1998/1999 Annual Review - Chemotherapy

History
Not since the late 70’s have there been such exciting times in systemic cancer treatment. At that time a number of new drugs including cisplatin and etoposide were introduced which revolutionised the management of a number of cancers including germ cell tumours, head and neck cancer, ovarian cancer, lung cancer and several others. (Photo: left to right: Jeff Koundakjian, Pharmacy Service Manager and David Smith, Clinical Director Chemotherapy)

During the 1980’s a number of analogues were developed including carboplatin which had some influence in reducing the toxicity of chemotherapy for many patients but probably the major advance during this decade was the improvement in anti-sickness therapy. The introduction of the 5HT3 antagonists and their rational use has transformed the tolerability of chemotherapy for many patients but particularly those receiving cisplatin. Nausea and vomiting which used to be difficult to control in this group of patients, is now more or less a thing of the past.

Current Developments
Now after a period of relatively slow progress there has been an explosion of new and active agents. In the field of endocrine therapy the aromatase inhibitors are now recognised as the most effective and least toxic second line therapy for metastatic breast cancer. At present these drugs are being actively investigated to assess their role as adjuvant therapy. In addition monoclonal antibodies are beginning to find an exciting role in the management of non-hodgkins lymphoma and breast cancer. There have also been major advances in systemic chemotherapy with the introduction of two new groups of drugs, the taxanes and topoisomerase inhibitors. The taxanes have shown major activity in ovarian cancer and breast cancer with emerging activity in other areas. The topoisomerase inhibitors and further platinum based chemotherapy drugs have also shown promising results in previously resistant gastro intestinal cancers.

Costs
As with all developments in medicine new treatments are expensive and within a year it is likely that the most effective first line treatment for advanced breast and colorectal cancer will cost 10-15 times the present level, with similar problems affecting other tumour types. In addition to their use in advanced disease over the next few years, these more expensive drugs are being looked at as adjuvant therapy, which will inevitably further increase budget pressure. Currently we are able to offer a comprehensive state of the art cancer treatment services, but this will become increasingly difficult unless major changes occur in cancer treatment funding. (Photo:Pharmacy Department)

Activity
In addition to the developments in systemic therapy the relentless increase in the use of current standard treatments has continued over the past year. During 1998/99 a total of 16,420 cycles of chemotherapy were administered compared to 15,043 the previous year.