EGFR antagonists in cancer treatment.

Oral chemotherapy is emerging as a new option for well-selected patients who can manage potentially complex oral regimens and self-monitor for potential complications. If a choice between oral and parenteral therapy is available, patients may opt for oral chemotherapy because it is more convenient to administer, allows them to avoid multiple office visits, and gives them a sense of control over their own cancer care. Whether these potential advantages are maintained in regimens that combine oral and parenteral drugs is less clear. The use of oral chemotherapeutic agents profoundly affects all aspects of oncology, including creating significant safety and adherence issues, shifting some traditional roles and responsibilities of oncologists, nurses, and pharmacists to patients and caregivers. The financing of chemotherapy is also affected. To address these issues, the NCCN convened a multidisciplinary task force consisting of oncologists, nurses, pharmacists, and payor representatives to discuss the impact of the increasing use of oral chemotherapy. (JNCCN 2008;6[Suppl 3]:S1–S14) Oral chemotherapeutic drugs have been available fordecades and include the familiar agents chlorambucil,cyclophosphamide, methotrexate, and 6-mercapto-purine (6-MP). However, the past 4 years has seen anaccelerating expansion of the development of oralanticancer drugs, including oral cytotoxic agents, smallmolecule inhibitors directed at cell surface receptorsand other proteins, and other agents targeted at thetumor microenvironment.Capecitabine received FDA approval in April 1998,ushering in a new era of oral chemotherapy. Capecitabineapproval was followed by FDA approval of a number oforal small molecule inhibitors of a variety of defined tar-gets, including imatinib in 2001, gefitinib in 2003, anderlotinib in 2004. Five more new oral agents were then © Journal of the National Comprehensive Cancer Network Volume 6 Supplement 3 March 2008JNSU3_GUID_60300bach.qxd 3/21/08 8:44 PM Page S-1