Advances and Innovations in Cancer Chemotherapy: From Conventional Cytotoxics to Precision Medicine and Emerging Therapeutics

Abstract: Very precise and individualized approaches developed in chemotherapy have dramatically transformed the treatment of cancer using non-selective cytotoxic agents. In the field of molecular biology, these breakthroughs enabled the development of targeted medications that selectively block the activation of oncogenic pathways, while immunotherapeutic approaches harness the immune system to trigger long-term antitumor responses. Simultaneously, developments in pharmacogenomics have enabled the development of individualized therapy, improved therapeutic effectiveness, and reduced toxicity. New technologies, such as artificial intelligence and nanotechnology, are also expediting the development of medications and treatment regimens, as well as enhancing drug delivery. To overcome resistance and improve therapeutic durability, new therapeutic modalities, such as proteolysis-targeting chimeras, bispecific antibodies, and tumor microenvironment-modulating modalities, are viable choices. Notwithstanding these advancements, problems with cost, accessibility, and acquired resistance continue to hinder long-term therapeutic success. This study presents a systematic description of contemporary chemotherapy practices, critically evaluates their limitations in clinical practice, and provides an overview of emerging technologies that may shape the future of chemotherapy.