identify some liver metastases that would have gone unnoticed before, helping surgeons in the study to achieve a cure rate above 50 percent for patients with metastatic disease.

New chemotherapy regimen becomes standard for advanced stomach cancer

New chemotherapy regimen becomes standard for advanced stomach cancer

A major trial shows that a new combination chemotherapy regimen involving the drugs epirubicin, cisplatin and fluorouracil (together called ECF) helps extend survival and reduces serious side effects for patients with advanced stomach cancer, compared with an earlier three-drug regimen. The study establishes ECF as a new standard for advanced stomach cancer, helping patients live longer with a better quality of life.

Adding hormone therapy to radiation improves prostate cancer survival

1996

Topotecan approved as second round of treatment for small cell lung cancer
Irinotecan is approved for advanced colon cancer

Irinotecan is approved for advanced colon cancer

The FDA approves irinotecan (Camptosar), given with the drugs 5-fluorouracil and leucovorin, for patients with advanced colon cancer that has returned despite prior treatment. Irinotecan is the first new chemotherapy drug approved for advanced colon cancer in roughly 40 years. Although prognosis generally remains poor for patients with this stage of cancer (also called metastatic disease), the new drug is shown to improve survival and help preserve quality of life.

New chemotherapy drug for advanced ovarian cancer
New treatment for prostate cancer that resists hormone therapy
Gemcitabine modestly extends survival, relieves symptoms with advanced pancreatic cancer

Gemcitabine modestly extends survival, relieves symptoms with advanced pancreatic cancer

Gemcitabine (Gemzar) is approved for pancreatic cancer that has spread to nearby organs or to distant parts of the body, based on a clinical trial demonstrating that it modestly extends survival compared to 5-fluorouracil, the previous standard of care. Gemcitabine is also shown to provide greater relief from disease-related symptoms, including pain. Gemcitabine is widely used today to treat the disease, either alone or in combination with other drugs.

1995

Analysis affirms benefits of chemotherapy for advanced non-small cell lung cancer

Analysis affirms benefits of chemotherapy for advanced non-small cell lung cancer

An analysis of data from more than 50 clinical trials sheds important new light on the benefits of chemotherapy for advanced non-small cell lung cancer, concluding that cisplatin chemotherapy, in addition to surgery, radiation therapy or supportive care, substantially extends survival. Prior to this analysis, there was significant concern that the risks and side effects of chemotherapy outweighed the limited benefits for patients with advanced disease. The authors of the analysis also suggest that giving chemotherapy following the surgical removal of lung tumors – adjuvant chemotherapy, considered a novel approach for lung cancer at the time – extends survival by as much as 5 percent. This finding prompts the launch of several large clinical trials to test this ultimately successful new treatment strategy.

Approval of tretinoin leads to 95 percent cure rate for rare leukemia

Approval of tretinoin leads to 95 percent cure rate for rare leukemia

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Tretinoin (Vesanoid), a drug related to vitamin A, is found to cause remission in patients with acute promyelocytic leukemia (APL), a rare form of leukemia. It may be given alone or in combination with other drugs in patients whose disease has recurred after previous therapy. The discovery of the drug is fueled by the realization that this form of leukemia develops when cells do not mature properly; tretinoin is the first drug to correct this abnormal process. Prior to the availability of this drug, APL was a rapidly progressing and often fatal illness. Today, patients are treated with a newer drug, called arsenic trioxide, as well as tretinoin, and APL is considered one of the most curable forms of leukemia.

1994

New generation of chemotherapy drugs for non-small cell lung cancer

New generation of chemotherapy drugs for non-small cell lung cancer

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Within just a few years, several new chemotherapy drugs for non-small cell lung cancer are shown to be effective, particularly when combined with cisplatin. These new drugs include paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine) and gemcitabine (Gemzar). Randomized studies show that regimens containing these drugs provide comparable levels of efficacy for patients with advanced disease.

1993

Taxanes emerge as a vital chemotherapy option for ovarian, breast cancer

Taxanes emerge as a vital chemotherapy option for ovarian, breast cancer

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A new family of treatments debuts with the FDA approval of paclitaxel (Taxol) for advanced ovarian cancer. The drug receives one of the fastest-ever approvals, on the heels of data showing it shrinks ovarian tumors by more than half in many women who had stopped responding to all other therapies. Later studies show it extends survival by over a year when used as an initial therapy for advanced ovarian cancer, along with the chemotherapy drug cisplatin.

