Lung cancer remains the biggest cancer killer in the Western world and is estimated to account for some 1.3 million deaths every year. Despite refinements in surgical approaches and countless international clinical trials evaluating different combinations of cytotoxic agents, the prognosis for lung cancer patients today is little better than it was 30 years ago. As a result, the disease is often viewed from a perspective of therapeutic nihilism by the medical community at large. Indeed, one of my mentors (an expert in the field) often comments that the only realistic way to improve mortality from lung cancer is to implement a total worldwide ban on the growth of tobacco!
However, the past decade has witnessed remarkable advances in molecular technologies that have led to a refinement in our understanding of the biological processes that lead to malignant transformation of normal lung tissue. In addition, advances in radiology and other early detection tools can increase the likelihood of identifying lung cancer at an earlier, more treatable stage. Finally, therapeutic innovations have heralded the advent of targeted treatments with the real possibility of “personalised medicine” for patients. Perhaps then, the future is no so bleak after all. It is timely, therefore, that two books have been published which offer slightly differing perspectives on the various aspects of lung cancer management.
Lung cancer, edited by F.R. Hirsch and P. Harper, is the latest in the State of the Art series published by Remedica Books and is intended to offer a succinct review of the latest data relating to the pathogenesis, diagnostic approaches and therapeutic strategies for lung cancer. It combines contributions by young investigators as well as established experts (all but one of the chapters is coauthored) from recognised centres of excellence from both North America and Europe. Consequently, this gives the text a dynamic and distinctly international flavour.
The book starts with chapters on disease epidemiology (incorporating a section on different early detection approaches) and pathogenesis. These chapters are followed by up-to-datediscussions on the treatment of nonsmall cell lung cancer according to different disease stages, including the role of currently available and speculative targeted therapies, and of small cell lung cancer in different clinical contexts. The chapter on adjuvant chemotherapy is particularly well conceived, being deliberately divided into sections that deal with the historical, current and possible future aspects of this form of treatment. The final chapter is dedicated to recent advances in the clinical application of relevant biomarkers and presents a useful summary of the predictive usefulness gleaned from various methods of analysing different cellular elements and signalling pathways, such as EGFR, KRAS, RRM1, BRCA1 and ERCC1, among others.
As each of the eight chapters provides a succinct overview rather than a comprehensive and detailed discussion of different aspects relating to lung cancer, the target readership of this book is presumably interested clinicians, rather than experts in the field. Nonetheless, for those seeking a means to keep abreast with recent important developments in the disease, this book is ideal. It should also be considered required reading for trainees in the disciplines of pulmonary medicine, clinical and radiation oncology, thoracic surgery and palliative care. Overall, the editors have succeeded in producing a well-written, highly readable, balanced and pleasingly concise review of the most important aspects of lung cancer
Lung Cancer: Prevention, Management and Emerging Therapies, part of the Current Clinical Oncology series, might, in contrast, be considered more of a reference book. This book provides a timely update from the previous 2002 edition in this series and begins with a thought-provoking preface by the editor, D.J. Stewart from the Anderson Cancer Centre in Houston, TX, USA. He has assembled a panel of internationally recognised experts to provide a collection of state-of-the-art reviews of key aspects of lung cancer for practising clinicians and researchers alike.
The authorship throughout the book is of an extremely high standard; nevertheless, certain chapters inevitably stand out. In particular, T.C. Walser and colleagues are to be comemded for a trulyexcellent resumé of the key literature relating to the various cellular and molecular components that make up the tumour microenvironment, and offer revealing insights into potential future therapeutic alternatives based on host immune cell infiltration patterns. Whereas the previous edition of this book had a single chapter dedicated to emerging “targeted” treatment strategies, the current edition features individual chapters that extensively detail current data on EGFR inhibitors, anti-angiogenesis agents, vaccine therapies and gene-based treatment approaches, highlighting the dramatic increase in the number of potential management alternatives that are likely to become part of our therapeutic armamentarium against lung cancer over the next decade.
A separate chapter provides an informative, understandable summary on the emerging role of pharmacogenetics in treatment decision making and highlights available data pertaining to the influence of genetic determinants on patient outcomes after socalled ‘tailored’ treatment approaches are employed. Elsewhere, insights into the anti-cancer potential of agents that focus on other critically important pathways, such as insulin-like growth factor, mTOR, RAS and Bcl-2 are provided in a succinct chapter by the book’s only non-North American authors. Separate chapters are dedicated to various treatment approaches with available and emerging therapies in different clinical contexts. There is also a welcome discussion dedicated to the different aspects of palliative care, a topic that is all too often neglected. Other areas covered in this book include: the molecular pathology of lung cancer; racial and ethnic differences in disease epidemiology, treatment and outcomes; disease prevention; and future study design and treatment approaches. Finally, there are two condensed yet highly readable chapters specifically covering the key aspects of molecular pathology, epidemiology, diagnosis, and current and speculative treatments strategies in the context of small cell lung cancer and mesothelioma.
Due to the nature of a textbook with such a broad scope as Lung Cancer: Prevention, Management and Emerging Therapies, certain sections, such as the aforementioned chapter by T.C. Walser and that by the book’s editor describing in detail the various mechanisms of chemotherapy resistance, may appear somewhat foreboding, particularly for clinicians without a keen interest in the minutiae of these topics. Nevertheless, these chapters serve as authoritative references for the respective subject matter. A minor criticism is the relative lack of figures in many of the chapters, although there are ample tables throughout the book.
An inevitable limitation of any publication that attempts to deal with a field as rapidly evolving as that of lung cancer is just that; the (welcome) pace at which important new developments continue to be made. As each of these books were written prior to the publication of the new International Association for Study of Lung Cancer (IASLC) staging system, the lack of reference to the fruits of this worldwide collaborative effort may appear somewhat odd to readers. For the same reasons, recently published, potentially practicechanging, mature, randomised clinical trial data, such as those relating to the use of tyrosine kinase inhibitors in advanced disease, particularly in patients with EGFR mutations, are lacking. However, these minor quibbles merely underscore the speed at which refinements in our understanding of the complex molecular signalling that characterises lung cancer are being made.
All in all, Lung Cancer: Prevention, Management and Emerging Therapies is a welcome addition to the field and represents an important resource both for lung cancer clinicians and basic scientists seeking authoritative and detailed discussions on all key aspects of lung cancer. Therefore, this book is recommended to all doctors charged with the management of patients with this deadly disease.
- ©ERS 2010