Novel Approaches to Cancer Chemotherapy

Apparently without benefit of a predecessory symposium, the editor of this collection of monographs has selected several topics as representative of areas from which many of the future advances in the treatment of neoplastic disease will come forth. His choices are uniformly praiseworthy and meritorious. In each of the chapters, which cover such diversified approaches as interferons, monoclonal antibodies, liposome-entrapped drug delivery, and plasma membrane-directed therapies, the authors have gone to great lengths to discuss the practical limitations of their individual research in terms of its ultimate clinical utility. Moreover, the issue of selective toxicity, the bench mark of any new chemotherapeutic modality, is examined to varying degrees in each of the sections, which is commendable indeed. Undoubtedly the product of a great deal of organization by Dr. Sunkara, there is a significant degree of continuity among the separate chapters. For example, both the first chapter on interferons, by Fleischmann and co-workers, and the chapter on monoclonal antibodies, by Davis and Rao, give evidence of the genuine difficulties which still exist in approaches which have already become enshrined in the secular conscience-while at the same time suggesting that more recent advances (recombinant human y-interferon and human monoclonals) offer real hope for progress in both diagnosis and treatment. Another example can be found in the section written by Poste and co-workers and that of Kleinerman and Fidler. After years of significant accomplishment, George Poste concludes that, overall, the potential for the use of liposomes in systemic therapies for malignant disease is severely restricted, both by host or patient physiology and by other, less esoteric factors. One area which is identified as having potential, however, is the utilization of the observed avidity of macrophages for lipid vesicles. This is immediately followed by a synopsis of the work of Fidler and co-workers, demonstrating the effectiveness that liposomes containing macrophage activating factor have when used as an adjuvant to the treatment of disseminated disease. So it goes through much of this book. Whether one is dealing with the complexities of prostaglandin-thromboxane-leukotriene biosynthesis (Honn and Marnett, p. 128) or the impact that potent and specific inhibitors of individual enzymes could have in treatment (Sunkara and Prakash, p. 94; Petrow and Padilla, p. 270), the effect is the same. This volume is speculative, in a very nonpejorative sense of that word, and should leave any reader with the notion that real improvements in the chemotherapy of cancer are near at hand.