A Way Forward for Cancer Chemoprevention : Think Local
Cet article passe en revue les stratégies permettant de délivrer localement un médicament dans la chimioprévention de certains cancers (peau, sein, poumon, côlon, rectum, voies aérodigestives supérieures et vessie)
As cells progress through carcinogenesis, the associated exponential expansion of genetic and molecular aberrations and resultant heterogeneity make therapeutic success increasingly unattainable. Therapeutic intervention at early stages of carcinogenesis that occur within the primary organ and in the face of a lower burden of molecular aberrations, constitutes a basic tenet of cancer chemoprevention, and provides a situation that favors a greater degree of therapeutic efficacy compared to that of advanced cancer. A longstanding barrier to chemoprevention relates to the requirement for essentially no systemic toxicity, and the fact that when large numbers of people are treated, the emergence of systemic toxicity is almost universal. A rational means to address this in fact relates to a second basic tenet of the chemopreventive strategy: the focus of therapeutic intervention is to disrupt a process that is in essence localized to a single organ. Based upon this consideration, a strategy which is based upon local delivery of therapeutics to an at-risk organ will achieve therapeutic efficacy while avoiding systemic delivery and its associated toxicity. This article will review the rationale for undertaking such an approach, will describe successful clinical achievements based on this strategy, will describe ongoing efforts to expand the impact of this approach and together will highlight the high impact that this approach has already had on the field as well as its extremely high potential for future impact.
Cancer Prevention Research , résumé, 2015