Chemotherapy
Summary
Chemotherapy encompasses a diverse repertoire of cytotoxic agents designed to interfere with key processes in cell division and survival. Classical regimens target DNA synthesis and repair (alkylating agents, antimetabolites and platinum compounds), microtubule dynamics (taxanes and vinca alkaloids) or topoisomerase activity (etoposide, camptothecins). Many agents act preferentially on cells in S-phase (antimetabolites) or M-phase (microtubule poisons), whereas others display cell-cycle non-specific effects. Treatment strategies range from curative intent—often incorporating neoadjuvant or adjuvant chemotherapy—to palliative schedules aimed at symptom control. Combination protocols exploit distinct mechanisms and non-overlapping toxicities to enhance tumour cell kill and suppress resistance. Emerging approaches include metronomic dosing to target angiogenesis and immune modulation, nanoparticle formulations to improve tumour delivery, and biomarker-driven selection to personalise regimens. Despite improvements in efficacy, the therapeutic index remains narrow, and management of acute toxicities (myelosuppression, mucositis, nausea) and long-term sequelae (cardiotoxicity, secondary malignancies, infertility) is integral to optimal care.
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Chemotherapy publication trend
The graph below shows the total number of articles in chemotherapy across all publications each year (not limited to Nature Index journals).
Technical terms
Adjuvant therapy: Chemotherapy given after primary treatment (usually surgery) to eradicate residual disease and reduce relapse risk.
Metronomic chemotherapy: Continuous or frequent low-dose administration of cytotoxic agents designed to target tumour angiogenesis and modulate immunity without high toxicity peaks.
Maximum tolerated dose (MTD): The highest drug dose that achieves an acceptable level of toxicity; conventional chemotherapy is often delivered at or near this threshold.
Neoadjuvant therapy: Chemotherapy administered before surgery to shrink the primary tumour and facilitate resection.
Therapeutic index: The ratio between a drug’s toxic dose and its effective dose; a narrow therapeutic index indicates that small dosage changes can lead to toxicity or loss of efficacy.
Topoisomerase inhibitors: Agents that interfere with DNA topoisomerase I or II, enzymes essential for DNA uncoiling during replication and transcription, leading to DNA damage and apoptosis.
References
- Anthracycline-containing and taxane-containing chemotherapy for early-stage operable breast cancer: a patient-level meta-analysis of 100 000 women from 86 randomised trials. The Lancet (2023).
- Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer (UK TACT2; CRUK/05/19): quality of life results from a multicentre, phase 3, open-label, randomised, controlled trial. The Lancet Oncology (2023).
- Metronomic chemotherapy in cancer treatment: new wine in an old bottle. Theranostics (2024).
- Metronomic Chemotherapy in Elderly Patients. Current Oncology Reports (2024).
- General Principles of Cancer Chemotherapy.
About these summaries
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