Over the next decade, paclitaxel also proves effective for all stages of breast cancer – extending lives and delaying disease progression compared to existing therapies, and delaying recurrence when used as adjuvant therapy (after surgery). The drug is derived from the bark of a yew tree, and is the product of a field of research exploring 'natural' cures for a range of diseases. Until drugmakers discovered a synthetic method for producing the drug, there was widespread concern that the natural resources needed to produce the drug would not meet demand.

Simultaneous radiation and chemotherapy boosts survival for small cell lung cancer

Simultaneous radiation and chemotherapy boosts survival for small cell lung cancer

Researchers demonstrate that starting radiation therapy together with chemotherapy dramatically improves the effectiveness of treatment for patients with early-stage small cell lung cancer, compared to starting radiation later in the course of treatment. This new approach is found to significantly delay cancer progression and improve survival.

Adding chemotherapy to radiation after surgery increases survival for malignant gliomas

Adding chemotherapy to radiation after surgery increases survival for malignant gliomas

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A large analysis of the results of several studies shows that adding chemotherapy to radiation therapy helps patients with surgically treated malignant gliomas live longer compared to radiation therapy alone. Randomized trials had previously found that this approach yielded only marginal benefits, yet when the data from these individual studies were assessed in combination, the survival advantage became more pronounced. Despite this result, the still-modest benefits of the combination approach, and the potential for serious side effects, have led to continued debate about its use.

1991

Combining chemotherapy and radiation prolongs survival for non-small cell lung cancer

Combining chemotherapy and radiation prolongs survival for non-small cell lung cancer

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Two studies show that treatment programs involving both radiation and chemotherapy are more effective than either approach alone for patients with "stage III" non-small cell lung cancer (including patients with larger tumors that may or may not have limited spread within the lungs and in nearby lymph nodes). This two-pronged treatment approach soon becomes the standard of care for this disease.

Better organ preservation with initial chemotherapy and radiation

Better organ preservation with initial chemotherapy and radiation

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A Phase III randomized trial shows that induction therapy, involving initial treatment with chemotherapy followed by radiation, is as effective as standard treatment but allows many patients with advanced laryngeal cancer to avoid surgical removal of their larynx and vocal cords. Until this time, such surgery, followed by radiation, was the only proven treatment for these patients.

This regimen – called induction therapy – remains the standard for more than a decade, until researchers discover that giving radiation and chemotherapy at the same time is more effective.

1990

Combination chemoradiation first emerges

Combination chemoradiation first emerges

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Researchers report successful results of a new approach for head and neck cancer therapy – so-called "chemoradiation." This approach involves giving cisplatin chemotherapy and radiation together (concurrently), rather than one after the other (sequentially). The two-pronged approach helps prevent the spread of advanced squamous cell cancers of the head and neck to other parts of the body and causes greater tumor shrinkage, compared to radiation therapy alone.

Several years later, another trial finds that a similar approach – combining radiation with both cisplatin and fluorouracil chemotherapy – helps reduce the size of tumors enough so that patients can eventually undergo surgery to remove them. This approach is proven to significantly extend survival and reduce the risk of recurrence.

Treatment after surgery increases colorectal cancer survival

Treatment after surgery increases colorectal cancer survival

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Doctors begin administering chemotherapy following surgery (adjuvant treatment) to patients with colon and rectal cancer whose disease has spread within the wall of the colon and to nearby lymph nodes (stage III), after clinical trials show that the approach improves survival and significantly reduces the risk of cancer recurrence. Adjuvant therapy becomes a mainstay of colon cancer treatment after a U.S. National Institutes of Health expert panel recommends the approach in 1990. Previously, about half of patients experienced a recurrence of their cancer after surgery, which often led to death. Adjuvant therapy was found to reduce the risk of recurrence and improve survival by about 40 percent.

1989

FDA approves carboplatin for ovarian cancer

FDA approves carboplatin for ovarian cancer

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The chemotherapy drug carboplatin (Paraplatin, Paraplat) becomes available as a second line of therapy for ovarian cancer, after research shows that it promotes tumor shrinkage. It becomes available as an initial therapy two years later, after being shown to increase survival. This approval offers an effective treatment alternative for patients who cannot tolerate the standard chemotherapy drug, cisplatin, which carries significant side effects. It later becomes the preferred initial chemotherapy, after studies show it is as effective as cisplatin but causes fewer side effects.

