23 - Introduction to Clinical Research

Summary

It is axiomatic that the most critical and life-threatening quality of many cancers is the ability to metastasize. Similarly, the biggest challenge for treatment of many malignancies is the successful management of metastatic disease. Indeed, the presence or absence of distant metastases is the single most important determinant of survival for most patients with cancer, as manifested by the prominent role that metastases play in the current staging system for cancer.

The past several decades have seen a wholesale increase in our understanding of the basic biology of the metastatic cascade, as discussed in Chapters 1–22 in this volume. In addition, improved therapy for the primary cancer can, paradoxically, open the opportunity for symptomatic metastatic disease to become manifest in some cases. It is also clear that the widespread availability of enhanced imaging capabilities means that today it is easier to diagnose metastatic disease – and, perhaps, at a seemingly earlier time. Finally, despite the commonality of certain mechanisms for metastases, there is much that is disease specific in both the biology and treatment of metastatic cancer. Think for a minute about the predilection of prostate cancer for the bone and ocular melanoma for the liver. But there is also much that is cross-cutting, such as the biology and treatment of bony metastases from several primary tumor types.

In the following pages, experts from a variety of disease orientations summarize findings and strategies in several important cancer types. From these chapters, tailored to individual cancer types, come several unifying themes.