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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2017

New chemotherapy regimen improves pancreatic cancer survival

New chemotherapy regimen improves pancreatic cancer survival

A new standard of care for pancreatic cancer treatment is set after data from a clinical trial show that adding a second chemotherapy drug, capecitabine (Xeloda), to gemcitabine (Gemzar) modestly improves survival after surgery. For the first time in 20 years, patients with pancreatic cancer – which is difficult to diagnose and often not found until it’s too late to be removed through surgery – have a new option for treatment after surgery.

2016

A new standard of care for high-risk, low-grade gliomas

A new standard of care for high-risk, low-grade gliomas

A federally-funded clinical trial shows that adding a chemotherapy regimen called PCV (procarbazine, CCNU, and vincristine) to radiation therapy slows cancer growth of grade 2 glioma and extends survival by a median of 5 years. Grade 2 gliomas are a rare, slow-growing type of brain tumor that occur most often in young people. As a result of this study, PCV chemotherapy after radiation therapy is now the standard of care for high-risk, low-grade gliomas.

2015

Immediate chemotherapy after surgery for advanced bladder cancer offers advantages

Immediate chemotherapy after surgery for advanced bladder cancer offers advantages

For the first time, a study shows that starting chemotherapy immediately following surgery is beneficial for patients with cancer that has spread beyond the bladder, compared to delaying chemotherapy until the cancer returns. While survival is similar with either approach, immediate chemotherapy was associated with longer time until the cancer worsens and fewer side effects.

Additional research will explore whether certain subgroups of patients may benefit more from each approach.

Adding chemotherapy to hormone therapy helps men with metastatic prostate cancer live longer

Adding chemotherapy to hormone therapy helps men with metastatic prostate cancer live longer

A large, federally funded clinical trial shows that adding docetaxel (Taxotere) chemotherapy to standard initial hormone (androgen deprivation) therapy for advanced prostate cancer extends patients’ lives by more than a year, on average. This marks the first study to identify a strategy that prolongs survival for men with newly diagnosed metastatic prostate cancer. In 2016, a second large study affirmed that docetaxel extends survival in this setting.

2014

Chemotherapy extends survival after stomach cancer surgery

Chemotherapy extends survival after stomach cancer surgery

A large trial shows that patients with early stomach cancer who receive chemotherapy with capecitabine (Xeloda) and oxaliplatin (Eloxatin) after surgery live longer than those who have surgery alone. These results affirm that adjuvant (post-surgery) chemotherapy can make a vital difference for patients with stomach cancer, as it does for breast, colon, and several other cancers.   

2011

Korean study affirms value of chemotherapy, alone, following surgery
New tool helps physicians tailor chemotherapy treatment for older patients

New tool helps physicians tailor chemotherapy treatment for older patients

Researchers develop a new assessment tool that helps physicians identify older adults with cancer who will have difficulty tolerating and completing chemotherapy. The tool considers factors such as other illnesses, mental function, social support, and nutritional status to predict an elderly patient's risk of side effects. The model will help physicians tailor cancer treatment in a way that maximizes quality of life for the patients.

2010

New drug for patients whose disease progresses despite other treatments

New drug for patients whose disease progresses despite other treatments

The FDA approves cabazitaxel (Jevtana), given together with the drug prednisone, for men with advanced stages of prostate cancer that has progressed despite prior hormone therapy and chemotherapy with a drug called docetaxel (Taxotere). The approval, the first for this group of patients who have few other options, was based on data showing cabazitaxel increases survival compared with standard mitoxantrone (Novantrone) chemotherapy in patients who have already received docetaxel treatment.

New combination chemotherapy regimen extends advanced pancreatic cancer survival

New combination chemotherapy regimen extends advanced pancreatic cancer survival

Major trial shows that initial treatment with FOLFIRINOX chemotherapy extends survival by nearly five months in patients with advanced pancreatic cancer, compared with standard gemcitabine (Gemzar) treatment. FOLFIRINOX combines the drugs 5-fluorouracil, leucovorin, irinotecan (Camptosar) and oxaliplatin (Eloxatin). This is the largest observed survival advantage in a major clinical trial among patients with advanced pancreatic cancer.

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Pre-surgery chemotherapy proven an effective option for women with advanced ovarian cancer

Major European trial reports that giving chemotherapy prior to surgery (called neo-adjuvant chemotherapy) or after surgery (called adjuvant chemotherapy) is equally effective in women with advanced ovarian cancer. These results resolve long-standing debate and provide an important treatment alternative, particularly for women with larger tumors. In this group, giving chemotherapy first can shrink the tumors so that less extensive surgery is needed later on in the course of therapy.

