English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

A bewildering number of clinical studies on the efficacy of cytotoxic chemotherapy for various adult solid tumours has been reported. Enthusiasm among medical oncologists has been generated largely by the dramatic successes achieved by chemotherapy over the past 10 years in fairly uncommon malignancies, such as Hodgkin's disease, histiocytic lymphoma, germ cell tumours, choriocarcinoma, and various solid tumours of childhood. In addition, high rates of partial response are often achieved nowadays with combinations of cytotoxic drugs in several hitherto untreatable adult malignancies. The race to conquer cancer with drugs has been further intensified by the non-medical press and by energetic advertising programmes of pharmaceutical companies. Despite the current wave of enthusiasm the vast majority of chemotherapy is given with palliative intent.1 Thus a rational decision to use cytotoxic drugs must inevitably entail the often complex trade off between likely benefits and expected side effects (both physical and non-physical). The use of toxic, and therefore potentially fatal, cytotoxic drugs should be seriously questioned unless they are likely either to yield a high incidence of durable complete remissions (some leading to ultimate cure) or to cause such regression of advanced cancer that symptomatic relief affords a prolonged period of improved quality of life. Lamentably, however, not only is our ability to assess palliation and quality of life rather rudimentary but the current proliferation of trial results that cannot be properly evaluated (see below) may lead both oncologists and non-oncologists to overestimate the role of chemotherapy and, at the same time, to undervalue the impact of toxicity related to treatment. The problem is compounded by recent technological innovations and a current vogue for intensive investigations to characterise the malignancy accurately in terms of its biological behaviour and extent of spread. Such intensive investigation is often inappropriate to the patient's needs and makes it extremely difficult for the clinician not to "do something," even though he may know enough to appreciate that active treatment might well do more harm than good. Lack of space precludes a discussion of all adult solid tumours, but I have examined here the current impact that cytotoxic chemotherapy is having in the treatment of the most common adult malignancies. To suggest reasonable recommendations on the role of cytotoxic drugs and to define subsets of patients most likely to derive benefit from such treatment I have emphasised those studies from which meaningful conclusions can be drawn.

Cytotoxic chemotherapy for common adult malignancies: "the emperor's new clothes" revisited?