Current Cancer Therapeutics, Fourth Edition

Any new medical textbook must compete for readershipunder new rules. It is not just the numerous other books being published butalso the wealth of information on the Internet that vies for the time andattention of the inquiring reader. Web-based general search engines and medicalliterature tools have made the previous frequent trips to the hospital librarynearly obsolete for many of us. There is ready access to original references ordiscussion about almost any topic in cancer care. A successful book on cancertreatment, therefore, must provide more—something unique for the practicingphysician, 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 thesecriteria by offering a useful compendium of information and periodic passages ofclinical savvy. It is a multiauthored text with nearly 70 contributors. Theeditors are senior clinicians and investigators with broad experience inmedical, surgical, and nursing oncology, who have selected chapter authors withsimilar expertise in clinical oncology and cancer investigation. The titleimplies a treatment-oriented text directed at a clinical audience; it achievesthat promise with a series of chapters describing categories of drugs,disease-directed treatments, and supportive care.

The emphasis on "therapeutics" as meaning essentially drugtreatment is a reasonable focus for much of the book and is the specific targetof the initial chapters. Agents are classified as alkylating/platinating,antimetabolic, biological, hormonal, and tubulin-targeting. (In the nextversion, there will surely be a section on kinase inhibitors and antibodies.)Each of these sections begins with background information, including somehistory and discussion of general features, such as pharmacology or themechanisms of resistance pertinent to all the agents in the class.

Following this is a page or two on each chosen drug. The selection of drugsis sometimes open to debate. For example, given its current limited use incancer therapeutics, does levamisole (Ergamisol) deserve an entire entry? Theseindividual drug sections are formatted into consistent topics of dosage,indications, pharmacokinetics, special precautions, and so forth. This makes forquick reference and is useful when checking on a specific drug in a clinic orwhen reviewing a treatment plan. The information presented is appropriate forstudents as well as for practicing doctors and nurses.

Each disease category follows a similar format, with an initial discussion ofthe disease and then individual sections of a page or two directed at treatmentregimens. Some of the discussions offer the sought-after clinical wisdom that isoften difficult to find in primary research papers. For example, in the breastcancer section, the authors highlight the dilemma of using both ovarian ablationand tamoxifen. Although survival may be longer with such a combined-modalityapproach, toxicity may not justify use of the combination. In many of theprotocol sections that follow, a useful graphic showing the treatment schema ispresented.

Occasionally, there are significant errors that need to be corrected in thenext edition. Discussion of the adjuvant AC regimen (doxorubicin,cyclophosphamide [Cytoxan, Neosar]) cites the National Surgical Adjuvant Breastand Bowel Project (NSABP) B-15 reference, which calls for administration of theregimen every 21 days for four cycles. However, in the graphic schema, the titleof the table describes 28-day cycles × 6. For those familiar with breast cancertreatment, this is obviously an error, probably carried over from the CMF(cyclophosphamide, methotrexate, fluorouracil) experience. Tolerance for sucheditorial lapses in a book emphasizing treatment regimens should be near zero.

A related but more minor problem that might be remedied in the next editionis the repeated appearance of the disclaimer regarding prescriber caution at thebottom of each page. Is it really necessary to include a statement on every pagein a bolded background that "information is… provided as guidance only…"?I would prefer that the editors and publisher’s legal department work out abetter method.

In general, the disease sections are informative and well-written. Iparticularly liked the chapter on malignant effusions in the chest. The authors’clinical experience was evident in the balanced discussion of how to managethese difficult problems. Although I personally think the authors overvalue thebenefit of tube thoracostomy, their discussion is a good starting point fordeliberations on a single patient or for devising a team approach to the problemof pleural effusions.

It would be helpful to see more of the clinical honesty expressed in thesarcoma discussion section translated to the regimen section. The author statesthat "treatment of established metastatic disease is difficult andassociated with poor response rates," but nevertheless lists the toxic MAIDregimen (mesna [Mesnex], doxorubicin [Adriamycin], ifosfamide [Ifex],dacarbazine [DTIC-Dome]), thus implying that it is reasonable to use. Theauthors might comment on such toxicity as well as the expenditure of resourceson diseases for which standardized but relatively ineffective regimens providelittle benefit. Routine use of toxic and expensive regimens that have become"standard" is a significant problem that, at the very least, preventspatients from enrolling in trials of more innovative therapy.

The chapters on supportive care are interesting and thought-provoking, withemphasis again on treatment. The chapter on palliative care is a condensedcurriculum on the subject with good advice: "Opioids are highly effective,easily titrated, and generally well tolerated"—what a nice introductionto pain management for any medical or surgical resident caring for patients withcancer. Useful discussions are included on myelosuppression and cancercomplications as well as treatment toxicities of the gastrointestinal,cardiopulmonary, neurologic, renal, and metabolic systems. These chapters roundout the text such that treatment issues can be approached from severaldirections: specific drugs, disease-oriented therapy, and body system problems.

The book offers much to a broad audience, including nurses and physicians aswell as trainees in both areas. The material is accessible, with shorterchapters and sections than in comprehensive oncology texts but with informationpresented in greater depth than in handbook-style texts. I would recommend it asa useful text to keep in the clinic and nearby when preparing talks on cancertreatment. In summary, it meets the challenge I stated earlier: This book offersmuch that large texts and the Internet do not.