Emerging strategies in the management of cancer.
OBJECTIVE
To review advances in understanding the biology of cancer that will lead to new prognostic indicators and approaches for treating cancer and its metastases and to explore the implications of these developments for oncology nurses.


METHODS
Published papers, abstracts, research result, package inserts, books, and personal experience.


RESULTS
Understanding is evolving that cancer is a genetic disease that occurs when a single cell and its progeny are remarkably changed by a series of genetic mutations. A new paradigm for managing cancer is emerging that is based on new prognostic indicators, intracellular and intercellular communication, and biologic control. Potential new therapeutic strategies include gene-directed therapy, control of cellular proliferation, exploitation of cell death, inhibition of metastasis, and reversal of multidrug resistance. Many of these therapies are only beginning to enter phase I/II clinical trials.


CONCLUSIONS
With continued progress, doctors will be able to identify patients with the highest likelihood of experiencing recurrent or progressive disease and formulate therapeutic strategies specific for their disease and even for their individual genetic makeup.


CONCLUSIONS
To remain abreast of these new and increasingly sophisticated treatments, oncology nurses must be knowledgeable about cell and cancer biology, human genetics, the immune system, a how advances in these fields are forming the foundation for new therapies. Nurses with creativity and drive will continue to lead the way in developing management strategies for patients receiving these new therapies.
Rieger
P T
PT
Clinical Cancer Genetics Program, University of Texas M.D. Anderson Cancer Center, Houston, USA.
D000970:Antineoplastic Agents / Q000494:pharmacology; D019008:Drug Resistance, Neoplasm; D015972:Gene Expression Regulation, Neoplastic; D015316:Genetic Therapy; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000451:nursing / Q000628:therapy*
D000970:Antineoplastic Agents