Lippman Scott M, Heymach John V
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Clin Cancer Res. 2007 Jul 15;13(14):4035-41. doi: 10.1158/1078-0432.CCR-07-0063.
Advances in our understanding of multistep and field carcinogenesis are erasing the clear demarcation of intraepithelial neoplasia from invasive neoplasia. The growing ability to define a very high risk of cancer is forging important commonalities between prevention and therapy, such as in potential prognostic/predictive markers, agents, and side effects that patients would be willing to tolerate, and the logistics of definitive trials. The emergence of promising new molecular-targeted agents and new technologies for screening and early detection provides new opportunities for applying clinical trial designs that integrate therapy and prevention end points. Such trials may be used to facilitate targeted drug development and help identify strategies for both cancer prevention and advanced cancer therapy. These several advances are creating a convergence of cancer therapy with cancer prevention that promises to streamline the development of targeted drugs and improve the control of major cancers.
我们对多步骤和场致癌作用认识的进展正在消除上皮内瘤变与浸润性肿瘤之间明确的界限。定义癌症极高风险的能力不断增强，正在形成预防与治疗之间的重要共性，比如在潜在的预后/预测标志物、药物以及患者愿意耐受的副作用方面，还有确定性试验的后勤保障。有前景的新型分子靶向药物以及用于筛查和早期检测的新技术的出现，为应用整合治疗和预防终点的临床试验设计提供了新机会。此类试验可用于促进靶向药物的开发，并有助于确定癌症预防和晚期癌症治疗的策略。这几方面的进展正在使癌症治疗与癌症预防趋于融合，有望简化靶向药物的开发并改善对主要癌症的控制。
