We have been using cancer chemotherapeutic drugs for non-cancer conditions like Rheumatoid arthritis, Scleroderma etc; now a study showing use of non-cancer drugs to prevent recurrence of cancer!

-Team@CMHF

• Cancer prevention and screening strategies are widely appreciated to be critically important public health efforts.
• Despite the relevance of these approaches in the overall management of malignant disease, however, the complexities associated with proving the effectiveness of any proposed screening or prevention program are well documented.
• Consider, for example, the substantial efforts undertaken during the past several decades to demonstrate the utility of an ovarian cancer screening strategy involving routine performance of vaginal ultrasounds and/or measuring CA-125 serum antigen levels.
• In a recent large national study, investigators discovered that this strategy not only failed to improve disease-specific mortality, but also was associated with causing excessive harm (eg, morbidity associated with unnecessary surgeries).
• The issue of harm is particularly relevant in a prevention or screening setting when the individual involved is currently not known to have cancer and may never develop the disease during his or her lifetime.
• But what about a setting where investigators are examining approaches to prevent cancer recurrence after the completion of primary (eg, surgery, radiation therapy, adjuvant chemotherapy) or even second-line therapy (eg, complete remission to systemic therapy following initial disease recurrence)?
• I believe that it is rational to argue that the risk–benefit ratio may be different, with greater risk possibly being justified in an effort to prevent disease recurrence.
• One can also argue that the absolute level of evidence required to consider employing a particular intervention outside the investigative setting (clinical trial) may be less, if the existence of the cancer in the particular individual is not just possible but rather definite.
• So, what if a reported, nonrandomized, population-based retrospective evaluation revealed a highly statistically significant association between the administration of a well-tolerated pharmaceutical agent routinely used for a non-oncologic indication and a reduced risk for recurrence of a highly fatal malignant condition?
• And what if a biological explanation could be provided to support the reported observation? The obvious next question is as follows: What level of evidence should be required before it would be considered both scientifically rational and ethical for an oncologist to discuss the particular study results with an individual patient, and, with appropriate informed consent, consider prescribing the medication?
• The informed consent would, of course, describe the limited evidence of hypothesized clinical benefit and genuine potential risks.
• In the absence of a contraindication to use this well-tolerated class of pharmaceutical agents in a specific melanoma patient, and in the presence of a disease (malignant melanoma) where recurrence is highly likely to result in death, what is wrong with at least discussing with an individual extended treatment with this drug?
• A doctor might decide that a single study of this nature should not (by itself) be sufficient for such an action, but what if a second retrospective analysis reached similar conclusions or quite striking favorable results were observed in a different malignancy?3
• Would use of the agent be a consideration at this point?
• Of course, if the cancer did not recur during long-term follow-up, one would never know if the delivery of a beta-blocker in this individual had anything to do with this most positive outcome. However, under these circumstances it is most unlikely that the patient, or anyone directly involved in his or her life and care (family, medical team) will be concerned about the absence of such definitive data.

For further reading log on to
http://www.clinicaloncology.com/ViewArticle.aspx?d=Hematologic+Malignancies&d_id=149&i=December+2011&i_id=799&a_id=19797