Any new medical textbook must compete for readership under new rules. It is not just the numerous other books being published but also the wealth of information on the Internet that vies for the time and attention of the inquiring reader. Web-based general search engines and medical literature tools have made the previous frequent trips to the hospital library nearly obsolete for many of us. There is ready access to original references or discussion about almost any topic in cancer care. A successful book on cancer treatment, therefore, must provide more—something unique for the practicing physician, student, or teacher. Ideally, it will present a useful synthesis, interpretation, and, with luck, clinical wisdom.
The fourth edition of Current Cancer Therapeutics meets some of these criteria by offering a useful compendium of information and periodic passages of clinical savvy. It is a multiauthored text with nearly 70 contributors. The editors are senior clinicians and investigators with broad experience in medical, surgical, and nursing oncology, who have selected chapter authors with similar expertise in clinical oncology and cancer investigation. The title implies a treatment-oriented text directed at a clinical audience; it achieves that promise with a series of chapters describing categories of drugs, disease-directed treatments, and supportive care.
The emphasis on "therapeutics" as meaning essentially drug treatment is a reasonable focus for much of the book and is the specific target of the initial chapters. Agents are classified as alkylating/platinating, antimetabolic, biological, hormonal, and tubulin-targeting. (In the next version, there will surely be a section on kinase inhibitors and antibodies.) Each of these sections begins with background information, including some history and discussion of general features, such as pharmacology or the mechanisms of resistance pertinent to all the agents in the class.
Following this is a page or two on each chosen drug. The selection of drugs is sometimes open to debate. For example, given its current limited use in cancer therapeutics, does levamisole(Drug information on levamisole) (Ergamisol) deserve an entire entry? These individual drug sections are formatted into consistent topics of dosage, indications, pharmacokinetics, special precautions, and so forth. This makes for quick reference and is useful when checking on a specific drug in a clinic or when reviewing a treatment plan. The information presented is appropriate for students as well as for practicing doctors and nurses.
Each disease category follows a similar format, with an initial discussion of the disease and then individual sections of a page or two directed at treatment regimens. Some of the discussions offer the sought-after clinical wisdom that is often difficult to find in primary research papers. For example, in the breast cancer section, the authors highlight the dilemma of using both ovarian ablation and tamoxifen(Drug information on tamoxifen). Although survival may be longer with such a combined-modality approach, toxicity may not justify use of the combination. In many of the protocol sections that follow, a useful graphic showing the treatment schema is presented.
Occasionally, there are significant errors that need to be corrected in the next edition. Discussion of the adjuvant AC regimen (doxorubicin, cyclophosphamide(Drug information on cyclophosphamide) [Cytoxan, Neosar]) cites the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-15 reference, which calls for administration of the regimen every 21 days for four cycles. However, in the graphic schema, the title of the table describes 28-day cycles × 6. For those familiar with breast cancer treatment, this is obviously an error, probably carried over from the CMF (cyclophosphamide, methotrexate(Drug information on methotrexate), fluorouracil(Drug information on fluorouracil)) experience. Tolerance for such editorial lapses in a book emphasizing treatment regimens should be near zero.
A related but more minor problem that might be remedied in the next edition is the repeated appearance of the disclaimer regarding prescriber caution at the bottom of each page. Is it really necessary to include a statement on every page in a bolded background that "information is… provided as guidance only…"? I would prefer that the editors and publisher’s legal department work out a better method.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