1987

Some testicular cancer patients can forego chemotherapy

Some testicular cancer patients can forego chemotherapy

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Studies show that many men with early-stage testicular cancer can forego chemotherapy after surgery, and instead receive "active surveillance" (regular check-ups to monitor for cancer recurrence). When cancer does recur, available drugs are generally able to cure the disease. This approach spares many men from the side effects of possibly unnecessary chemotherapy, and is now the standard approach for about 75 to 80 percent of patients.

Improved combination chemotherapy regimens boost pediatric leukemia cure rates

Improved combination chemotherapy regimens boost pediatric leukemia cure rates

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Cure rates for pediatric acute lymphoblastic leukemia (ALL) climb above 80 percent with the introduction of combination chemotherapy regimens.

In the same time period, cancer remissions (which may or may not be permanent) also climb as high as 99 percent, with the help of ongoing advances in supportive care. Supportive care dramatically eases the side effects of treatment and enables greater numbers of patients to complete their full chemotherapy regimen on schedule.

Researchers hone standard chemotherapy to increase effectiveness, minimize side effects

Researchers hone standard chemotherapy to increase effectiveness, minimize side effects

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A new standard of care is established when a trial shows that using the drug etoposide (Toposar, VePesid), instead of vinblastine (Velban, Velsar), together with cisplatin and bleomycin (Blenoxane) leaves more patients cancer-free and causes far fewer nerve and muscular side effects. Over time, researchers also learn that many men respond well to three cycles of chemotherapy, rather than four, and that patients who do relapse can generally be cured with one additional round of chemotherapy.

Chemotherapy before surgery helps children with bone cancer avoid amputation

1986

Tamoxifen reduces breast cancer recurrence

1985

First successful combination chemotherapy for advanced bladder cancer

First successful combination chemotherapy for advanced bladder cancer

Researchers identify the first multi-drug chemotherapy regimen to extend survival for patients with advanced bladder cancer, offering cures in some cases. The regimen – called MVAC – involves a combination of the drugs methotrexate, vinblastine, doxorubicin, and cisplatin. Researchers later confirm that MVAC is superior to single-drug chemotherapy with cisplatin, although the combination regimen causes more side effects.

Chemotherapy plus radiation effective as adjuvant therapy
Effective, less toxic two-drug therapy is introduced

Effective, less toxic two-drug therapy is introduced

Researchers first show that initial ("induction") chemotherapy with a combination of the drugs cisplatin and 5-fluorouracil results in high rates of tumor shrinkage in patients with advanced head and neck cancers. In 2007, larger trials show induction therapy also extends survival, firmly establishing this strategy as a standard treatment.

1982

Early hormone therapy drugs introduced

Early hormone therapy drugs introduced

Studies demonstrate the effectiveness of treatments known as luteinizing hormone receptor hormone antagonists (LHRHa therapy). These drugs – the first of which is approved by the FDA three years later – chemically reduce the production of testosterone and are used to slow the growth of prostate cancer, which is fueled by male sex hormones. The new approach is reversible, and thus preferable to the other options available at the time, including surgical removal of the testicles. Hormone therapy is now a standard approach for treating the disease.

Daunorubicin proven superior to doxorubicin for AML

Daunorubicin proven superior to doxorubicin for AML

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Large trial shows that using the anthracycline drug daunorubicin (Cerubidine, Rubidomycin), in combination with cytarabine (ara-C), is more effective at causing complete remissions of acute myelocytic leukemia – one of the most common leukemias in adults – than the previous standard drug, doxorubicin (Adriamycin). Over the following decade, researchers evaluate similar drugs, such as idarubicin (Idamycin), that provide similar, and possibly better, remission rates.

1981

Chemotherapy plus radiation effective for patients who cannot be treated surgically

Chemotherapy plus radiation effective for patients who cannot be treated surgically

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Adding the chemotherapy drug 5-fluorouracil to standard radiation is shown to boost one-year survival from 10 percent to 40 percent for patients with locally advanced inoperable pancreatic cancer (disease that has spread to nearby tissues but cannot be surgically removed). The findings show the benefits of combining different treatment approaches for this stage of disease.

1980

Mitomyacin chemotherapy reduces risk of bladder cancer's return

Mitomyacin chemotherapy reduces risk of bladder cancer's return

This treatment is proven to lower the risk of recurrence following surgery for certain early-stage bladder cancers. To maximize its effectiveness, mitomycin is administered directly to the bladder using a tiny catheter (intravesical chemotherapy). Over time, researchers identify new strategies to increase the dose and potency of mitomycin treatment while limiting patients’ side effects.

