Instruct: Given a question, retrieve relevant documents that answer the question.
Query: When was chemotherapy first introduced as a cancer treatment?
The era of cancer chemotherapy began in the 1940s with the first use of nitrogen mustards and folic acid antagonist drugs. The targeted therapy revolution had arrived, but many of the principles and limitations of chemotherapy discovered by the early researchers still apply.
Each type of cancer needs a specific combination of treatments aimed at that particular kind of cancer. When the extent of spread of cancer is deep, total removal of the cancer growth by surgery may not be possible. At times, after surgical removal of a part of the cancer, radiotherapy and/or chemotherapy may be necessary to treat the remnant portion of cancer. It is widely known that Chemotherapy has profound toxic side effects and has limitations in efficacy. Radiotherapy is also a very effective mode of treatment in certain types of cancer, but it has its own adverse effects as well. These two modalities affect not only the cancer affected cells, but also the normal cells
Chemotherapy is useful in oral cancers when used in combination with other treatment modalities such as radiation therapy. It is not used alone as a monotherapy. When a cure is unlikely, it can also be used to extend life and can be considered palliative but not curative care. Biological agents such as Cetuximab have recently been shown to be effective in the treatment of squamous cell head and neck cancers, and are likely to have an increasing role in the future management of this condition when used in conjunction with other established treatment modalities. Likewise, molecularly targeted therapies and immunotherapies maybe be effective for the treatment of oral and oropharyngeal cancers. Adding epidermal growth factor receptor monoclonal antibody (EGFR mAb) to standard treatment may increase survival, keeping the cancer limited to that area of the body and may decrease reappearance of the cancer.
In 2001, Somers was diagnosed with breast cancer. She had a lumpectomy, and radiation, but declined to undergo chemotherapy. In November 2008, Somers announced she was diagnosed with inoperable cancer by six doctors, but she learned a week later that she was misdiagnosed. During this time, she interviewed doctors about cancer treatments and these interviews became the basis of her book, "Knockout", about alternative treatments to chemotherapy. In her book "Knockout", Somers promotes alternative cancer treatments, for which she was criticized by the American Cancer Society:
Chemotherapy is the standard treatment for non-seminoma when the cancer has spread to other parts of the body (that is, stage 2B or 3). The standard chemotherapy protocol is three, or sometimes four, rounds of Bleomycin-Etoposide-Cisplatin (BEP). BEP as a first-line treatment was first reported by Professor Michael Peckham in 1983. The landmark trial published in 1987 which established BEP as the optimum treatment was conducted by Dr. Lawrence Einhorn at Indiana University. An alternative, equally effective treatment involves the use of four cycles of Etoposide-Cisplatin (EP).
In 1949, Dr. Wright joined her father at the Cancer Research Foundation at Harlem hospital. During her time at the research institute, she and her father sparked an interest in chemotherapeutic agents. They were interested in making chemotherapy more accessible for everyone. In the 1940s chemotherapy was a new development, so it was not a well-known or well-practiced source for treatment because it was still in its experimental stage of drug development. Chemotherapy was considered the “last resort” and the drugs available and dosage was not very well defined. Both Jane and her father wanted to make chemotherapy a more accessible method of cancer treatment. They were the first groups to report the use of nitrogen mustard agents and folic acid antagonists as cancer treatments. The Folic acid antagonist can block folic acid in the body, which is required for cells to produce certain types of amino acids. By inhibiting the folic acids, cells are unable to make new strands of DNA/RNA or produce proteins to drive mitosis. Because cancer cells are highly proliferative compared to the other class in the human body, it is crucial to stop mitosis from happening. The folic acid antagonists that were tested were probably the most important discovery because the antifolates are highly potent against a vast array of solid tumors, including several types of leukemia, Hodgkin's disease, lymphosarcoma, melanoma, breast cancer, and prostate cancer. Methotrexate is still one of the main chemotherapy drugs used today to treat many types of cancer, and it has been a basis for all modern chemotherapy.
Wright's research work involved studying the effects of various drugs on tumors, and she was the first to identify methotrexate, one of the foundational chemotherapy drugs, as an effective tool against cancerous tumors. Wright's early work brought chemotherapy out of the realm of an untested, experimental hypothetical treatment, into the realm of tested, proven effective cancer therapeutics—thus literally saving millions of lives. Wright and her father introduced nitrogen mustard agents, similar to the mustard gas compounds used in World War I, that were successful in treating the cancerous cells of leukemia patients. Wright later pioneered combinatorial work in chemotherapeutics, focusing not simply on administering multiple drugs, but sequential and dosage variations to increase the effectiveness of chemotherapy and minimize side effects. She was successful in identifying treatments for both breast and skin cancer, developing a chemotherapy protocol that increased skin cancer patient lifespans up to ten years. She also developed a non-surgical method, using a catheter system, to deliver potent drugs to tumors located deep within the body such as the liver and spleen. She published more than 100 papers on cancer chemotherapeutics during her career and served on the editorial board of the Journal of the National Medical Association.