New chemotherapy drug improves survival for advanced breast cancer
Older patients should be considered for the same aggressive chemotherapy as younger patients

Older patients should be considered for the same aggressive chemotherapy as younger patients

Older patients have traditionally received less aggressive therapy than younger patients, out of concern that they would not be able to handle the side effects. But a large study shows that a combination of two commonly used chemotherapy drugs, paclitaxel (Taxol) and carboplatin (Paraplatin, Paraplat), significantly increased survival in patients age 70 or older with advanced non-small cell lung cancer, compared to the standard single-drug therapy used among older patients. The findings suggest that older patients should be considered for the same aggressive combination therapy as younger patients.

Targeted drug denosumumab helps prevent common bone-related complications in advanced breast cancer

Targeted drug denosumumab helps prevent common bone-related complications in advanced breast cancer

About 80 percent of women with metastatic breast cancer experience cancer spread to the bone, a complication that causes pain, bone weakening and other side effects that affect quality of life. In 2010, a large study shows that the targeted drug called denosumumab (Xgeva) can prevent or significantly delay bone metastases. Other drugs, such as zoledronic acid (Zometa), have previously been used to prevent and treat these bone-related complications, but this study suggests denosumumab may be more effective.

2009

Standard chemotherapy is an option for older women

Standard chemotherapy is an option for older women

Researchers find that chemotherapy with capecitabine (Xeloda) alone is less effective and is associated with more serious side effects among older women with early-stage breast cancer than the three-drug chemotherapy regimen that younger women typically receive. The finding resolves a long-running debate about whether a single oral drug would be more tolerable or more effective than a combination of drugs for older patients, showing that otherwise healthy elderly patients can tolerate and benefit from the standard treatment regimen.

Maintenance therapy improves survival for advanced non-small cell lung cancer

Maintenance therapy improves survival for advanced non-small cell lung cancer

Large clinical trials show that patients with advanced non-small cell lung cancer who continued to receive drug therapy after completing their initial chemotherapy regimen lived longer than patients who did not receive such therapy. In separate studies, this finding is shown with the chemotherapy drug, pemetrexed (Alimta) and with the targeted therapy erlotinib (Tarceva). Based on this research, the FDA ultimately approves these agents for this use.

2008

New chemotherapy regimen extends survival for metastatic gastric cancers

New chemotherapy regimen extends survival for metastatic gastric cancers

Chemotherapy with the drugs cisplatin or fluorouracil was used to shrink or stall the growth of tumors in patients with advanced gastric cancers, but results were inconsistent and treatment often caused significant side effects. In 2008, a large trial finds that adding oxaliplatin to fluorouracil and leucovorin chemotherapy shrinks tumors in many patients and generally causes fewer side effects than a regimen of cisplatin, fluorouracil and leucovorin. The newer regimen is particularly effective in older patients.

A later trial finds that replacing one part of this regimen – fluorouracil – with an oral version of the same drug, called capecitabine (Xeloda) is comparably effective. This alternative allows patients the freedom to receive more of their treatment outside of their doctor's office.

Adjuvant gemcitabine further extends survival for patients with early pancreatic cancer

Adjuvant gemcitabine further extends survival for patients with early pancreatic cancer

Two important studies demonstrate that adjuvant (post-surgery) treatment with gemcitabine (Gemzar) is beneficial. In one study, 6 months of gemcitabine doubled the average time it took for the disease to come back and extended patients' lives by nearly 3 months. In the other study, the addition of gemcitabine to adjuvant 5-fluorouracil-based chemotherapy and radiation was also associated with a survival benefit.

Adjuvant chemotherapy alone, without radiation, may be sufficient for early gastric cancer

Adjuvant chemotherapy alone, without radiation, may be sufficient for early gastric cancer

A large Japanese trial suggests that surgery plus adjuvant (post-surgical) chemotherapy with the drug S-1 – without radiation – is an effective treatment option. Patients in the trial had outcomes comparable to those in past trials who were treated with another standard chemotherapy regimen, plus radiation, following surgery. Further research has shown that S1 tends to be safer and more effective in Asian patients, whose cancers tend to grow and respond to treatment differently than those of Western patients. While debate continues about the best adjuvant approach, in particular for patients who undergo more extensive surgery, this study suggests that patients may be able to forgo the added side effects of radiation without reducing their chances of long-term survival.

