Nontoxic, fiscally responsible, future of oncology: could it be beginning in the Third World?
Nontoxic, fiscally responsible, future of oncology: could it be beginning in the Third World?
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无毒、经济可靠的肿瘤学未来：它可以从第三世界开始吗？
DOI：
10.1097/mph.0b013e3182024918
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Kamen,BartonA
中科院分区：
文献类型：
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作者：
Klement,GiannoulaLakka;Kamen,BartonA
在本期杂志中，Fousseiny等人进行了一项前瞻性儿科研究1，评估了马里患有难以治疗的恶性肿瘤的儿童的多药物节拍治疗方案2,3。它首次以一种前瞻性的方式考察了在另一种“节奏”疗法中使用已建立的非专利代理人的适用性。作者间接地提出，在使用毒性更强的疗法所必需的三级护理可能难以提供的地方，或在新型生物反应调节剂的成本过高的地方，获得稳定的疾病可能是一种有效的替代方案。这项工作表明，即使在资源没有限制或约束的情况下，完全缓解并不总是转化为总生存期的增加，而且毒性较小的疾病控制模式值得追求。“无病癌症”的概念似乎越来越被接受。5 .除非国际卫生保健政策发生重大变化，否则实验性疗法不太可能在第三世界国家产生重大影响，因此迫切需要替代疗法。作者建议，应该探索在毒性最小的节律化疗环境中使用廉价、广泛可用的药物，并提供此类努力的第一个例子。我们同意，设计良好的节律化疗方案结合药物与无重叠的毒性可能提供一个可行的选择，在国家的恶性肿瘤儿童的护理获得医疗保健和资源有限。首先，它可能会改变这些国家仍然普遍存在的观念，即癌症总是一种无法治愈的疾病，会导致迅速死亡。节拍疗法也可以通过无毒疗法和高质量的生活来延长儿童的寿命。正如下面所讨论的，即使资源不那么有限，公众普遍认为“越多越好”，更合理地利用信息可能会导致更便宜、更好的抗癌治疗。
In this issue of the journal, a prospective pediatric study by Fousseiny et al1 evaluating a multidrug metronomic regimen2, 3 in children with difficult-to-treat malignancies in Mali, is presented. It examines, for the first time in a prospective manner, the applicability of using established, off-patent agents in an alternative ‘‘metronomic’’4 regimen. The authors, indirectly, make the case, that attainment of stable disease may be a valid alternative in places in which tertiary care necessary for the use of more toxic therapies may be difficult to provide, or in places where cost of novel biological response modifiers is prohibitive. The work suggests that even when there are no limitations or constraints on resources, a complete remission does not always translate to an increased overall survival, and the paradigm of disease control with less toxicity is worth pursuing. The concept of ‘‘cancer without disease’’seems to be growing in acceptance. 5Unless a significant change in international health care policies occurs, experimental therapeutics are unlikely to make a significant impact in Third World countries and alternatives are badly needed. The authors suggest that the use of inexpensive, widely available agents in a minimally toxic metronomic chemotherapy setting should be explored, and provide the first example of such an effort. We agree that a well-designed metronomic chemotherapy regimen combining drugs with nonoverlapping toxicities may provide a viable option for the care of children with malignancies in countries where access to medical care and resources is limited. For one, it may change the still prevalent perception in these countries that cancer is always an incurable disease and causes rapid demise. Metronomic therapy may also create an option of keeping children alive longer with nontoxic therapies and good quality of life. As discussed below, even when resources are less limited and the ‘‘more is better’’mentality is the prevailing public perception, a more rational use of information may lead to less expensive and better anticancer therapy.