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How should we move the field of chemopreventive agent development forward in a productive manner?
Frank Louis Meyskens1, Eva Szabo
1Department of Internal Medicine (Hematology/Oncology) and Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA 92868, USA. flmeyske@msx.ndc.mc.uci.edu
Abstract:
Epidemiologic observations and preclinical experimental investigations suggest that the prevention or reversal of precancers should be an effective strategy in humans to control cancer. Although "proof of principle" has been established in humans, the results of randomized trials have not been confirmatory in most cases. Toxicity in normal or near-normal populations has also been greater than anticipated. We examine the problems associated with testing chemoprevention agents in humans and offer a process and guidelines that may better inform the logical development of this relatively young clinical field.
Insights
Preventing precancerous lesions may control cancer, but human trials face challenges. This study offers guidelines for developing chemoprevention strategies more effectively.
Area of Science:
- Oncology
- Preventive Medicine
- Clinical Trials
Background:
- Epidemiologic and preclinical data suggest cancer prevention via precancer reversal is promising.
- Human "proof of principle" for chemoprevention exists, but randomized trial results are often inconclusive.
- Anticipated toxicity in healthy populations has been a significant concern in chemoprevention trials.
Purpose of the Study:
- To examine the challenges in testing human chemoprevention agents.
- To propose a structured process and guidelines for the logical development of clinical chemoprevention.
- To advance the field of cancer chemoprevention research.
Main Methods:
- Review of existing epidemiologic and preclinical evidence.
- Analysis of outcomes from previous randomized chemoprevention trials.
- Development of a proposed framework and guidelines for future research.
Main Results:
- Human chemoprevention trials have yielded non-confirmatory results.
- Toxicity issues in normal populations have exceeded expectations.
- A need for improved strategies in designing and conducting chemoprevention studies is evident.
Conclusions:
- Chemoprevention holds potential for cancer control but requires rigorous development.
- Addressing toxicity and improving trial design are crucial for success.
- The proposed guidelines aim to enhance the logical progression of this clinical field.
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