Taxane therapy improves survival for several types of advanced head and neck cancers

Taxane therapy improves survival for several types of advanced head and neck cancers

Two large studies show that patients with advanced head and neck cancers who receive initial chemotherapy with docetaxel (Taxotere), together with the drugs cisplatin and fluorouracil, have substantially longer survival than patients who receive two-drug therapy. All patients in these studies had squamous cell carcinomas, which represent approximately 90 percent of head and neck cancers.

2007

Children with neuroblastoma benefit from less aggressive treatment

Children with neuroblastoma benefit from less aggressive treatment

A large, international trial finds that some children with neuroblastoma (a cancer of the nerve tissue) can receive a much less aggressive chemotherapy regimen than the previous standard treatment, without reducing their survival. Reducing chemotherapy, surgery and radiation helps children avoid serious, long-term side effects such as hearing loss. Today, certain key factors, such as age, stage of the tumor and specific tumor characteristics help determine which children with neuroblastoma can have reductions in therapy.

Bendamustine is effective against chronic lymphocytic leukemia (CLL)

Bendamustine is effective against chronic lymphocytic leukemia (CLL)

Bendamustine (Treanda), a nitrogen mustard-based drug which has been used in Europe for decades, is found to triple the time it takes for cancer to progress and produce more complete remissions than the standard chemotherapy for chronic lymphocytic leukemia. Bendamustine is approved by the FDA as an initial treatment for the disease in early 2008.

Addition of an arsenic compound found to improve survival for rare form of leukemia

Addition of an arsenic compound found to improve survival for rare form of leukemia

A large clinical trial finds that adding arsenic trioxide (Trisenox) to the standard treatment for acute promyelocytic leukemia (APL) improves survival for adults newly diagnosed with the disease. Arsenic has historically been known as a potent poison, but its use in traditional Chinese medicine led to the development of this drug. The drug is approved by the FDA later the same year.

First in new class of drugs approved for advanced breast cancer that resists other treatments

First in new class of drugs approved for advanced breast cancer that resists other treatments

The FDA approval of ixabepilone (Ixempra) offers a new treatment option to stop or slow the growth of tumors in women whose advanced breast cancer no longer responds to any other chemotherapy. The drug is used as a single therapy or in combination with the chemotherapy drug capecitabine. Ixabepilone is part of a new class of chemotherapy drugs called epothilones, which fight the disease by preventing cancer cells from dividing.

2006

Direct chemotherapy approach increases survival

Direct chemotherapy approach increases survival

Researchers report that adding intraperitoneal chemotherapy – delivering chemotherapy directly into the abdomen through a catheter – to intravenous chemotherapy following surgery extends survival by over a year for women with advanced ovarian cancer, compared to surgery and intravenous chemotherapy alone. This report confirms two earlier studies and based on the combined findings, the National Cancer Institute encourages physicians to discuss the newer approach with certain patients with advanced disease. This combination regimen causes more side effects than intravenous chemotherapy alone, including some that are life-threatening, so researchers continue to study lower-dose and alternative drug approaches that provide may provide similar benefits with fewer side effects.

New addition to chemotherapy improves survival for select patients
Chemotherapy before and after surgery improves survival for many patients

Chemotherapy before and after surgery improves survival for many patients

Results of the "MAGIC" trial provide one of the most significant advances against stomach cancer in many years, showing that chemotherapy both before and after surgery improves survival. This regimen soon becomes standard for patients with operable gastric cancer. The substantial benefit of chemotherapy leads investigators to question for the first time whether post-surgery radiation therapy is needed for patients with this form of gastric cancer.

Genetic mutations affect survival for oligodendroglioma

Genetic mutations affect survival for oligodendroglioma

Two studies find that patients with oligodendroglioma tumors (a form of glioma) that lack certain parts of chromosomes 1 and 19 are more sensitive to treatment and have better survival than patients whose tumors are not missing this genetic material. Follow-up data later show that these patients fare much better, living several years longer, when they receive chemotherapy and radiation together, rather than radiation alone. 

2005

New treatment option for children with rare forms of leukemia and lymphoma

2004

Adjuvant therapy proven effective in lung cancer

Adjuvant therapy proven effective in lung cancer

In findings that quickly change the standard of care, clinical trials show that giving chemotherapy after surgery dramatically improves survival for patients with early-stage non-small cell lung cancer, the most common form of the disease. Previously, chemotherapy was considered to be largely ineffective for lung cancer. These study results demonstrate that adjuvant chemotherapy could have an equal or greater impact on survival in lung cancer as it does in breast or colon cancer.

