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.

The term chemotherapy has come to connote non-specific usage of intracellular poisons to inhibit mitosis cell division or induce DNA damage, which is why inhibition of DNA repair can augment chemotherapy. The connotation of the word chemotherapy excludes more selective agents that block extracellular signals signal transduction. The development of therapies with specific molecular or genetic targets, which inhibit growth-promoting signals from classic endocrine hormones primarily estrogens for breast cancer and androgens for prostate cancer are now called hormonal therapies. By contrast, other inhibitions of growth-signals like those associated with receptor tyrosine kinases are referred to as targeted therapy.

Importantly, the use of drugs whether chemotherapy, hormonal therapy or targeted therapy constitutes systemic therapy for cancer in that they are introduced into the blood stream and are therefore in principle able to address cancer at any anatomic location in the body. Systemic therapy is often used in conjunction with other modalities that constitute local therapy i.e. treatments whose efficacy is confined to the anatomic area where they are applied for cancer such as radiation therapy, surgery or hyperthermia therapy.

Traditional chemotherapeutic agents are cytotoxic by means of interfering with cell division mitosis but cancer cells vary widely in their susceptibility to these agents. To a large extent, chemotherapy can be thought of as a way to damage or stress cells, which may then lead to cell death if apoptosis is initiated. Many of the side effects of chemotherapy can be traced to damage to normal cells that divide rapidly and are thus sensitive to anti-mitotic drugs: cells in the bone marrow, digestive tract and hair follicles. This results in the most common side-effects of chemotherapy: myelosuppression decreased production of blood cells, hence also immunosuppression, mucositis inflammation of the lining of the digestive tract, and alopecia hair loss. Because of the effect on immune cells especially lymphocytes, chemotherapy drugs often find use in a host of diseases that result from harmful overactivity of the immune system against self so-called autoimmunity. These include rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, vasculitis and many others.

Treatment Strategies

There are a number of strategies in the administration of chemotherapeutic drugs used today. Chemotherapy may be given with a curative intent or it may aim to prolong life or to palliate symptoms.

1. Induction chemotherapy is the first line treatment of cancer with a chemotherapeutic drug. This type of chemotherapy is used for curative intent.
2. Combined modality chemotherapy is the use of drugs with other cancer treatments, such as surgery, radiation therapy, or hyperthermia therapy.
3. Consolidation chemotherapy is given after remission in order to prolong the overall disease-free time and improve overall survival. The drug that is administered is the same as the drug that achieved remission.
4. Intensification chemotherapy is identical to consolidation chemotherapy but a different drug than the induction chemotherapy is used.
5. Combination chemotherapy involves treating a person with a number of different drugs simultaneously. The drugs differ in their mechanism and side-effects. The biggest advantage is minimising the chances of resistance developing to any one agent. Also, the drugs can often be used at lower doses, reducing toxicity.
6. Neoadjuvant chemotherapy is given prior to a local treatment such as surgery, and is designed to shrink the primary tumor. It is also given for cancers with a high risk of micrometastatic disease.
7. Adjuvant chemotherapy is given after a local treatment (radiotherapy or surgery). It can be used when there is little evidence of cancer present, but there is risk of recurrence.  It is also useful in killing any cancerous cells that have spread to other parts of the body. These micrometastases can be treated with adjuvant chemotherapy and can reduce relapse rates caused by these disseminated cells.
8. Maintenance chemotherapy is a repeated low-dose treatment to prolong remission.
9. Salvage chemotherapy or palliative chemotherapy is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, in general, a better toxicity profile is expected.

Efficiency

The efficiency of chemotherapy depends on the type of cancer and the stage. The overall effectiveness ranges from being curative for some cancers, such as some leukemias, to being ineffective, such as in some brain tumors,to being needless in others, like most non-melanoma skin cancers.

Journal of Cancer Research and Immuno-Oncology is an open access rapid peer reviewed journal in the field of cancer research. Journal announces papers for the upcoming issue. Interested can submit their manuscript through online portal.

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