Cytotoxic chemotherapy

Aldoxorubicin is doxorubicin, the workhorse chemotherapy nicknamed the red devil, attached to a linker that hitches it to the body's own albumin so more reaches the tumour and less reaches the heart; it beat doxorubicin in a randomised phase 2 sarcoma trial but missed the primary endpoint of its phase 3, and a new company is now trying to finish its development.

Alitretinoin gel is a vitamin A derivative applied directly to Kaposi sarcoma skin lesions in people with AIDS, approved in the United States in 1999 as the first topical treatment for the disease.

Altretamine is an oral chemotherapy tablet approved in 1990 as a single agent for ovarian cancer that has persisted or come back after platinum-based treatment, now rarely used.

Aminopterin was the first drug to send childhood leukaemia into remission. In 1948 Sidney Farber reported temporary remissions in children with acute leukaemia, the birth of cancer chemotherapy; its safer cousin methotrexate replaced it within a decade.

Amrubicin is a Japanese anthracycline approved there in 2002 for small cell and non-small cell lung cancer, a standard second-line option for small cell lung cancer in Japan that failed to beat topotecan in a Western phase 3 trial and now serves as the comparator in global trials.

Amsacrine is an intravenous leukaemia drug, approved in Europe, Canada and Australia in the 1980s, used mainly for acute myeloid leukaemia that has relapsed or resisted anthracycline-based treatment.

An enzyme that starves leukaemia cells of an amino acid they cannot make; a mainstay of childhood ALL therapy for 50 years, with new versions solving allergy and supply problems.

A gentle chemotherapy that switches silenced genes back on. With venetoclax it became the standard for older people with AML who cannot take intensive treatment.

An East German chemotherapy rediscovered in the 2000s that became the backbone partner for rituximab in follicular, mantle cell and Waldenström lymphomas.

Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.

Busulfan is one of the oldest cancer drugs. As a tablet it controlled chronic myeloid leukaemia before imatinib; as an infusion it is used to clear the bone marrow before a stem cell transplant.

A second taxane that works after docetaxel and beat a second hormone pill head-to-head (CARD).

Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.

CAPTEM (capecitabine plus temozolomide) is an all-oral chemotherapy pair that shrinks pancreatic neuroendocrine tumours in about a third of patients.

CAPOX pairs the oral fluoropyrimidine capecitabine with intravenous oxaliplatin as a pill-based alternative to FOLFOX. For low-risk stage III colon cancer three months after surgery works as well as six and halves nerve damage; it is also standard in gastric cancer, with hand-foot syndrome as its price.

Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.

Carmustine is a chemotherapy that reaches the brain. It is given by infusion for brain tumours, lymphoma and myeloma, and as a slow-release wafer left in the cavity after a brain tumour is removed.

Chlorambucil (Leukeran) is a gentle oral chemotherapy tablet used for decades in chronic lymphocytic leukaemia and low-grade lymphomas, mainly in older patients.

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

A one-week infusion that puts most people with hairy cell leukaemia into remission for years; also used in multiple sclerosis in tablet form.

Clofarabine (Clolar) is an infusion for children and young adults whose acute lymphoblastic leukaemia has come back after at least two other treatments.

The two old chemotherapy drugs packed together into tiny fat bubbles at a fixed ratio, which doubled five-year survival in older adults with high-risk AML.

Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.

Cytarabine is the core chemotherapy for acute myeloid leukaemia, given with an anthracycline as the classic 7+3 induction and at high doses for consolidation; it is also injected into the spinal fluid to treat or prevent leukaemia in the brain.

The intensive chemotherapy that has induced remission in fit AML patients since 1973: seven days of one drug, three of another. Still the backbone that targeted drugs are added to.

Dacarbazine is an older chemotherapy infusion. It was the standard treatment for advanced melanoma for decades and is the D in the ABVD regimen that cures most Hodgkin lymphoma.

The first antibiotic used as an anticancer drug (1954) and still the core of chemotherapy for Wilms tumour, rhabdomyosarcoma and gestational trophoblastic disease.