Docetaxel helps reduce breast cancer recurrence

Docetaxel helps reduce breast cancer recurrence

Docetaxel (Taxotere), a chemical cousin of paclitaxel (Taxol) that blocks cell division, is shown to decrease the risk of cancer recurrence by more than 25 percent and increase survival among women with operable breast cancer that has spread to the lymph nodes, compared to the previous standard therapy, fluorouracil. The FDA approval of docetaxel later the same year expands the arsenal of chemotherapy drugs for women with breast cancer.

Adjuvant chemotherapy shown to benefit patients with early pancreatic cancer

Adjuvant chemotherapy shown to benefit patients with early pancreatic cancer

The European Study Group for Pancreatic Cancer (ESPAC) finds that adjuvant use (after surgery) of the chemotherapy drug 5-fluorouracil more than doubles 5-year survival for patients with early-stage disease, compared to surgery alone. The findings resolve a long-running debate about the value of adjuvant chemotherapy. The study also calls into question the need for adjuvant radiation following surgery, since chemotherapy alone was effective. Researchers continue to address this question.

Adding new drug, gemcitabine, extends survival for some women with advanced breast cancer
Single dose of chemotherapy reduces risk of cancer recurrence in men with early-stage disease

Single dose of chemotherapy reduces risk of cancer recurrence in men with early-stage disease

A large European study shows that a single dose of the chemotherapy drug carboplatin (Paraplatin, Paraplat), following surgical removal of the cancerous testicle, lowers the risk of cancer recurrence and may reduce the risk of cancer developing in the opposite testicle. This finding results in a new treatment option for men with early-stage testicular cancer, potentially sparing them from standard radiation therapy, which is highly effective but is associated with an increased risk of developing a second cancer in another organ later in life.

New chemotherapy for hard-to-treat prostate cancers
Chemotherapy and radiation before surgery reduce side effects for rectal cancer patients

Chemotherapy and radiation before surgery reduce side effects for rectal cancer patients

Results from a large clinical study show that giving chemotherapy and radiation therapy before, rather than after, rectal cancer surgery reduces the risk of local recurrence (cancer recurrence in the pelvis, near the original tumor). Survival was similar in both approaches, but because the pre-surgery treatment regimen was more tolerable, it is now the standard approach for treatment of rectal cancer.

New class of drugs, aromatase inhibitors, introduced

New class of drugs, aromatase inhibitors, introduced

The FDA approves the drug letrozole (Femara), the first in a new class of drugs called aromatase inhibitors that block an enzyme the body needs to make estrogen (estrogen fuels the growth of some breast cancers). The drug is first approved for long-term use in post-menopausal women who have completed five years of tamoxifen (Novaldex) treatment, based on studies showing letrozole reduces the risk of breast cancer recurrence and spread even more than tamoxifen alone. In 2005, letrozole is also approved as an initial therapy following surgery for post-menopausal women.

In the same time period, additional trials show that aromatase inhibitors, including letrozole and similar drugs like anastrazole (Arimidex), also improve survival and alleviate the symptoms of cancer for post-menopausal women with advanced breast cancer.

2003

New "FOLFOX" chemotherapy effective for colon cancer

New "FOLFOX" chemotherapy effective for colon cancer

Oxaliplatin (Eloxatin) combined with 5-fluorouracil and leucovorin (a regimen called FOLFOX) is approved to treat advanced colon cancer that has spread despite other treatments. FOLFOX is later approved for stage III colon cancer (cancer involving the nearby lymph nodes) following surgery, after a pivotal trial finds that it increased the time that patients live without their cancer returning (disease-free survival). Longer-term data from the same study found that the combination also extends patients' lives.

New chemotherapy regimen – docetaxel and paclitaxel – provides important treatment option

New chemotherapy regimen – docetaxel and paclitaxel – provides important treatment option

A large study finds that combination chemotherapy with docetaxel (Taxotere) and carboplatin (Paraplatin, Paraplat) is as effective as the standard paclitaxel (Taxol) and carboplatin regimen for newly diagnosed, advanced ovarian cancer. The docetaxel combination has different side effects than the paclitaxel combination, offering patients a potential treatment alternative. However, docetaxel is not FDA approved for ovarian cancer and has not been widely used for this purpose in the United States.

First oral chemotherapy drug helps simplify colon cancer treatment

First oral chemotherapy drug helps simplify colon cancer treatment

The FDA approves capecitabine (Xeloda) for patients with advanced (metastatic) colon cancer, and later for patients with stage III colon cancer (cancer with limited spread in the surrounding tissue) who have had surgery to remove the tumor. Capecitabine is a pill version of the widely used intravenous chemotherapy drug 5-fluorouracil that offers comparable effectiveness with a more convenient way for patients to receive their treatment. Recently, capecitabine has been combined with the drug oxaliplatin (Eloxatin) as an initial therapy for metastatic colon cancer and for early-stage colon cancer.

