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Textbook of Medical Oncology, 2nd Edition

Textbook of Medical Oncology, 2nd Edition

In this day of encyclopedic oncology texts, frequently
updated online reference sites, and literature searches at the click of a
button, is there a place for a basic medical oncology textbook? The second
edition of the Textbook of Medical Oncology, edited by Drs. Cavalli, Hansen, and
Kaye, is approximately 50% longer than the first edition, due in large part to
the inclusion of newer therapeutic approaches.

The book differs from many other general oncology texts in two ways. First,
the information is presented from a medical oncology viewpoint, eschewing
details of surgical and radiation techniques in favor of a focus on systemic
therapy issues. Second, because the editors and many of the contributors are
European, studies coordinated by the European Organization for Research and
Treatment of Cancer (EORTC) and other regional or national European cooperative
groups figure more prominently in discussions of the evolution of various
treatments than they do in most US texts.

The text opens with a well-written chapter on the molecular biology of cancer
that uses easy-to-follow text and illustrations to explore topics ranging from
the somatic mutation theory of cancer through oncogenes, tumor-suppressor genes,
signal transduction, and cell-cycle control to the possible role of gene therapy
in reversing the malignant phenotype. It features an extremely useful glossary
of molecular biology terms that may be unfamiliar to clinicians. This chapter is
followed by one on the principles of systemic therapy. Detailed descriptions of
approved antineoplastics are supplied in an appendix, allowing this chapter to
focus on concepts and to include discussions of novel approaches such as
tumor-specific immunotherapy, gene therapy, and the identification of new
biologic targets (signal transduction pathways and tumor-induced angiogenesis).

The third chapter is an excellent introduction to clinical trial design and
interpretation. It takes a would-be investigator through the major issues
associated with designing a study, including the selection of appropriate end
points, from tumor response and survival through toxicity, impact on quality of
life, and cost-effectiveness analysis. It also addresses timely issues such as
the challenge of choosing appropriate end points for studies of noncytotoxic
therapies, the risks of subgroup analysis, and the strengths and weaknesses of
meta-analysis.

The next 15 chapters address malignancies by organ system, and although they
focus on the most common cancers affecting that organ system, they also address
many less common malignancies. In general, the discussions achieve a balance
between historical and current data to support general treatment recommendations
and important research questions going forward. Extensive bibliographies include
many of the pivotal papers in each area.

Many of the individual chapters are excellent and short enough to be digested
in one sitting, but with sufficient detail to provide a good base of information
from which to approach most common clinical situations or to assess newly
presented or published data. One notable exception is the chapter on breast
cancer, which presents lists of potential prognostic factors and treatment
options without sufficient guidance on the relative value of each. In that same
chapter, the author asserts that ductal carcinoma in situ (DCIS) is
"usually treated by some form of radical surgery"; in fact,
breast-conserving surgery has become the treatment of choice for many women with
DCIS.

Given the lead time required to produce a textbook, it is not surprising that
certain novel therapies—such as the potential of BCR-ABL tyrosine kinase
inhibition in chronic myelogenous leukemia—are mentioned only briefly, if at
all. Other omissions are more puzzling—for example, the absence of a
discussion of the influence of BRCA1/BRCA2 mutations on the incidence of ovarian
cancer, the treatment and screening options available to women identified as
being at high risk, and the passing mention of interleukin-2 (Proleukin) and
biochemotherapy as systemic therapy for advanced melanoma.

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