Daunorubicin is the anthracycline most often combined with cytarabine to bring acute myeloid leukaemia into remission; it is also part of induction for acute lymphoblastic leukaemia.

Devimistat tried to starve pancreatic cancer cells of their energy supply alongside chemotherapy; the phase 3 AVENGER 500 trial found no survival gain.

The first chemotherapy to extend life in prostate cancer (2004), now part of triplet therapy at first metastatic diagnosis.

Doxifluridine is an oral fluorouracil prodrug approved in Japan in 1987 and used in China and Korea for stomach, bowel and breast cancers; capecitabine, which the body turns into doxifluridine, later carried the same idea to the rest of the world.

The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.

Epirubicin (Ellence) is a close relative of doxorubicin used mainly after breast cancer surgery when lymph nodes are involved, and in stomach cancer regimens; it is a little kinder to the heart.

A sea-sponge-derived chemotherapy that extended survival in heavily pretreated breast cancer and in liposarcoma, where almost nothing else had.

Eryaspase packed a leukaemia enzyme into red blood cells to starve pancreatic cancer of an amino acid; the phase 3 TRYbeCA-1 trial missed its survival goal.

Estramustine is an oral prostate cancer drug that combines an oestrogen with an alkylating agent, approved in the United States in 1981 for metastatic disease and later combined with taxanes, though its clotting risk has pushed it out of routine use.

Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.

FLOT is the four-drug chemotherapy given before and after surgery for stomach cancer in the West; since 2025 immunotherapy is added to it.

Floxuridine is a cousin of fluorouracil pumped directly into the liver's artery to treat bowel cancer that has spread to the liver, delivering a very high local dose with little reaching the rest of the body.

Fludarabine is a chemotherapy infusion for chronic lymphocytic leukaemia. It anchored the FCR regimen that was the first to give long remissions, and today it is used above all to prepare patients for CAR-T cells and transplants.

The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.

FOLFIRI is the other backbone bowel-cancer chemotherapy, swapping oxaliplatin for irinotecan. Used first or second line and, since 2026, with the BRAF combination.

FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.

FOLFOX is the workhorse chemotherapy combination for bowel cancer, used after surgery to cure and in advanced disease as the backbone that targeted drugs are added to.

All three of the active bowel cancer chemotherapy drugs given together instead of two. It shrinks more tumours than a doublet and is chosen when shrinking the tumour is what matters, usually with bevacizumab.

A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.

Gemcitabine plus cisplatin has been the chemotherapy backbone for bile duct cancer since 2010 and is now given with immunotherapy.

Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.

Hydroxyurea is a cheap, decades-old pill that lowers high blood counts in polycythaemia vera and essential thrombocythaemia and is also the main drug for sickle cell disease.

Idarubicin is an anthracycline chemotherapy approved in 1990 for adult acute myeloid leukaemia, given with cytarabine in 3+7 induction and FLAG-Ida salvage and in acute promyelocytic leukaemia protocols. Randomised trials showed more complete remissions than with daunorubicin, which is why centres prefer it; heart damage, marrow suppression and extravasation injury are the class risks.

Ifosfamide is an alkylating chemotherapy partnered with doxorubicin in sarcoma and with etoposide in Ewing sarcoma, given with a bladder-protecting drug.

Irinotecan is a topoisomerase-blocking chemotherapy central to bowel and pancreatic cancer regimens (FOLFIRI, FOLFIRINOX, NALIRIFOX) and to salvage therapy in childhood sarcomas; it carries the same warhead as the deruxtecan ADC payloads.

Ixabepilone (Ixempra) is a chemotherapy infusion for breast cancer that has stopped responding to anthracyclines, taxanes and capecitabine.

Leucovorin is not a cancer drug in itself: it rescues normal tissue after high-dose methotrexate and, given with fluorouracil, makes that chemotherapy work better, which is why it appears in FOLFOX, FOLFIRI and FOLFIRINOX.

Irinotecan wrapped in a fat bubble so it circulates longer. It is approved for pancreatic cancer, and in bile duct and gallbladder cancer one Korean trial found it helped as second-line treatment while a German trial did not.

