Combination Therapy
Commonly, several chemotherapy drugs are combined (combination chemotherapy). The rationale for combination chemotherapy is to use drugs that work on different parts of the cancer cell's life cycle, thereby increasing the likelihood that more cancer cells will be killed. When drugs with different toxicities are combined, each drug can be used at its optimal dose, helping avoid intolerable side effects. Finally, drugs with very different properties are sometimes combined. For example, drugs that kill tumor cells may be combined with antibodies or with drugs that stimulate the body's immune system against cancer (biologic response modifiers).
For some cancers, the best approach is a combination of surgery, radiation, and chemotherapy. Surgery or radiation therapy treats cancer that is confined locally, while chemotherapy also kills cancer cells that may have spread. Sometimes radiation or chemotherapy is given before surgery to shrink a tumor, thereby making the complete removal of the tumor using surgery more likely, or after surgery to destroy any remaining cancer cells. The stage of the cancer often determines whether single therapy or a combination is needed. For example, early-stage breast cancer may be treated with surgery alone or surgery combined with radiation therapy, chemotherapy, or with all three treatments, depending on the size of the tumor and the risk of recurrence. Locally advanced breast cancer is usually treated with chemotherapy, radiation therapy, and surgery.
Sometimes combination chemotherapy is used not to cure but to reduce symptoms and prolong life. Combination chemotherapy can be useful for people with advanced cancers that are not suitable for irradiation or surgical treatment (for example, those with nonsmall cell lung cancer, esophageal cancer, or bladder cancer).
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