Combination chemotherapy improves outcomes for advanced stomach cancer

Combination chemotherapy improves outcomes for advanced stomach cancer

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Throughout the 1970's, many chemotherapy drugs are tested in combinations of two to four drugs in the hope of improving survival for patients with inoperable stomach cancer. While most combinations have no significant impact, a three-drug regimen called FAM (5-fluorouracil, mitomycin C and Adriamycin, also known as doxorubicin) provides some benefit and is widely used throughout the 1980s. In 1989, doctors find that adding methotrexate to fluorouracil and Adriamycin, a three-drug regimen called FAMTX, further improves survival for some patients.

1978

Cisplatin approved for advanced ovarian cancer

Cisplatin approved for advanced ovarian cancer

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The chemotherapy drug cisplatin becomes available as a treatment for newly-diagnosed ovarian cancer, as well as ovarian cancer that persists after initial therapy, after trials show the drug decreases the size of patients' tumors. Later research leads to the development of new and more effective combination chemotherapy regimens that utilize cisplatin, such as cyclophosphamide (Cytoxan) plus cisplatin and a regimen called CHAP, which combines the drugs doxorubicin (Adriamycin), hexamethylmelamine, cyclophosphamide and cisplatin.

FDA approves the first chemotherapy drug for bladder cancer

FDA approves the first chemotherapy drug for bladder cancer

Cisplatin emerges as a standard chemotherapy drug for patients with bladder cancer, following results of several studies showing that the drug shrinks many bladder cancer tumors and, in some cases, induces cancer remissions. Later, combination chemotherapy using cisplatin together with other chemotherapy drugs becomes the cornerstone of bladder cancer treatment.

First effective combination chemotherapy regimen for ovarian cancer

First effective combination chemotherapy regimen for ovarian cancer

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Researchers led by Robert Young develop a combination chemotherapy regimen for advanced ovarian cancer, known as HEXACAF. This regimen combines the drugs hexamethylmelamine, cyclophosphamide (Cytoxan), methotrexate and 5-fluorouracil, each of which was already known to have an effect on ovarian cancer tumors. The combined regimen is found to benefit more patients, cause greater tumor shrinkage and extend survival by more than 12 months over single-drug chemotherapy with melphalan (Alkeran), an earlier drug commonly used to treat advanced ovarian cancer. However, this new combination regimen causes significantly more side effects.

1977

Breakthrough drug, tamoxifen, receives initial FDA approval

Breakthrough drug, tamoxifen, receives initial FDA approval

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The chemotherapy drug tamoxifen (Novaldex) is approved for the treatment of advanced breast cancer, based on studies showing the drug caused significant tumor shrinkage. Tamoxifen blocks the activity of estrogen, a hormone that fuels the growth and spread of many breast tumors. Over the next two decades, the FDA approves additional uses of tamoxifen, including as a preventative for breast cancer, based on clinical trials that provide a deeper understanding of which women are most likely to benefit. Researchers also learn that the drug is only effective in women whose tumors contain receptors for the hormones estrogen and/or progesterone – a finding that spares women without these receptors from the unnecessary side effects of the drug.

Chlorambucil induces remissions for chronic lymphocytic leukemia
New treatment regimen cures majority of advanced testicular cancers

1976

CHOP regimen boosts cure rates for non-Hodgkin lymphoma

CHOP regimen boosts cure rates for non-Hodgkin lymphoma

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A combination of cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone (CHOP) is shown to cure some patients with aggressive non-Hodgkin lymphoma. The introduction of CHOP chemotherapy boosts cure rates to 40 to 50 percent for this otherwise very aggressive and fatal form of lymphoma. In more recent years, cure rates have climbed to approximately 90 percent for some types of lymphoma, with the addition of the targeted drug rituximab (Rituxan) to the regimen – a combination called R-CHOP.

First study finds chemotherapy effective for liver cancer

First study finds chemotherapy effective for liver cancer

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Researchers report that advanced liver cancers respond to single-drug treatment with doxorubicin (Adriamycin). The study stirs substantial debate when other research teams are unable to consistently reproduce these initial results. Doxorubicin becomes accepted as a standard treatment for liver cancer, but with general agreement that better therapies are urgently needed.

1975

New chemotherapy regimen boosts Hodgkin lymphoma cure rates to 70 percent

New chemotherapy regimen boosts Hodgkin lymphoma cure rates to 70 percent

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Researchers led by Gianni Bonnadonna find that a new chemotherapy combination of doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban, Velsar) and dacarbazine (known as ABVD) is more effective than the older MOPP combination regimen, and causes fewer side effects. Originally developed for use as a treatment when MOPP no longer worked, ABVD quickly becomes the standard of care when it's found to cure approximately 70 percent of patients with advanced stage Hodgkin lymphoma.

