The Lancet Oncology (TLO)

Billions of dollars are currently being spent on the search for effective drugs that will stop disease before it happens. Advances in genetic testing are providing more opportunities to find out which diseases people are likely to be at risk of developing--but this knowledge has put huge pressure on the medical profession to come up with ways of avoiding disease altogether. This month's leading edge questions the ethical issues involved in chemoprevention and highlights the difficulties in obtaining reliable data from chemoprevention clinical trials. It concludes: "Genetic tests have created a demand for chemoprevention that is threatening to push medicine to its limits; health services could be stretched beyond capacity because they are treating healthy people as well as the sick. To stop this snowball effect it is essential that one simple idea is kept in mind: you can spend all the money in the world on preventive medicine, but when people won't even stop smoking, can it really work?"

STOMACH CANCER - THE LATEST TARGET FOR THE 'MAGIC BULLET'

Gastrointestinal stromal tumours (GISTs) are the most recent cancer type to be targeted by the most effective new drug of recent years--imatinib mesylate. Effective treatment of GISTs has been hindered in the past by their characteristic resistance to conventional chemotherapy and persistent misclassification of these tumours in clinical studies has made pre-2000 data difficult to interpret. However, it is now known that most GISTs contain a mutation in the KIT tyrosine kinase, which means they are an ideal target for imatinib. In their review, Heikki Joensuu and colleagues discuss the recent advances in understanding of these difficult-to-treat tumours and discusses the impact of imatinib on outcome for patients with GISTs. The authors conclude that imatinib "has provided physicians with a well-tolerated and highly effective therapeutic option for a disease for which no systemic therapy existed previously".

Imatinib was heralded the "magic bullet" drug after extraordinary success in treatment of chronic myeloid leukaemia, for which it received FDA approval last year. It has also recently been granted FDA approval for the treatment of GISTs.

Other reviews:

Antisense therapy -- the time of truth

Radiation-induced tumour necrosis factor-alpha expression -- clinical application of transcriptional and physical targeting of gene therapy

Radiotherapy for cancer of the head and neck -- altered fractionation regimens

Totally implantable venous-access ports -- local problems and extravasation injury

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