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Current Cancer Therapeutics, Fourth Edition

Current Cancer Therapeutics, Fourth Edition

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 (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. 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

Occasionally, there are significant errors that need to be corrected in the
next edition. Discussion of the adjuvant AC regimen (doxorubicin,
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, 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.


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