General progress in clinical chemotherapy of advanced disease.

Abstract

Advanced cancer, because of its accompanying tumor burden, complex adverse host effects, and cellular heterogeneity, will prove much more difficult to control successfully than grave infectious diseases such as tuberculosis. This will likely be so, even when moderately successful chemotherapy is or will be available. Nevertheless, prospects for improving current results are present through application of chemotherapy alone or in combination with other modalities. Important developments include not only the availability of an increasing number of effective drugs, but also a better understanding of drug pharmacology, prediction of tumor cell cytotoxicity, locoregional drug delivery, exploitation of interactions with other forms of local therapy, and delineation of immunologic factors in tumor control. The single, most likely contribution to a curative approach to cancer, however, is likely to emerge from the application of aggressive systemic treatment in the circumstances of minimal residual disease. This topic is covered elsewhere.