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Clinical Oncology: Onward and Upward

Dana Farber Cancer Institute, Boston, MA

Change is inherent in the field of oncology, as fundamental science has exploded our knowledge of the cancer cell. How that change will benefit patients depends on the process of drug development and evaluation, especially when a target is known or presumed. It is, after all, a risky business as well as an expensive business to develop new treatments that will pass review of regulatory bodies and acceptance by patients and physicians. Despite these many hurdles, the field continues to carry on with the passage of time. Certainly, in the last 5 years since my editorship of the Journal of Clinical Oncology (JCO), the change is noteworthy.

By way of return to the history of JCO from those early days to the present, I should note that I was asked to serve as Associate Editor by the inaugural Editor-in-Chief, Dr Jospeph Bertino, a pioneer in our field from many points of view. We were cautioned about losing money, and we all worked to gain visibility for the Journal in those early days.

During my tenure as Editor-in-Chief, we tried to establish visibility in the overseas field with Spanish and Chinese versions, as well as supplemental efforts in the audio journal area through AudioMedica (London, UK).

The field of medical oncology and the scope of the Journal has grown concomitantly with sections devoted to basic science, reviews, quality of life, images, and correspondence. The impact factor grew proportional to the increasing interest and personnel in clinical oncology.

The field since my editorship has grown at an even greater pace in cancer-related basic science, and the fallout from that has begun with a panoply of new targeted agents, many of which have already been approved in the US Food and Drug Administration. The key publications that contributed to the acceptance often appeared in JCO for such antibodies against CD20, CD52, Her-2/neu, epidermal growth factor receptor, and the vascular endothelial growth factor, to name a few. It is clear that there is a new direction for cancer therapy with the continuing hope that an agent will be found that will have the same profound impact on disease as we saw with imatinib in chronic myeloid leukemia. A positive dividend was the dramatic impact on the disorder gastrointestinal stromal tumors (GIST), a disease for which no effective therapy was previously known.

Another significant growth in our knowledge base has been the role and design of controlled clinical trials which began in the 1970s but continued in earnest at around the time of the founding of JCO.

JCO has been the emblem of quality cancer care with concern for communication of new science and treatments as well as issues of palliative medicine where appropriate. In the latter area, cancer physicians specializing in palliative medicine are now an integral component of the care teams in many centers. It will continue to grow as a subspecialty area of medical oncology.

Finally, we have entered the new era of therapeutics, where clinical oncology is catching up to basic science. The field is moving faster in our scientific knowledge than the clinical trial process can hardly keep pace, as new agents become available in the treatment of leukemia and solid tumors. My optimistic view is that great benefits will emerge from the explosion of scientific knowledge of the cancer cells. It is only the rate of time that limits the benefit for tomorrow's patients. Such is the evolution of human knowledge. I consider myself extremely fortunate to have been a part of the whole process from investigation to communication in clinical cancer. The future is bright. The field of medical oncology will slowly change from the more myelotoxic treatments to oral targeted small molecules with specific toxicity for the cancer cell.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

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