ESMO Handbook of Cancer Diagnosis and Treatment Evaluation PDF

Foreword

Since the 1940s, when Denoix conceived the TNM (Tumor, node, metastasis) system, Karnofsky codified the concept of tumor response and patient performance status, and Papanicolau introduced the vaginal smear, clinical oncology has developed a "clinical method". At least in part, it has specificities, within the broader domain of the clinical method that every physician learns during training years. Unfortunately, though, little attention has been paid over the decades to teaching this method, and even less to further elaborating on it. This is in striking contrast with the formidable progress made, since the very same years, by the medical therapy of tumors, i.e., by medical oncology. Medical therapies of tumors have become more and more powerful, but medical oncology has found it difficult to focus on the clinical method with which they were used. The shortcomings of this can be found, I would say, in our routine practice. They are well perceivable as long as our treatment tools improve. Suffice it to recall the recent difficulties with assessing tumor response to molecularly targeted agents. It would be wrong to see these difficulties as exclusively radiological, thus technological. They are much more cultural, having to do with a concept—tumor response—which has always failed to find solid ground in biology as well as in the clinic. The notion of tumor response has been confined, theoretically, to Phase II studies, but it has been widely resorted to, actually, in the clinic, thus highlighting an obvious need.

This Handbook is a rare attempt to make an appraisal of where we are in this field, by focusing on some key issues of the clinical method of medical oncologists. Authors should be praised for this, even before thanking them for the product of their work. I hope, as well, that ESMO might be acknow ledged by kind readers to have tried to fill an educational gap at the heart of the discipline it wants to promote. The hope is that medical oncologists may recognize these issues as worth learning, of course, but also as a subject of research themselves, exactly as new drugs, or treatments, obviously are.