An old chemotherapy pill used when glioblastoma comes back, and the control arm most new glioblastoma drugs must beat.

A marine-derived chemotherapy that jams cancer's gene-reading machinery, approved for relapsed small-cell lung cancer and, since 2025, as first-line maintenance with atezolizumab.

Mechlorethamine, or nitrogen mustard, was the first chemotherapy ever used, in 1940s Hodgkin lymphoma. Today its main use is as a skin gel (Valchlor in the US, Ledaga in Europe) for early cutaneous T-cell lymphoma.

The myeloma chemotherapy that is also the standard high-dose conditioning before autologous transplant, and, delivered directly into the liver's blood supply or the eye, treats uveal melanoma metastases and retinoblastoma.

Mercaptopurine is a daily tablet, or a liquid for children, that keeps acute lymphoblastic leukaemia in remission during the long maintenance phase of treatment.

The 1948 antifolate that produced the first chemotherapy remissions in childhood leukaemia and the first cure of a solid tumour; still essential in ALL, lymphoma, osteosarcoma and CNS lymphoma.

Mitobronitol was a Hungarian-developed oral tablet used in Europe from the 1960s to control chronic myeloid leukaemia and polycythaemia, an alternative to busulfan that disappeared once hydroxycarbamide, interferon and imatinib took over.

The chemotherapy given with radiation to cure anal cancer without surgery, used as a bladder instillation after tumour resection, and since 2020-25 in gel form for upper-tract and recurrent bladder cancers.

A relative of the insecticide DDT that is the only drug specific to adrenal cortex cancer; it needs blood-level monitoring and permanent steroid replacement.

Mitoxantrone is a blue chemotherapy infusion used with cytarabine for acute myeloid leukaemia and, historically, to relieve pain in advanced prostate cancer; it is also licensed for multiple sclerosis.

Paclitaxel bound to albumin so it needs no solvent and no steroid premedication. Adding it to gemcitabine and cisplatin looked promising in a small study of bile duct and gallbladder cancer but did not lengthen life in the 452-patient SWOG S1815 trial.

NALIRIFOX is a version of FOLFIRINOX using a liposome-wrapped irinotecan, approved in 2024 as a first-line option for metastatic pancreatic cancer.

Nedaplatin is a Japanese platinum drug, approved there in 1995, used for head and neck, oesophageal, lung, cervical and other squamous cancers as a gentler alternative to cisplatin on the kidneys; it has never been approved in the West.

Nelarabine (Arranon) is an infusion for T-cell acute lymphoblastic leukaemia and lymphoma that has come back after at least two other treatments; it is now also added to first-line therapy for children with T-cell leukaemia.

The platinum drug that works in bowel cancer where cisplatin does not, the 'OX' in FOLFOX and CAPOX; its cost is nerve damage in hands and feet.

A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.

Doxorubicin wrapped in a fatty bubble so it reaches tumours with less heart damage; a workhorse of relapsed ovarian cancer.

Pemetrexed is the chemotherapy that, with a platinum drug, became the first approved treatment for mesothelioma in 2004, and is still the backbone today.

An intravenous drug given every other week that produces long remissions in hairy cell leukaemia by poisoning the leukaemic lymphocytes' purine metabolism; cladribine is the one-week alternative.

Pipobroman was an oral tablet approved in 1966 for polycythaemia vera, the blood disorder that makes too many red cells, and for chronic myeloid leukaemia; it was discontinued after studies showed it raised the risk of leukaemia compared with hydroxycarbamide.

Pirarubicin is a doxorubicin relative developed in Japan and used there and in China for breast cancer, lymphoma, bladder cancer and other tumours, including instillation into the bladder after tumour resection.

Pixantrone is an anthracycline-like drug engineered to spare the heart. The European Union authorised it in 2012 as a single agent for adults with aggressive B-cell lymphoma that had relapsed several times; the authorisation expired in June 2024 when the company did not renew it.

Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.

