Update on cancer therapeutics最新文献

Over the past decade progress in the establishment of effective supportive care strategies has assumed an increasingly important role within the realm of cancer clinical investigation. This manuscript briefly summaries a number of highly relevant developments in the supportive care arena, specifically in antiemetic therapy, management of infections, complications associated with indwelling intravenous catheters, and prevention of mucositis and stomatitis.

This review details major new observations in the diagnosis and treatment of leukemias and plasma cell dyscrasias that have been communicated since the last version of this work. This review is not exhaustive and may appear to some to be rather superficial. However, it should serve as an accurate index of current thinking and accomplishments. The review clearly demonstrates a trend away from traditional chemotherapeutic approaches to the leukemias and related diseases in favor of the more rational design of treatments for specific diseases based on laboratory observations. Some refer to the agents that have resulted from such an approach as targeted therapy and suggest that they represent a new era in cancer treatment, although one of the first targeted therapy agents to be conceived, synthesized and tested was 6-mercaptopurine decades ago. Furthermore, there is no cancer therapy more targeted than surgery, which has been practiced longer than any of us has lived. At any rate, whatever slogan may be used to describe current cancer treatment, it is clear that it is based on more preclinical science and more rational design than ever before. This chapter demonstrates that is certainly true for the leukemias and plasma cell dyscrasias. What has not been demonstrated yet is that better rationale has led to better results. That remains to be proven or disproven by continued observation of our treated patients.

Approximately twice as many individuals are living with type 1 human immunodeficiency virus infection (HIV-1), as opposed to cancer and as such improved therapies for HIV-1 with an emphasis on availability of such medicines, is arguably the greatest medical problem of the 21st century. Importantly, these two conditions occur together and cancer remains a common cause of morbidity and mortality in the 60 million individuals infected with this retrovirus. In particular, there is a markedly increased risk of Kaposi's sarcoma, non-Hodgkin's lymphoma and invasive cervical cancer during the course of infection with this retrovirus. Treatment options are limited for patients with advanced acquired immunodeficiency syndrome related Kaposi sarcoma (AIDS-KS). The management of early stage cutaneous AIDS-KS has been revolutionised by the introduction of highly active anti-retroviral therapy (HAART) and for most patients HAART alone will control early stage AIDS-KS. However, patients with advanced stage KS with visceral disease, tumour-associated oedema or extensive oral disease require systemic chemotherapy in addition to their anti-retrovirals. Cytotoxic treatment is complicated however by underlying immunoparesis and options are often limited. Despite these difficulties, outcomes are improving and an increased appreciation of the biological mechanisms underlying viral tumorigenesis will hopefully delineate new therapeutic options and strategies.