Principles of chemotherapy

Combination chemotherapy is the mainstay of treatment for most childhood cancer, either alone or in combination with surgery and radiotherapy. Sequential national and international studies of combinations of mostly well established cytotoxic drugs, with careful attention paid to the maintenance of dose intensity and the optimization of supportive care to manage acute toxicity, have resulted in dramatic improvements in the outcome for childhood cancer. Increased understanding of the molecular basis of childhood cancer will lead to the introduction of more targeted anti-cancer drugs, probably in combination with existing conventional agents. This will allow the remaining stubbornly drug-resistant childhood cancers to be treated more effectively, but will also allow does reduction of conventional agents in sensitive tumour types, reducing both acute and chronic toxicity. Increasing understanding of both pharmacokinetics and pharmacogenomics offers the opportunity for more personalized anti-cancer treatment, to optimize drug dosing for an individual, and to reduce their toxicity.