Chemotherapy 60 Years On 

It’s the 60th anniversary of the first use of chemotherapy. This is not an anniversary that is likely to attract much attention. It can be a demanding treatment and it does not get a good press. However we should not forget that it has saved lives and extended life for millions. We must also recognise that for some cancer patients it has failed to deliver any benefit.

It was in 1956 that a very rare cancer, choriocarcinoma – a cancer which starts in the womb – was treated with a drug called methotrexate. This drug, along with others, is still used for this cancer.

Today the most widely used chemotherapy worldwide is doxorubicin, the ‘red one’ that many patients will report. It was developed from soil based microbes, originally in Italy. It is used to treat a wide range of cancers and is regarded by the World Health Organisation as an essential ingredient in the drug formulary of every nation.  One major side effect of doxorubicin is that it can damage the heart. As a result the lifetime dose is limited. Today there are over 2000 variants.

The chemotherapy I had in 2000 was ifosfamide. This is also on the WHO list. It has its origin in nitrogen mustard – the main active ingredient in mustard gas. A drug derived from mustard gas was used in treating cancer as early as 1942 in the USA but it was too toxic and today is classified as a chemical weapon. Ifosfamide finally came into use in the early 1960s and today there are many variants. Its main side effect is haemorrhagic cystitis, a very unpleasant urinary tract complaint that can be fatal. A preventative drug called mesna is always prescribed alongside it.

Drugs based on platinum, taxanes derived from the yew tree and more recently drugs derived from toxins found in primitive sea creatures are also mainstays of chemotherapy. Treatment is often given with combinations of drugs and great care is taken to ensure that combinations do not have additive side effects which are hard to tolerate.

These cytotoxic treatments are being complemented today by hormonal and targeted therapies aimed at stopping specific genetic markers in tumours from being activated rather than at destroying tumours by blunt force. The ‘hammer’ of chemo is being replaced by subtler methods which are less toxic and more easily tolerated. I am told that there will be a place for chemotherapy for many years to come in treating cancer but the numbers of people needing these toxic treatments will slowly decrease.

Those of us who have been successfully treated with chemotherapy look back on the experience with no great wish to repeat it but we can at least celebrate the 60th birthday and give thanks for those scientists and researchers who have opened the way to life.