Plicamycin, approved in 1970, was a chemotherapy for testicular cancer that fell out of use as cisplatin arrived, and was kept for treating dangerously high calcium levels caused by cancer until it was discontinued in 2000.

Plitidepsin is a chemotherapy derived from a Mediterranean sea squirt, approved in Australia in 2018 with dexamethasone for multiple myeloma after several other treatments; the European regulator refused it, and it drew attention in 2021 as a possible COVID-19 antiviral.

Porfimer sodium is the drug half of photodynamic therapy: injected, it gathers in tumours, and a laser passed through an endoscope two days later activates it to burn away oesophageal and lung tumours that block the airway or gullet.

Pralatrexate was the first drug approved specifically for relapsed peripheral T-cell lymphoma; about a third of patients respond.

Procarbazine (Matulane) is an old chemotherapy capsule from the MOPP regimen for Hodgkin lymphoma; it is now used mainly in the PCV combination for certain brain tumours.

Raltitrexed is a three-weekly intravenous antifolate used in Europe, Canada and Australia for advanced bowel cancer, and with cisplatin for mesothelioma, in patients who cannot take fluorouracil.

A first-in-class drug that blocks cortisol signalling in tumour cells, approved in 2026 for platinum-resistant ovarian cancer with chemotherapy.

Streptozocin is a chemotherapy drug that seeks out pancreatic islet cells, approved in 1982 for the rare tumours that arise from them; the same selectivity makes it the standard way to induce diabetes in laboratory animals.

Teysuno (S-1) is an oral chemotherapy combining a fluorouracil pro-drug with two protectors. It is a standard in Japan and approved in Europe for stomach cancer with cisplatin and for bowel cancer when other fluoropyrimidines cause hand-foot syndrome or heart problems.

The only chemotherapy proven to extend life in glioblastoma, given during and after radiation. It works best when the tumour has switched off a repair gene called MGMT.

Teniposide is a close relative of etoposide approved in the United States in 1992 for children whose acute lymphoblastic leukaemia has come back after induction, and used in Europe for childhood brain tumours and neuroblastoma.

Thioguanine (Tabloid) is an oral chemotherapy tablet used in some regimens to induce and consolidate remission in acute myeloid leukaemia; long-term use is avoided because it damages the liver.

Thiotepa is an old chemotherapy with a modern job: at high doses it prepares patients for stem cell transplants, and it is still instilled into the bladder or body cavities for superficial bladder cancer and malignant effusions.

Topotecan is the long-standing second-line chemotherapy for relapsed small-cell lung cancer, and now the comparator that new drugs must beat.

A chemotherapy derived from a sea squirt, used with liposomal doxorubicin in relapsed ovarian cancer in Europe and for sarcomas.

A conditioning chemotherapy given before donor stem-cell transplant in AML and MDS; it was long used in Europe and reached the US in 2025.

An oral chemotherapy pill for bowel cancer that has stopped responding to everything else; with bevacizumab it extends life by about three months.

Uracil mustard was an oral alkylating agent approved in 1962 for chronic lymphocytic leukaemia and lymphomas, one of the early nitrogen mustard tablets, and long since discontinued.

Utidelone is Biostar Pharmaceuticals' epothilone chemotherapy, approved in China in 2021 with capecitabine for advanced breast cancer after anthracyclines and taxanes.

Vinblastine is the vinca alkaloid in ABVD, the standard Hodgkin lymphoma regimen, and was formerly in the cisplatin combinations that first cured testicular cancer.

A plant-derived chemotherapy from the Madagascar periwinkle that has been in almost every childhood leukaemia and lymphoma regimen since the 1960s.

Vindesine is a vinca alkaloid, a semi-synthetic relative of vinblastine, used in Europe and elsewhere for acute lymphoblastic leukaemia and some solid tumours; it was never marketed in the United States.

Vinflunine (Javlor) is a chemotherapy infusion used in Europe as a second treatment for advanced bladder cancer after platinum chemotherapy has stopped working.

Vinorelbine is a vinca chemotherapy for lung and breast cancer, available orally, and is now part of maintenance therapy that improved survival in childhood rhabdomyosarcoma.