Breast cancer chemotherapy refers to the use of cytotoxic drugs (chemotherapy) in the treatment of breast cancer.
The improvement in survival rates for many cancers in the last half century is due to improved understanding about the causes of cancer and the availability of new treatment options, which are continually evolving. Where surgery was previously the only option for treatment, cancer is now treated with radiation and chemotherapy, including combination chemotherapy that favors treatment with many drugs over just one. Availability and access to clinical trials has also lead to more targeted therapy and improved knowledge of treatment efficacy. There are currently over 60,000 clinical trials related to cancer registered on ClinicalTrials.gov, so novel approaches to cancer treatment are continuing to be developed. The NCI lists over 100 targeted therapies that have been approved for the treatment of 26 different cancer types by the United States Food and Drug Administration.
Treatment usually begins with surgery and then a course of radiation for cancer that has progressed past Stage I. For cancer that is advanced, which is typical of hypopharyngeal cancer, neoadjuvant chemotherapy may be used. This is performed by administering chemotherapy before surgery. Neoadjuvant chemotherapy in conjunction with radiation and surgery has yielded the best results in patients with Stage III and Stage IV cancers.
VAMP regimen or VAMP chemotherapy is a four-drug combination chemotherapy regimen, used today in the treatment of Hodgkin lymphoma. It was one of the earliest combination chemotherapy regimens, originally developed as a treatment for childhood leukemia by a group of researchers at the National Cancer Institute led by Emil Frei and Emil Freireich. The first clinical trial of VAMP began in 1961. Because it was the first time that four chemotherapeutic agents were used at once, the trial was highly controversial at its time. Although new combination chemotherapy regimens have replaced the use of VAMP in the treatment of childhood leukemia, VAMP is considered an important precursor to modern treatments, confirming the effectiveness of combination chemotherapy and leading to the use of combination chemotherapy regimens to treat other types of cancer.
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents) as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent (which almost always involves combinations of drugs), or it may aim to prolong life or to reduce symptoms (palliative chemotherapy). Chemotherapy is one of the major categories of the medical discipline specifically devoted to pharmacotherapy for cancer, which is called "medical oncology".
Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of many cancer treatments. Nausea and vomiting are two of the most feared cancer treatment-related side effects for cancer patients and their families. In 1983, Coates et al. found that patients receiving chemotherapy ranked nausea and vomiting as the first and second most severe side effects, respectively. Up to 20% of patients receiving highly emetogenic agents in this era postponed, or even refused, potentially curative treatments. Since the 1990s, several novel classes of antiemetics have been developed and commercialized, becoming a nearly universal standard in chemotherapy regimens, and helping to better manage these symptoms in a large portion of patients. Efficient mediation of these unpleasant and sometimes crippling symptoms results in increased quality of life for the patient, and better overall health of the patient, and, due to better patient tolerance, more effective treatment cycles.
Surgery may be performed before or after other forms of treatment. Treatment before surgery is often described as neoadjuvant. In breast cancer, the survival rate of patients who receive neoadjuvant chemotherapy are no different to those who are treated following surgery.[8] Giving chemotherapy earlier allows oncologists to evaluate the effectiveness of the therapy, and may make removal of the tumor easier. However, the survival advantages of neoadjuvant treatment in lung cancer are less clear.[9]
Cancer Treatment Centers of America offers conventional cancer care treatments such as surgical oncology, chemotherapy, radiation therapy, immunotherapy, stem cell transplantation, and targeted therapy in conjunction with supportive therapies such as nutrition, mind-body medicine, and spiritual support to support healing and manage side effects. When appropriate, CTCA will offer genomic testing to patients to identify tumor markers that may respond to chemotherapies that may have not been typically prescribed.
There are five different stages of colon cancer, and these five stages all have treatment. Stage 0, is where the patient is required to undergo surgery to remove the polyp (American Cancer Society[27]). Stage 1, depending on the location of the cancer in the colon and lymph nodes, the patient undergoes surgery just like Stage 0. Stage 2 patients undergoes removing nearby lymph nodes, but depending on what the doctor says, the patent might have to undergo chemotherapy after surgery (if the cancer is at higher risk of coming back). Stage 3, is where the cancer has spread all throughout the lymph nodes but not yet to other organs or body parts. When getting to this stage, Surgery is conducted on the colon and lymph nodes, then the doctor orders Chemotherapy (FOLFOX or CapeOx) to treat the colon cancer in the location needed (American Cancer Society[27]). The last a patient can get is Stage 4. Stage 4 patients only undergo surgery if it is for the prevention of the cancer, along with pain relief. If the pain continues with these two options, the doctor might recommended radiation therapy. The main treatment strategy is Chemotherapy due to how aggressive the cancer becomes in this stage not only to the colon but to the lymph nodes.
