Published online by Cambridge University Press: 05 November 2015
The role of systemic anti-cancer therapy (SACT) in the management of cancer is evolving rapidly with widening indications for treatment and, in many diagnoses, additional therapies and lines of treatment now available. In 2015, there are now over 140 drugs licensed to be used for cancer treatment and it is not practical within this chapter to give a comprehensive description of each drug or treatment regimen. More detailed information can be found in chemotherapy textbooks, at the manufacturers' websites, the electronic Medicines Compendium (eMC) or from oncology pharmacy websites (e.g. http://www.medicines.org.uk/emc and www.bccancer.bc.ca, accessed January 2015). However, we hope this chapter, which focuses mainly on classic cytotoxic chemotherapy drugs, will provide SACT prescribers, pharmacists and administrators with sufficient information to discuss treatment with patients, to prescribe and deliver drugs safely and to recognise common treatment-related side effects.
Over the last decade there has been a major increase in activity and workloads within chemotherapy treatment units. The 2009 National Cancer Advisory Group report described an increase in overall activity of 60% in just a four year period (NCAG, 2009). This rise in activity is in part a result of increased numbers of patients but there has also been a major expansion in the indications for which there is effective treatment, the upper age range of patients treated and, in many malignancies, the number of lines of therapy available for use. Whilst the newer drugs are predominantly oral agents, the recent development of maintenance monoclonal antibody therapies for breast cancer and non-Hodgkin lymphoma and the more modern prolonged and complex regimens in gastrointestinal malignancies have added considerable pressure to the workload of pharmacy and chemotherapy treatment units.
A summary of the rapid increase in both the number of new cancer treatment drugs and the change in identity of new SACT agents can be see in Table 1.1 that shows both the historical and modern trends in new cancer drugs. This demonstrates the change from the initial cancer treatment drugs of the 1970s/80s/90s that were predominantly classic cytotoxic chemotherapy agents to a new, varied range of agents including monoclonal antibodies, TKI and MTOR inhibitors and other new agents (Savage and Mahmoud, 2013).