Adding two drugs to standard chemotherapy improves survival for children with early-stage Ewing sarcoma

Adding two drugs to standard chemotherapy improves survival for children with early-stage Ewing sarcoma

Scientists show that adding two additional drugs (ifosfamide and etoposide) to the standard four-drug combination chemotherapy regimen (doxorubicin, vincristine, cyclophosphamide and dactinomycin) significantly increases five-year survival rates in patients with early-stage Ewing sarcoma (a form of bone cancer, that most often occurs in the legs, spine, ribs, or pelvis). This new combination soon becomes the standard treatment.

Pre-surgical chemotherapy proven to extend survival
Higher density, shorter term chemotherapy improves breast cancer survival

2002

Chemo-embolization offers improved survival for select patients

Chemo-embolization offers improved survival for select patients

Unlike other organs, the liver has two major sources of blood supply, instead of one. For unknown reasons, cancer only develops around the lower of these arteries, the hepatic artery, and uses this blood supply to fuel its growth. Doctors have long debated whether temporarily blocking – or embolizing – this artery to starve the tumor of blood can improve overall outcomes.

In 2002, two studies show that repeatedly (every 2-6 months) injecting the chemotherapy drug doxorubicin and then embolizing the hepatic artery increases survival in a set of patients whose tumors cannot be removed surgically. However, the approach is still debated by researchers, who question its overall impact.

2001

Adjuvant therapy improves long-term survival for patients with early-stage stomach cancer

Adjuvant therapy improves long-term survival for patients with early-stage stomach cancer

In 2001, a major trial shows that giving patients chemotherapy and radiation after surgery – an approach known as adjuvant therapy – significantly improves survival. The study compared surgery alone with surgery followed by the chemotherapy drugs fluorouracil and leucovorin, together with radiation.

These findings quickly establish adjuvant chemotherapy and radiation as a standard of care, and make stomach cancer one of several cancers in which adjuvant therapy can increase patients' chances of cure.

2000

Second round of chemotherapy boosts survival in advanced non-small cell lung cancer

Second round of chemotherapy boosts survival in advanced non-small cell lung cancer

Studies report that patients with advanced non-small cell lung cancer that worsens after prior treatment with platinum-based chemotherapy (such as cisplatin or carboplatin) live significantly longer when they receive additional docetaxel (Taxotere) chemotherapy than when they receive only supportive care (treatment to ease their cancer-related symptoms, but not to fight their disease). These are the first data to show a survival benefit from administering a second round of chemotherapy to patients with advanced non-small cell lung cancer.

High-dose chemotherapy plus stem cell transplant does not improve breast cancer survival

High-dose chemotherapy plus stem cell transplant does not improve breast cancer survival

In several large, randomized studies, researchers demonstrate conclusively that high-dose chemotherapy with supportive stem-cell or bone marrow transplantation does not improve survival among women with advanced breast cancer or earlier-stage cancer. These results immediately change practice. (Based on the results of earlier small-scale studies, the approach came into widespread use for both advanced and early-stage breast cancer patients – well before large, randomized clinical trials were conducted.) The approach involves administering extremely high doses of chemotherapy to fight the cancer, which had been used successfully in other cancers such as lymphoma and leukemia. However, because such high doses destroy bone marrow, they are fatal if not supported by bone marrow transplantation or stem cell support, which repopulate these vital cells. The negative trial results underscore the importance of confirming preliminary data from uncontrolled pilot trials in more definitive phase III studies.

Fludarabine works faster, better for patients with CLL

Fludarabine works faster, better for patients with CLL

A large, long-term clinical trial demonstrates that the drug fludarabine (Fludara) – originally developed as a back-up therapy for patients with chronic lymphocytic leukemia – works in more patients and produces longer-lasting remissions than the previous standard drug, chlorumbucil (Leukeran). However, the drug only works reliably in patients younger than age 65, and stem cell transplantation from a healthy, matched donor remains the only curative therapy for this disease.

New treatment alternative for advanced bladder cancer

New treatment alternative for advanced bladder cancer

While the MVAC chemotherapy regimen (methotrexate, vinblastine, doxorubicin, and cisplatin) remains the standard of care for patients with advanced bladder cancer, some patients, including those who are older and have other health problems, cannot tolerate its side effects. In 2000, researchers demonstrate that a new chemotherapy combination regimen using gemcitabine (Gemzar) together with cisplatin is comparably effective but has relatively fewer side effects than standard MVAC.