ABSTRACT
INTRODUCTION Two-thirds of patients with cancer will develop metastatic or advanced disease during their illness. The most appropriate management for metastatic disease is systemic treatment, and this is most commonly chemotherapy. The possibility of a systemic therapy for cancer has been observed anecdotally for some time – in 1875, Cutler and Bradford induced remission in a patient with chronic myeloid leukaemia by treatment with arsenic.1 During World War I, soldiers who died of mustard gas poisoning (Figure 27.1) were noted to have aplastic bone marrow, suggesting a cytotoxic effect of mustard,2
and, in 1946, Goodman and colleagues3 successfully demonstrated that the cytotoxic effects of the nitrogen mustard could be put to therapeutic use, in the treatment of a mouse transplanted with lymphosarcoma. The first cancer to be cured by chemotherapy
was choriocarcinoma, which has been cured with single-agent methotrexate since the 1950s.
