Dear Colleagues,   

Focusing on the earliest manifestations of cancer is the most promising approach to cancer prevention. Pre-malignancies may display simpler genomic aberrations that can increase the likelihood of pinpointing targets for transformational therapies. Prevention efforts require a thorough understanding of the mechanism of carcinogenesis. Knowledge of the molecular basis of carcinogenesis is critical, including elucidating the signaling and metabolic pathways and defining genetic progression models.

The use of this knowledge by transdisciplinary scientists in utilizing natural, synthetic, or biologic agents and vaccines to inhibit or reverse pre-invasive or early-stage carcinogenesis is called cancer chemoprevention.

Cancer chemoprevention is an active way of combating early-stage cancer and carcinogenesis. The aims of the cancer chemoprevention initiative is to produce regression of prevalent precursors of cancer, suppress recurrent precursors, and prevent incident precursors and/or cancer.

The identification of chemopreventive agents holds tremendous promise in reducing the burden of cancer. Our experience from past trials of preventive agents offers important lessons that can inform the design and conduct of future trials, revealing (a) the need for more preclinical and early-phase work before undertaking phase III trials; (b) the imperative for broad, sensitive toxicological and human safety assessments; (c) how safety can be improved in iterative generations of agents and trials; and (d) how synergy between agents can lead to lower doses, improved efficacy, and fewer or less severe toxicities. We have learned there are substantial benefits to employing germline, familial, or increased-risk cohorts, including, among others, accumulating more data over a shorter time frame. An assessment of endpoints in trials resulting in approval of a preventive agent reveals that nearly all have been approved on the basis of intraepithelial neoplasia, particularly in accessible organs. Lessons gleaned regarding the overall design of clinical trials underscore the importance of the randomized, placebo-controlled design and the need for long-term follow-up and monitoring to meet FDA requirements and promote acceptance in the marketplace. 

For this focused Special Issue, we are inviting authors/research teams to submit reviews and reports of the approaches used to identify and test promising chemoprevention agents and strategies for the primary and secondary clinical chemoprevention of breast, prostate, lung, colon, bladder, and other cancers. Reviews may utilize a systematic approach to summarize the safety, efficacy, and mechanisms of action based on evidence from in vitro and preclinical models of promising agents targeting these cancers. Furthermore, they may provide a rationale for translating this knowledge into an evaluation of the safety and efficacy of these agents in clinical trials targeting populations at risk due to exposure to carcinogenic agents, familial and genetic predisposition, or due to the presence of premalignant lesions, while validating intermediate endpoints of carcinogenesis and correlate these with clinical endpoints.

Dr. Nagi B. Kumar
Guest Editor

Manuscript Submission Information

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• carcinogenesis
• cancer chemoprevention
• chemoprevention agents
• clinical cancer
• clinical chemoprevention