The history of cancer treatment

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We humans have been searching for successful ways to treat cancer for as long as written records have been kept, and likely longer. This entry will take a broad historical look at one form of cancer treatment, chemotherapy.

Coining 'chemotherapy'

Despite its association with cancer, the term 'chemotherapy' was coined as it applied to the experimental treatment of syphilis with chemicals by early 20th century chemist Paul Ehrlich.

However, the notion of using chemicals to treat cancer did not begin to catch hold until the 1930s, although the accepted birth year for cancer chemotherapy is slightly later than that.

The dawn of cancer chemotherapy

Dawn broke on cancer chemotherapy in 1943 thanks to the United States' secret chemical weapons program, during which it was discovered that nitrogen mustard, better known as mustard gas, had a curious effect on the human body: namely, it could wipe out a person's bone marrow and their lymph nodes.

Researchers then hypothesized that nitrogen mustard might therefore be effective in certain cancer patients, notably in patients with lymphoma since they were suffering from a massive proliferation of white blood cells, precisely the cell type wiped out by mustard gas.

Chemical testing on a national level

In 1955, the US launched the Cancer Chemotherapy National Service Center, thanks in part to the success seen with nitrogen mustard, and thanks in part to the success seen from the development of the second chemo drug, methotrexate. Over the ensuing years, researchers would put several thousand different chemicals to the test, to see if they had any anticancer effect on in vitro cancer cells.

However, this isn't to say that chemotherapy was widely embraced by the medical community. Rather, it was ridiculed and denounced, and many determined researchers lost their jobs and their reputations in the process.

The breakthrough: Combination chemotherapy

The enormous criticism against chemotherapy began to dissolve in the face of the singularly most stunning and unexpected development imaginable: long-term remission and in some cases, cure. Patients—namely those with childhood leukemia and Hodgkin's lymphoma—were going into remission and in various instances were considered cured thanks to the key breakthrough in understanding how chemical therapy might best defeat a cancer: in combinations.

Combination chemotherapy regimens—using multiple drugs to kill cancer cells in various stages of division—were producing results in blood cancer patients who just a decade or two prior, were seen to have a death sentence. The first such regimen was VAMP (vincristine, Adriamycin, methotrexate and prednisone), which was followed by MOPP (mustargen or nitrogen mustard, vincristine, procarbazine and prednisone). Although VAMP is no longer in common use, MOPP (or close variations of it), is still occasionally used as second-line therapy in some cases of Hodgkin's lymphoma.

The next step: Targeted treatments

Cancer treatment in the 1970s and 1980s was dominated by the development of chemotherapy and combination chemotherapy, used as first-line treatment against many different forms of cancer. However, the various risks of chemotherapy—often brutal side effects, the carcinogenic capacity of many chemotherapy drugs to bring about secondary cancers, and the indiscriminate cell and tissue destruction wrought by these drugs—began to weigh heavily on the medical field, and research looked towards less destructive, less systemic drugs to treat cancer. The answer is in targeted treatments.

Whereas chemotherapy drugs attempt to kill every cell they meet, targeted treatments seek out a specific molecular marker on the surface of cells, and when they find them, they kill them. This is the equivalent of a surgical strike, as opposed to the carpet-bombing of chemotherapy.

That said, it remains quite common for targeted treatments such as monoclonal antibodies are often used to greatest efficacy when used with combination chemotherapy and other forms of therapy, including radiation.

The future of chemotherapy

As our understanding of cancer as a molecular disease develops, the transition will likely be away from blindly destructive chemotherapy drugs and towards targeted drugs that can deliver drug payloads to multiple cancerous cell types, since cancer is rarely a disease caused by a single cellular abnormality but rather by multiple abnormalities. Meanwhile, the drive is towards minimizing the side effects of these treatments, since many of them can be as brutal and difficult to deal with as those caused by the oldest and most well-understood chemotherapy drugs.

 

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