Nausea and vomiting are two of the most feared cancer treatment-related side-effects for people with cancer and their families. In 1983, Coates et al. found that people receiving chemotherapy ranked nausea and vomiting as the first and second most severe side-effects, respectively. Up to 20% of people receiving highly emetogenic agents in this era postponed, or even refused, potentially curative treatments. Chemotherapy-induced nausea and vomiting (CINV) are common with many treatments and some forms of cancer. Since the 1990s, several novel classes of antiemetics have been developed and commercialized, becoming a nearly universal standard in chemotherapy regimens, and helping to successfully manage these symptoms in many people. Effective mediation of these unpleasant and sometimes-crippling symptoms results in increased quality of life for the recipient and more efficient treatment cycles, due to less stoppage of treatment due to better tolerance and better overall health.
Certain treatments for childhood cancer are known to cause learning problems in survivors, particularly when central nervous system (CNS)-directed therapies are used (e.g. cranial radiation; high-dose methotrexate or cytarabine; or intrathecal chemotherapy). As the mortality rates of childhood cancers have plummeted since effective treatment regiments have been introduced, greater attention has been paid to the effect of treatment on neurocognitive morbidity and quality of life of survivors. The goal of treatment for childhood cancers today is to minimize these adverse "late effects", while ensuring long-term survival.
Bevacizumab was approved by the FDA in February 2004 for use in metastatic colorectal cancer when used with standard chemotherapy treatment (as first-line treatment) and with 5-fluorouracil-based therapy for second-line metastatic colorectal cancer.
Tenovus Cancer Care's first Mobile Support Unit was launched in February 2009. Since its launch, the Unit has opened its services in more than 50 locations and has accommodated over 5,000 patients and visitors. Working with Velindre NHS Trust, Tenovus Cancer Care has been delivering chemotherapy and other cancer treatments in Cwmbran and Nantgarw. During this period, over 10,000 treatments have been provided. In October 2013 the second Mobile Support Unit was launched to deliver support for people with Lymphoedema, an incurable condition which can be a side-effect of cancer treatment. In October 2018, HRH The Princess Royal unveiled the charity's new £1m Mobile Support Unit, the largest mobile chemotherapy treatment unit in the world. It is 60% bigger than the first Mobile Support Unit, with seven chemotherapy chairs and is capable of seeing 30 patients a day and delivering more than 8,500 treatments a year. Calculations show that the two existing Mobile Support Units save the NHS in Wales more than £1m a year, and the new Mobile Support Unit could deliver more than 125,000 treatments over the course its lifetime. 
Chemotherapy is the treatment of cancer with drugs ("anticancer drugs") that can destroy cancer cells. In current usage, the term "chemotherapy" usually refers to cytotoxic drugs which affect rapidly dividing cells in general, in contrast with targeted therapy (see below). Chemotherapy drugs interfere with cell division in various possible ways, e.g. with the duplication of DNA or the separation of newly formed chromosomes. Most forms of chemotherapy target all rapidly dividing cells and are not specific to cancer cells, although some degree of specificity may come from the inability of many cancer cells to repair DNA damage, while normal cells generally can. Hence, chemotherapy has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (e.g. intestinal lining). These cells usually repair themselves after chemotherapy.
While HDC/ABMT has been discontinued, a rising therapy for cancer that is similar to HDC/BMT is CAR-T cell therapy, which is a type of immunotherapy. CAR T therapy collects the patient's own immune cells to treat their cancer, which is a similar idea to that behind HDC/BMT. Currently, there exist FDA-approved CAR T-cell therapies for children with acute lymphoblastic leukemia and adults with advanced lymphomas, but clinical trials are still in development as to whether CAR T-cell therapy can be effective against solid tumor cancers, like breast cancer. In a similar way to HDC/BMT, the treatment was first introduced for people for whom all other treatments have stopped working. The first women to participate in Peters's clinical trial were also those who had advanced breast cancer and for whom other treatments had stopped working.
Although the causes and existence of post-chemotherapy cognitive impairment have been a subject of debate, recent studies have confirmed that post-chemotherapy cognitive impairment is a real, measurable side effect of chemotherapy that appears in some patients. While any cancer patient may experience temporary cognitive impairment while undergoing chemotherapy, patients with PCCI continue to experience these symptoms long after chemotherapy has been completed. PCCI is often seen in patients treated for breast cancer, ovarian cancer, prostate cancer, and other reproductive cancers, as well as other types of cancers requiring aggressive treatment with chemotherapy.
High-dose chemotherapy and bone marrow transplant (HDC/BMT), also high-dose chemotherapy with autologous bone marrow transplant (HDC/ABMT or just ABMT), was a treatment regimen for metastatic breast cancer, and later high-risk breast cancer, that was considered promising during the 1980s and 1990s. It was ultimately determined to be no more effective than normal treatment, and to have significantly higher side effects, including treatment-related death.
In Stage I colon cancer, no chemotherapy is offered, and surgery is the definitive treatment. The role of chemotherapy in Stage II colon cancer is debatable, and is usually not offered unless risk factors such as T4 tumor, undifferentiated tumor, vascular and perineural invasion or inadequate lymph node sampling is identified. It is also known that the people who carry abnormalities of the mismatch repair genes do not benefit from chemotherapy. For stage III and Stage IV colon cancer, chemotherapy is an integral part of treatment.