Advances in the treatment of cancer have continued at an intense pace over the 25 years since the Handbook of Cancer Chemotherapy was first published in 1982. This is reflected in the expansion of the list of clinically useful antineoplastic drugs from 43 to over 115 and the growth of the Handbook from 280 pages to over 750 pages with the current edition. While the number and benefit of cytotoxic agents has continued to grow over this time, the greatest change has been the development and demonstrated efficacy of a new class of systemic treatments called molecular targeted therapy, which has resulted from the wealth of biologic discoveries and insights into the etiology and behavior of cancer that have taken place over the last quarter century. Although the ultimate role that these new agents will play in the control of cancer remains to be seen, they have clearly changed the face of cancer treatment and will undoubtedly become more dominant in cancer treatment over the next decade. For this reason, we have expanded the coverage of these agents in the discussion of the biologic and pharmacologic basis for chemotherapy, in the description of characteristics and use of chemotherapeutic and biologic agents, and in the chapters on the treatment of individual cancers.
As with previous editions of this book, primary indications, usual dosage and schedule, special precautions, and expected toxicities have been added for new drugs and biologic agents that oncologists have begun to use in the past 5 years, and new data have been added to the information for many of the older agents. Each of the chapters dealing with specific cancer sites has been revised to reflect current best medical practice and to point the way toward future advances. The section on supportive care has been updated to highlight those issues and pharmacologic agents that are most essential to the daily care of patients with cancer. Because cancer screening is so important to reducing the number of cancer deaths, current American Cancer Society screening guidelines have been continued in the appendix, along with an updated list of helpful Internet addresses for cancer information.
The Handbook continues to be a practical pocket or desk reference, with a wide range of information for oncology specialists, nononcology physicians, house officers, oncology nurses, pharmacists, and medical students. It can even be read and understood by many patients and their families who want to be able to find practical information about their cancer and its treatment. Unlike many other books, the Handbook combines in one place the most current rationale and the specific details necessary to safely administer chemotherapy for most adult cancers.
The realization of a more specific, less toxic, and more effective medical treatment for cancerÑÐФ which has been stimulated by the tremendous recent increase in information on the molecular basis of cancerÑÐФ is still in its early days, but patients have already reaped the benefits of these developments. Growing from the first agents rituximab, trastuzumab, and imatinib (which 10 years ago were just entering the clinical practice arena), there are now a host of other molecular targeted therapies. Prominent among the new agents now in clinical use are those that target signal transduction pathways crucial for delivering messages from the outside environment into the nucleus to enable it to carry on the crucial processes of survival of the cell, including cell proliferation and differentiation. Other new agents target the cancer cell milieu through inhibition of angiogenesis, selectively impede degradation of proteins involved in cell proliferation and survival, or modulate other intracellular pathways critical to maintenance of the cancer phenotype.
Cure of cancer with less toxic systemic treatment has been a long-term aspiration for many people: those engaged in cancer research, physicians who daily are faced with anxious patients who have cancer, and others in the health professions. It has also been a fervent hope of patients and their families. Although cure is possible for some common tumors, particularly when there is only micrometastasis, and for some more advanced tumors such as lymphomas, for most patients chemotherapy remains palliative, at best. When curing and minimizing the cancer can no longer be achieved, then expert, compassionate supportive care becomes the essential and appropriate focus of the oncology team.
Progress is always slower than patients, physicians, and basic scientists would like. Current research that joins the expertise and discoveries of the basic scientist, systematic investigation through clinical trials by the clinician, and their interaction in ÑÐЬtranslationalÑÐÐ research continues to offer a realistic expectation of accelerated progress in the control of cancer in the decades ahead.
