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Introduction
Cancer therapy has been an area of constant discovery and evolution over the past two centuries, with innovative therapeutic strategies being developed as understanding of the underlying biologic processes increases. This has led to an expansion of treatment options in recent years with newer, more effective, and better-tolerated alternatives developed seemingly daily.
Until the early 20th century, surgical excision of tumors remained the mainstay of cancer therapy. Perhaps the most influential individual to have shaped the surgical approach to cancer was William Halstead (1852-1922) through his advocacy for the en bloc resection of the tumors and enough surrounding tissue to remove all the cancer cells. However, this approach was useful only for solid tumors that had not spread beyond their site of origin. With the discoveries of X-rays by Roentgen and radium by Pierre and Marie Curie, radiation therapy was introduced as a second modality to combat cancer.1 Nitrogen mustard, used during the first World War as an agent of chemical warfare, was noted to have destructive effects on white blood cells, and subsequently was approved by the U.S. Food and Drug Administration (FDA) as a chemotherapeutic agent against Hodgkin lymphoma.2 This marked the advent of cancer chemotherapy as an adjuvant to surgery and radiation. Successful trials involving Hodgkin lymphoma and childhood leukemia using regimens such as MOPP (nitrogen mustard, vincristine, procarbazine, prednisone) and prednisone with 6-MP (6-mercaptopurine) introduced the concepts of combination chemotherapy in the 1960s.3,4 For the next several decades, surgery, radiation, and chemotherapy would remain the mainstays of cancer therapy.
In recent years, a paradigm shift has occurred in cancer therapeutics. A vast number of newer treatment modalities are being used today, including targeted therapies, cancer vaccines, and, most recently, immunotherapy. Since 2006, the FDA has approved more than 130 new cancer drugs and indications for their use.5
Such major improvements in the ability to fight cancer have led to a 27% decline in death rates and increased five-year survival rates. Two-thirds of people diagnosed with cancer live at least five years after diagnosis. The projected population living with a cancer diagnosis is expected to grow to nearly 26 million by 2040, with 73% of survivors 65 years of age or older.5,6 In turn, this...