Chemotherapy started in the early 20th century when scientists observed nitrogen mustards suppressed bone marrow activity. Early chemotherapy was given as a palliative, but over time the goals adjusted to causing remission or cure.

While the other mainstays of cancer treatment – radiation therapy and surgery – are directed at one portion of the body at a time, chemotherapy is a systemic treatment. The anti-cancer drugs travel through the body and can attack cancerous cells anywhere.

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Explanation of how medicines are named

Spreadsheet of chemotherapy agents: All Chemotherapy Agents

In Excel format: All Chemotherapy Agents

PDF of above table: All Chemotherapy Drugs

Properties we want in anti-cancer medicines

How would you attack a cancerous cell? In a body full of trillions of cells, how do you get the cancerous ones and not the healthy ones.  It’s not easy, and devising a method that can kill only malignant cells while leaving normal cells unscathed is a holy grail of cancer.

If we could have the ideal chemotherapy drug, what characteristics would it have? Some ideas:

• Would work both to cure cancer and to prevent it
• Easy to give to patients, avoids needles or extended administration times.  Oral administration in a pill might be ideal
• Has no negative effect from chronic administration
• Rapidly shrinks tumor and/or kills cancer cells with no effect on non-cancerous cells.  In other words, has high specificity for cancer.

And what biochemical targets would these drugs aim at?  Perhaps those:

• High level of expression in neoplastic tissue
• Important in pathogenesis of cancer
• Not important in regular functioning of tissue
• Susceptible to pharmacological disruption
• If you inhibit the target, you stop or slow the cancer

The earliest antineoplastic compounds aimed at cellular reproduction. One way malignant cells differ is in that they reproduce more quickly than other cells. If you send in a drug to disrupt the mitosis (cell dividing) process, you can affect fast-multiplying cancerous cells more than normal cells. And this is the method by which most chemotherapy drugs have their effects. Kill the cells while they divide. We say the drugs are cytotoxic.

Of course the specificity is not even close to perfect, which means many healthy cells are inadvertently killed. That’s why chemotherapy drugs have severe side effects.

This also explains why side effects show up where they do. In the cancer-free body some cells multiply faster than others. Cells in the bone marrow, skin, lining of the digestive system, for instance, grow faster than most cells, and that’s why common side effects include anemia, skin rashes, and nausea.

The cell reproduction cycle is complex and different chemotherapy drugs attack different points in the cycle, so we see somewhat different side effects from different drugs.

This is why chemo nay-sayers say chemo is poison. The difference between a poison and a medicine is at least partly in the intent of the administrator.

Liver and Kidney damage

The body eliminates foreign substances largely through action of the kidneys and liver. The liver metabolizes foreign substances – that is – it chemically transforms them to different materials. If these foreign substances are poisons, the liver might be able to make them non-poisonous, or less poisonous. The kidneys are super-filters that remove unusual materials from the bloodstream. When the kidneys function correctly, foreign substances are sent to the urine stream and they exit the body.

Because they are at the front line in the war against poison, the kidneys and liver often take the most damage, and emergency room doctors know to check liver and kidney function when a patient has swallowed something hazardous. Likewise, liver and kidney damage happens during chemotherapy treatment and is a particular danger if the dose is too high. The assault on these organs is fundamentally different from the side effects chemotherapy bring; damage to the liver and kidneys is acute and often causes immediate cessation of the cancer treatment. Further, if the cancer itself damages the liver or kidneys, options for chemotherapy treatment are reduced.

Popular combination regimens for chemotherapy.

The economics and market structure of the chemotherapy industry.

Chemotherapy agents on WHO List of Essential Medicines.

Chemo FDA Approved for Specific Cancers

Medicines Approved for Specific Cancers (A-D)

Medicines Approved for Specific Cancers (E-L)

Medicines Approved for Specific Cancers (M-Z)