The first volume of Cancer Therapy in the Twenty-First Century provides background information on some of the molecular and immunologic approaches that are becoming increasingly important in the diagnosis and management of cancer patients. The 307-page text is divided into four sections with 40 contributors, and contains 45 illustrations and 36 tables.
Oncogenes and tumor suppressor genes are introduced in the first section. Clear definitions and examples provide a very nice review of this evolving field. Well-organized tables show different classification schemes for these genes, as well as their association with various malignancies. The likely physiologic role of these gene products is discussed so as to point out the complexity and the multiple molecular targets/events within a cell that can lead to the transformed phenotype. The current status of oncogenes and tumor suppressor genes in cancer diagnosis and prognosis is summarized. Various interesting approaches to treatment based on this knowledge are discussed, including an extensive segment on the rational development of selective inhibitors of tyrosine kinases.
Section 2 describes advances in cancer prediction, diagnosis, and prognosis. The first chapter focuses on the usefulness of the prostate-specific antigen in the current management of prostate cancer, but it also reviews the large variety of tumor markers that are available in oncologic practice. One chapter is devoted exclusively to the polymerase chain reaction in molecular oncology. Background is provided on the technique itself, as well as on current and potential future uses.
Antisense strategies are discussed in the next section, which explores both the promise and the complexities of antisense oligonucleotide therapy. Key issues, including chemical structure and stability, ribozymes, triplex DNA, uptake, specificity, and problems with delivery, are well outlined.
The final section is titled "Immunotherapy"; however, only antibody-based approaches are included. Chapters are devoted to radioimmunotherapy, bi-specific antibodies, antibody-toxin conjugates, and the use of cytokines in monoclonal antibody therapy. The first and last chapters in this section are more laboratory-oriented, with illustrative experimental data. Nevertheless, each of these antibody-based therapy topics provides basic background information along with the problems and future promise of the modalities.
Overall, this first volume of Cancer Therapy in the Twenty-First Century provides good basic information on molecular and immunologic approaches. It will be useful for both academic and practicing oncologists who are trying to stay abreast of, or are just curious about, the many discoveries in basic science that are moving into the clinic. Although no book can be up-to-the-minute in these rapidly changing fields, this text gives the reader an appreciation of the marked influence new techniques and novel approaches are likely to have on the future practice of clinical oncology.
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?
