Preface | p. xv |
Introduction | p. xvii |
Cancer and Cancer Treatment Basics | |
What Is Cancer and How Is It Treated? | p. 3 |
What Is Cancer? | p. 3 |
The Six Hallmarks of Cancer | p. 4 |
The Three Mainstays of Cancer Treatment | p. 5 |
Surgery | p. 6 |
Radiation Therapy | p. 8 |
Medical Therapy (Medications) | p. 9 |
Evolution of Medicine: From Systematic Knowledge to Evidence-Based Medicine and Toward Personalized Medicine | p. 14 |
The Bottom Line | p. 17 |
What Are Clinical Trials and How Are They Organized? | |
What Is a Clinical Trial? | p. 21 |
A Brief History of Clinical Trials | p. 21 |
Dr. Lind's Plan | p. 22 |
Modern Medicine | p. 22 |
The Key Ingredients of a Clinical Trial | p. 23 |
Clinical Trials Versus Standard Care | p. 25 |
The Eligibility Checklist Process | p. 26 |
Informed Consent | p. 27 |
Information About You | p. 28 |
Statistics in Clinical Trials | p. 28 |
What Is Risk Reduction? | p. 29 |
What Is a Survival Benefit? | p. 31 |
What Does "Significant" Mean? | p. 32 |
The Bottom Line | p. 34 |
The Types of Clinical Trials: Four Phases and More | p. 35 |
Phase I: Safety Testing | p. 36 |
Blood Level Studies | p. 37 |
Variations of Phase I Testing | p. 38 |
The Biologically Effective Dose | p. 39 |
Why Would You Want to Participate in a Phase I Study? | p. 40 |
Phase II: Initial Efficacy Testing: Does the New Drug Work? | p. 40 |
Types of Phase II Studies | p. 41 |
What's in a Phase II Study for You? | p. 41 |
Phase III Trials: The New Treatment Compared to Standard Care | p. 42 |
Why Would You Volunteer for a Phase III Clinical Trial? | p. 43 |
Phase IV Studies | p. 44 |
What's in a Phase TV Study for You? | p. 44 |
Phase 0 (Zero) Studies | p. 45 |
A Word About Other Types of Studies | p. 45 |
Why Would You Consider Participating in a Clinical Trial That Doesn't Involve a Treatment Intended to Directly Treat Cancer? | p. 46 |
The Bottom Line: The Advantages and Disadvantages of Various Types of Clinical Trials | p. 46 |
Randomized Trials and Placebos | p. 49 |
Randomization: Letting the Computer Decide | p. 49 |
Randomization in Today's Clinical Trials | p. 50 |
Comparing Active Treatment to No Treatment | p. 51 |
Blinding and Placebos | p. 52 |
Benefits Can Be Hard to See Without Blinding | p. 54 |
The Appropriate Role of Placebos in Clinical Trials | p. 55 |
The Placebo Effect | p. 56 |
Placebos in History | p. 57 |
Why Are Randomized Trials So Large? | p. 58 |
What Happens If a Study Shows a Benefit Even Before It Is Finished? | p. 58 |
Did I Get the Best Treatment? | p. 59 |
How Can I Be Sure I Get the New Treatment? | p. 60 |
The Bottom Line | p. 62 |
Clinical Trials That Have Changed Cancer Care | p. 65 |
Surgery Cures More Women with Breast Cancer When Supported by Chemotherapy | p. 66 |
When Less May Be More | p. 67 |
Does Surgery Really Help Men with Prostate Cancer? | p. 68 |
A Sum That Is Truly Better Than Its Parts: Combining Chemotherapy Drugs | p. 68 |
Location, Location, Location | p. 69 |
A Successful Revolution: Targeting Mutations That Cause Cancer | p. 70 |
Hormones and Cancer Prevention | p. 71 |
Boost Your Immune System | p. 72 |
Debunking a Medical Bias | p. 73 |
When Our Basic Beliefs Are Challenged | p. 74 |
The Next Breakthrough Study-What Will it Be? | p. 75 |
