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Palliative chemotherapy is aimed at prolonging survival and improving patient comfort.

Statistically, there is no, or very little improvement on survival.

The response rate is low (15-20%) or the duration of response is short (from a few months to a year). However, a few patients may benefit from a good response with a clear advantage in terms of survival, thus fully justifying such palliative chemotherapy. Others will not benefit from the treatment and will only suffer from its side effects.

Thus, a careful attitude should be adopted in order to analyse each toxic symptom and, if necessary, stop the treatment. The same caution should guide physicians when presenting such treatment to the patient or his/her family (always endeavouring not to give false hopes)..

Explanatory diagram of the aim of palliative chemotherapy

In this category of chemotherapy, can be treated:

• myeloid chronic leukaemia (although, with Gleevec, this is, in fact, no longer palliative chemotherapy),

• lymphocytic chronic leukaemia,

• myeloma

For these pathologies, although they are rarely definitively cured by chemotherapy, very long remission may be obtained with excellent quality of life. In these cases, if the word 'palliative' is stricto sensu correct, the increase in survival duration transforms this treatment into pseudo-curative chemotherapy.

Other palliative chemotherapy indications:

• metastatic breast cancer,

• soft tissue sarcoma,

• thyroid carcinoma,

• melanoma (?)..

For these latter palliative chemotherapies, one question should always be asked: is this chemotherapy of genuine benefit to the patient? If the benefit is low or if toxicity is high, then is it legitimate to continue this inefficient treatment, despite my personal desire to treat the patient and his/her desire to nourish hope through such treatment?

Palliative chemotherapy should not cover situations where patients and/or carers want 'to do something' and refuse to accept reality. In all cases, the physician should carefully monitor the efficiency and the toxicity and protect the patient from unnecessary side effects.