The oncologist
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Cancer chemotherapy celebrated its fiftieth anniversary last year. It was in 1945 that wartime research on the nitrogen mustards, which uncovered their potential use in the treatment of leukaemias and other cancers, was first made public. Fifty years later, more than sixty drugs have been registered in the USA for the treatment of cancer, but there are still lessons to be learnt. ⋯ Unfortunately the regulatory authorities find it less risky to stick with extensive safety testing rather than to use shortcuts, however well-validated clinically. Many but not all drug companies, mindful of profits, prefer the easy way out and concentrate on analogues, while most clinicians opt for trials of combinations of known agents, being aware that they are worth a publication or two. Reprinted with permission from Helix, Volume V, Issue 1, 1996, pp. 20-21.
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COMMENTS FOR PROFESSOR BARRIE R. CASSILETH: I have enjoyed reading the two issues of The Oncologist I've received so far. I would like to make some comments on Dr. ⋯ But most oncologists, like Dr. Quah, indeed are faced with trying to advise patients about therapies for which there is little hard evidence. The best guiding principles at this point are to discourage remedies that promise cancer cure or are promoted for use instead of mainstream treatment, encourage non-invasive, comforting, complementary (adjunctive) therapies such as massage, green tea and qi gong, and check medical journals and newspapers for warnings such as those issued recently for Ma Huang (ephedrine), a still-common ingredient in herbal remedies widely available through catalogs and in health food stores.
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CHARACTERISTICS AND PATHOLOGY OF MYELODYSPLASTIC SYNROME: Myelodysplastic syndrome (MDS) is a disease of the blood whose etiology is unclear. There is little that can be done therapeutically, and the prognosis for patients with this disease is poor. The main hematologic finding is anemia, but MDS responds poorly to the various kinds of drugs used to treat anemia, and in the past it was called refractory anemia. ⋯ From the standpoint of chromosomal research, it is believed that MDS occurs not from a single type of stem cell damage, but from an accumulation of multiple and random stem cell damage. MDS is a prime candidate for research on the onset of human leukemia, and when we combine what we know about MDS with its development into leukemia, we can understand the development of MDS from the standpoint of apoptosis, genetic abnormalities, chromosomal abnormalities and progression of cloning. RISK FACTORS: Many risk factors for MDS have been proposed, and it has been confirmed internationally that the four major risk factors are the blast cell ratio in the bone marrow, advanced age, chromosomal abnormalities, and thrombocytopenia.
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There is often a considerable lapse of time between the definition of what causes a disease in the laboratory and the development of successful therapy. However, the history of medicine teaches us that the need to understand the scientific basis of disease before the discovery of new treatments is both essential and inevitable. During the middle of the 19th century, the work of the great German pathologist, Rudolf Virchow, defined disease as having an anatomic or histologic basis. ⋯ Oncogenes and growth suppressor genes give us new targets to inhibit or replace. Tumor-specific kinases will meet their inhibitors. The oncologist will play a leading role in understanding, applying and interpreting this new information in the clinic-an exciting and challenging future!
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If instead of the title "Prophylactic Oophorectomy: Reducing the U. S. Death Rate from Epithelial Ovarian Cancer," the title were "Drug X Reducing the U. ⋯ Whether the inherited BRCA1 and BRCA2 mutations that result in familial ovarian cancer also cause primary peritoneal carcinoma is as yet unknown. All such women are followed closely post prophylactic oophorectomy by physical examination and CA125 blood testing. In conclusion, it is posited that prophylactic oophorectomy in women with a history of familial ovarian cancer who have completed their family by age 35 and desire prophylactic oophorectomy and in women age 40 or older who undergo hysterectomy for benign uterine conditions may result in a significant decrease in the death rate from ovarian cancer - a disease in search of a highly sensitive screening test(s) and improved therapy.