DeCensi Andrea, Thorat Mangesh A, Bonanni Bernardo, Smith Samuel G, Cuzick Jack
Division of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, Genoa 16128, Italy ; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK ; Breast Services, Division of Surgery and Interventional Science, Whittington Hospital, Magdala Avenue, London N19 5NF, UK.
Ecancermedicalscience. 2015 Nov 24;9:595. doi: 10.3332/ecancer.2015.595. eCollection 2015.
The global cancer burden continues to rise and the war on cancer can only be won if improvements in treatment go hand in hand with therapeutic cancer prevention. Despite the availability of several efficacious agents, utilisation of preventive therapy has been poor due to various barriers, such as the lack of physician and patient awareness, fear of side effects, and licensing and indemnity issues. In this review, we discuss these barriers in detail and propose strategies to overcome them. These strategies include improving physician awareness and countering prejudices by highlighting the important differences between preventive therapy and cancer treatment. The importance of the agent-biomarker-cohort (ABC) paradigm to improve effectiveness of preventive therapy cannot be overemphasised. Future research to improve therapeutic cancer prevention needs to include improvements in the prediction of benefits and harms, and improvements in the safety profile of existing agents by experimentation with dose. We also highlight the role of drug repurposing for providing new agents as well as to address the current imbalance between therapeutic and preventive research. In order to move the field of therapeutic cancer prevention forwards, engagement with policymakers to correct research imbalance as well as to remove practical obstacles to implementation is also urgently needed.
全球癌症负担持续上升，只有治疗的改善与癌症预防并驾齐驱，抗癌之战才能取胜。尽管有多种有效药物，但由于各种障碍，如医生和患者意识不足、对副作用的恐惧以及许可和赔偿问题，预防性治疗的利用率一直很低。在本综述中，我们详细讨论了这些障碍，并提出了克服它们的策略。这些策略包括提高医生的认识，并通过强调预防性治疗与癌症治疗之间的重要差异来消除偏见。不能过分强调药物-生物标志物-队列（ABC）范式对提高预防性治疗效果的重要性。未来改善癌症预防治疗的研究需要包括改进对益处和危害的预测，以及通过剂量试验改善现有药物的安全性。我们还强调了药物重新利用在提供新药物以及解决治疗性研究和预防性研究之间当前不平衡方面的作用。为了推动癌症预防治疗领域向前发展，还迫切需要与政策制定者合作，以纠正研究不平衡，并消除实施过程中的实际障碍。