Chemotherapy combinations prove effective in small cell lung cancer

Chemotherapy combinations prove effective in small cell lung cancer

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Researchers show that a treatment regimen involving the drug doxorubicin (Adriamycin), together with cyclophosphamide (Cytoxan), vincristine (Oncovin), and radiation therapy, causes significant tumor shrinkage in some patients with early-stage small cell lung cancer. These findings lead to many additional studies testing various chemotherapy combinations for this disease.

Successful use of adjuvant therapy in osteosarcoma

Successful use of adjuvant therapy in osteosarcoma

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Researchers find that adjuvant chemotherapy – treating cancer with chemotherapy following surgery for early-stage cancers – offers major benefits for children with osteosarcoma (cancer of the bone). This approach prolonged the time that most patients in the study remained free of cancer recurrence after their surgery. In 1986, results from a long-term randomized trial establish adjuvant chemotherapy as the standard of care for all children with osteosarcoma.

Adjuvant chemotherapy increases cure rates for early-stage breast cancer

Adjuvant chemotherapy increases cure rates for early-stage breast cancer

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After overcoming concerns in the cancer community about whether the benefits outweigh the risks, Drs. Bernard Fisher and Gianni Bonadonna demonstrate that chemotherapy after surgery – known as adjuvant chemotherapy – prolongs the lives of women with early stage breast cancer. Their studies explore use of the drugs 1-phenylalanine mustard or a combination of cyclophosphamide, methotrexate and fluorouracil. Over time, adjuvant chemotherapy becomes a major component of treatment for the disease, improving survival and cure rates in the years ahead. Today, about 9 in ten women with early stage breast cancer are alive five years after their diagnosis.

This research also sets the stage for research on adjuvant therapy in other common cancers, including colon and lung cancer, making it one of the most important advances in modern cancer care.

1974

FDA approves doxorubicin, a vital part of combination chemotherapy

FDA approves doxorubicin, a vital part of combination chemotherapy

Doxorubicin (Adriamycin), an anticancer antibiotic, is widely used to treat many cancers, including Hodgkin lymphoma and some leukemias. It is also routinely used to treat cancers of the bladder, breast, stomach, lung, ovaries, thyroid and other organs. Doxorubicin and similar drugs (anthracyclines) are now considered the backbone of chemotherapy to cure diffuse large B-cell lymphoma, the most common type of aggressive lymphoma.

First promising chemotherapy for glioma

First promising chemotherapy for glioma

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Researchers report the first data on efficacy of the chemotherapy drug carmustine (BCNU). Unlike other chemotherapy drugs available at the time, carmustine is able to cross the blood-brain barrier and directly attack gliomas. Although this drug can cause significant side effects, the first trials show that it shrinks some tumors. Later trials show that carmustine and other similar drugs also provide a small but significant increase in long-term survival when used with other treatments.

Doxorubicin active against advanced breast cancer
Antibiotic bleomycin helps reduce treatment-related side effects

Antibiotic bleomycin helps reduce treatment-related side effects

Bleomycin (Blenoxane), an anticancer antibiotic, is approved by the FDA, and soon becomes part of standard treatment for testicular cancer. The new drug is found to be an ideal component of combination chemotherapy because, unlike other anticancer drugs, it does not suppress the bone marrow's ability to produce red and white blood cells. Patients who are able to maintain higher blood cell counts are far less likely to experience treatment-related complications.

1970

Two new drugs produce first complete remissions in advanced testicular cancer

Two new drugs produce first complete remissions in advanced testicular cancer

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Clinical trials show that the drugs vinblastine (Velban, Velsar) and mithramycin are effective in men with advanced stages of testicular cancer. By combining the new drugs with existing treatments, physicians find that they can achieve complete remissions in 10 to 20 percent of cases – an impressive result for any cancer at an advanced stage.

High-dose methotrexate therapy results in significant tumor shrinkage

High-dose methotrexate therapy results in significant tumor shrinkage

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Researchers discover that giving high doses of methotrexate – a chemotherapy drug already used to treat leukemia – followed by "leucovorin rescue" can shrink the majority of head and neck tumors by as much as 50 to 75 percent. Such shrinkage makes it possible for more patients to have their tumors surgically removed, offering some a chance of cure.