The Bottom Line | p. 75 |
Deciding Whether to Participate in a Clinical Trial | |
Is There a Clinical Trial That's Right for Me? | p. 79 |
Deciding Whether to Participate in a Clinical Trial | p. 79 |
What Should You Know Before Choosing a Clinical Trial? | p. 80 |
What Potential Benefits and Risks Should You Consider Before Choosing a Clinical Trial? | p. 80 |
The Effects of Attitudes, Emotions, and Reality in Choosing a Clinical Trial | p. 81 |
"I Just Want to Be Left Alone!" | p. 82 |
Cancer Support Groups | p. 83 |
Choosing the Right Trial for Your Needs | p. 84 |
I'm Interested. What Do I Do Next? | p. 84 |
Start Close to Home | p. 85 |
Know Your Disease State, Stage, and Prior and Current Treatments | p. 85 |
Searching Online-The Basics | p. 86 |
Advanced Searches | p. 88 |
I've Done My Homework…Now What? | p. 90 |
The Bottom Line | p. 92 |
Who Is Looking Out for You and What Can You Expect? | p. 93 |
How Are Studies Overseen and Regulated? | p. 93 |
The Power of the FDA | p. 94 |
Not One, but Two Animal Tests! | p. 95 |
Truly Independent, Ail-Powerful Oversight: The Data Safely Monitoring Board | p. 95 |
What Can I Expect From My Doctor and Investigative Team? | p. 97 |
What If I Have Concerns and I'm Not Sure Where to Go for an Answer? | p. 98 |
Am I Free to Quit If I Want To? | p. 98 |
What If I Have Side Effects? How Will I Know If I Should Be Concerned? | p. 99 |
What If Something Goes Wrong? | p. 100 |
How Do You Get Through the Red Tape? | p. 100 |
Why Are There Delays? | p. 101 |
A Concern You May Have: "If I Start a Clinical Trial, and the Trial Medications Don't Work, I Could Be Wasting Valuable Time." | p. 102 |
The Bottom Line | p. 105 |
Who Pays for Clinical Trials-And What Can They Cost? | p. 107 |
What Costs Are Involved in Clinical Trials? | p. 108 |
Who Pays for These Costs? | p. 108 |
Costs of Your Care and Insurance Coverage of Cancer Clinical Trials | p. 109 |
Medicare Comes Through | p. 111 |
Traditional Health Insurance | p. 114 |
The Bottom Line | p. 121 |
Medical Treatment of Cancer Now, and in the Future | |
Cancer Drugs Currently in Use and Being Tested in Trials | p. 125 |
Chemotherapy Drugs | p. 125 |
Antimetabolites | p. 127 |
Alkylating Agents | p. 128 |
DNA Cross-Linking Platinum Derivatives | p. 128 |
Antitumor Antibiotics | p. 129 |
Topoisomerase Inhibitors | p. 129 |
Microtubule Assembly and Disassembly Inhibitors (Mitotic Inhibitors) | p. 129 |
Hormonal Agents | p. 130 |
Testosterone- and Estrogen-Lowering Drugs | p. 130 |
Hormone-Blocking Drugs | p. 131 |
Testosterone Conversion/Activation Blockers | p. 132 |
Small-Molecule Targeted Drugs | p. 132 |
Monoclonal Antibodies | p. 134 |
Immunotherapy | p. 134 |
Differentiation Therapy | p. 135 |
Gene Therapy | p. 136 |
A Last Word About Drugs | p. 136 |
The Bottom Line | p. 137 |
The Future of Cancer Treatment and Clinical Trials: Personalized Medicine | p. 139 |
Targeted Therapy | p. 139 |
Personalized Therapy | p. 140 |
Pharmacogenomics | p. 142 |
The Bottom Line | p. 142 |
A Final Word | p. 144 |
Tell Us What You Think | p. 144 |
Glossary | p. 145 |
Resources | p. 155 |
General Clinical Trials Information | p. 155 |
Information Specific by Tumor Type | p. 156 |
Index | p. 157 |
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