Book Review

Molecular Biology in Cancer Medicine

N Engl J Med 2000; 342:595-596February 24, 2000

Article

Molecular Biology in Cancer Medicine
Second edition. Edited by Razelle Kurzrock and Moshe Talpaz. 679 pp., illustrated. London, Martin Dunitz, 1999. $139.95. ISBN: 1-85317-676-1

As oncology changes from a largely empirical endeavor to a science in which diagnosis and therapy are guided and, indeed, defined by the genetic alterations in a patient's tumor, books such as this one will become increasingly important. The ultimate necessity will be to move from simplistic classifications of tumors according to histologic features or alleged organ of origin toward an understanding of tumors as the result of the combinatorial action of deregulated or mutated genes. For this reason, molecular oncology will need to establish an efficient format to convey its core information: methods of defining which genes are important in which tumors and the implications of these genetic changes for treatment. The achievement of this goal, attempted in Molecular Biology in Cancer Medicine, is not well served by large, clinically oriented books, which emphasize the complexities of clinical presentation, staging, and nuances of multimodal treatment.

This book succeeds partially in meeting its goals. It is divided into parts that address cytogenetics, clinical applications of laboratory techniques, and molecular pathogenesis and a disease-by-disease consideration of the genes that have been defined as relevant in hematologic cancers, solid tumors, sarcomas, and hereditary tumors. A final section addresses gene-directed therapy. The book's major problems are common in multiauthored books: poor integration of chapters, redundancy, and inconsistent presentation of information. It would have been useful if the first three parts had been combined into a carefully integrated section called “Basis of Molecular Oncology,” with an introductory, aerial view of how knowledge of cytogenetics leads to knowledge of specific genetic alterations, which then leads to an understanding of the molecular physiology of cancer.

Certain chapters pertaining to specific tumors tend to contain uneven and, at worst, superficial discussions of clinical events (e.g., weight loss and enlarged livers in patients with pancreatic cancer probably do not need to be mentioned here), followed immediately by considerations of the molecular abnormalities in particular tumors. Since the molecular characterization of certain diseases (e.g., ovarian cancer) is so poorly understood, whether such diseases deserve their own chapters is debatable. On the other hand, the omission of detailed considerations of certain tumors, such as neuroblastoma and endometrial, bladder, and germ-cell tumors, is notable. The chapter on lung cancer is especially unsophisticated, given what we know about the disease. What happened to myc genes, loss of chromosome 3p, and autocrine growth factors? The section on farnesyl transferase inhibitors misses the point that the ras gene probably has little to do with the antiproliferative effect of these inhibitors in real tumor cells, as compared with model systems. The promise of gene-microarray hybridization technology and other computationally oriented approaches to the classification of disease is not mentioned.

Having voiced these criticisms, I recognize that, viewed in terms of its individual chapters, the book contains a wealth of valuable and well-presented information for the student, clinician, and scientist. In fact, when the book works, it works very well. The chapter on oncogenes, a succinct presentation of “the grand scheme,” should have been placed earlier in the book. The information on apoptosis and transcription factors is usefully and efficiently presented, with up-to-date information. The chapter on acute myeloid leukemia is a masterpiece. Its theme is that aberrant fusion proteins formed from transcription factors are central to the pathogenesis of hematologic cancers (and perhaps may serve as targets for treatment). B-cell lymphomas are likewise dealt with in an informative and complete fashion. The chapters on breast and colorectal cancers are scholarly, excellent examples of the successful integration of genetic and functional information and represent ideal formats for presentation. The chapters on renal cancer, sarcoma, and hereditary tumors are also excellent. The chapter on melanoma is useful and efficient in its presentation of a disease whose molecular characterization is just becoming apparent. The chapter on gene therapy is appropriately critical of the field, yet it includes a discussion of the many opportunities that remain to be explored under the rubric of “gene therapy.”

The references are largely current and contain many citations through 1997. The illustrations and tables are uniform in style and are unusually useful in augmenting the text; they are a strong point of the book. Efforts to define complex jargon with glossaries are useful, but these reference guides might have been combined and moved to the front of the book. The book contains much unique information for the price, and this should certainly increase its attractiveness for departmental libraries.

The world is clearly better off for having this book. It provides information from disparate sources that is not commonly found in one place. Students will find it a useful and, in many cases, complete introduction. In the chapters that are done well, scientists will encounter a disease-oriented basis for thinking about their gene of interest. Clinicians will find it an important reference that will reshape how they approach neoplastic diseases. Rapid progress in molecular oncology will probably make a third edition necessary within a few years, and one hopes that it will deal with the problems with format and integration and build on our progress in thinking about cancer as a disease of genes. The editors' commitment to this goal remains the most important basis for the book's considerable value.

Edward A. Sausville, M.D., Ph.D.
National Cancer Institute, Bethesda, MD 20892