Around this time, researchers explore the benefits of giving increasingly large doses of methotrexate for a range of cancers, finding that it is safe and effective as long as patients receive carefully timed supportive treatment with leucovorin, which helps protect the bone marrow and other healthy cells from the otherwise damaging effects of methotrexate.

1967

Treating central nervous system helps achieve first cures for the common childhood leukemia

Treating central nervous system helps achieve first cures for the common childhood leukemia

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Researchers at St. Jude Children's Research Hospital first show that adding central nervous system radiation and intrathecal therapy (chemotherapy that is injected into the fluid-filled space between the layers of tissue that cover the brain and spinal cord) to standard chemotherapy, provides prolonged remissions and the first long-term cures for acute lymphocytic leukemia (ALL). ALL is the most common form of childhood leukemia.

1966

First standard chemotherapy regimens for prostate cancer

1965

Chemotherapy found to cure Hodgkin lymphoma

Chemotherapy found to cure Hodgkin lymphoma

Researchers led by Vincent DeVita discover that a new chemotherapy regimen called MOPP (mechlorethamine, vincristine, procarbazine and prednisone) cures up to 50 percent of patients with advanced Hodgkin lymphoma. This regimen quickly becomes the standard treatment. In the 1970s, a different chemotherapy combination (doxorubicin, bleomycin, vinblastine and dacarbazine – known as ABVD) proves even more effective, curing about 70 percent of patients with advanced Hodgkin lymphoma. The ABVD combination remains a mainstay of treatment today.

1964

Cytarabine provides major boost to combination chemotherapy for acute myelocytic leukemia

Cytarabine provides major boost to combination chemotherapy for acute myelocytic leukemia

Various studies show that the drug cytarabine (ara-C) has activity against leukemias and is highly effective for treating a type of the disease known as acute myelocytic leukemia. Over time, the drug becomes a critical component of chemotherapy for adults and children with this form of leukemia, and researchers learn that precise timing and dosing of the drug is critical to successful treatment. The drug is still widely used today, often in combination with other chemotherapy drugs.

1961

Innovative technique enables intensive chemotherapy without increased systemic side effects

Innovative technique enables intensive chemotherapy without increased systemic side effects

A new approach known as isolated limb perfusion is introduced to help doctors deliver higher-than-usual doses of chemotherapy to an arm or leg where melanoma tumors have spread, without increasing the risk that the drugs will harm other parts of the body. During this procedure, the doctor temporarily stops the flow of blood to and from the affected limb, essentially isolating it with a tourniquet from the rest of the body, and then intravenously administers and circulates chemotherapy through the affected limb with the help of a special machine. The approach is further refined in the 1990s with the introduction of isolated limb infusion, which cuts procedure time, requires fewer specialized medical personnel and is less costly. Investigations continue to try to find better treatments using this technique.

FDA approves new chemotherapy drugs vinblastine and vincristine

FDA approves new chemotherapy drugs vinblastine and vincristine

Vinblastine (Velban, Velsar) is approved after researchers demonstrate that the drug blocks a key protein involved in cancer cell division and induces some leukemias and lymphomas into remission. Vincristine (Oncovin), a sister drug to vinblastine, is approved in 1963. These drugs are in a family of chemotherapies called "microtubule drugs," and further investigation leads to the development of similar, more effective and sometimes less toxic drugs for leukemia and other cancers, including lymphoma, breast cancer, ovarian cancer and others.

1960

First effective chemotherapy found for men with advanced testicular cancer

1958

Pioneering "combination chemotherapy" cures leukemia

Pioneering "combination chemotherapy" cures leukemia

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NCI scientists demonstrate that combination chemotherapy – in which multiple drugs are administered together – can cause remissions in both children and adults with acute leukemia. Their findings set the stage for nearly all modern chemotherapy, in which drug combinations, dosing and scheduling have been carefully refined to maximize effectiveness while minimizing side effects.

1954

5-FU becomes mainstay of chemotherapy for colorectal cancer

5-FU becomes mainstay of chemotherapy for colorectal cancer

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Researchers begin using the chemotherapy drug 5-fluorouracil (5-FU) in patients with advanced colorectal cancer, following promising data on the drug in other cancer types. Over the following decades, researchers continue to refine 5-FU dosing and administration to maximize its effectiveness and manage the often-intense side effects of the drug. 5-FU remains a mainstay of treatment for colorectal cancer and has helped cure thousands of patients when used in combination with other treatments, including radiation, surgery and other chemotherapy drugs.