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Cancer on Trial: Oncology as a New Style of Practiceby Peter Keating
Synopses & Reviews
Until the early 1960s, cancer treatment consisted primarily of surgery and radiation therapy. Most practitioners then viewed the treatment of terminally ill cancer patients with heroic courses of chemotherapy as highly questionable. The randomized clinical trials that today sustain modern oncology were relatively rare and prompted stiff opposition from physicians, who were loath to assign patients randomly to competing treatments. Yet today these trials form the basis of medical oncology. How did such a spectacular change occur? How did medical oncology pivot from a nonentity and, in some regards, a reviled practice to the central position it now occupies in modern medicine?
In Cancer on Trial Peter Keating and Alberto Cambrosio explore how practitioners established a new style of practice, at the center of which lies the cancer clinical trial. Far from mere testing devices, these trials have become full-fledged experiments that have redefined the practices of clinicians, statisticians, and biologists. Keating and Cambrosio investigate these trials and how they have changed since the 1960s, all the while demonstrating their significant impact on the progression of oncology. A novel look at the institution of clinical cancer research and therapy, this book will be warmly welcomed by historians, sociologists, and anthropologists of science and medicine, as well as clinicians and researchers in the cancer field.
There were no medical oncologists until a few decades ago. In the early 1960s, not only were there no such specialists, many practitioners regarded the treatment of terminally-ill cancer patients with heroic courses of chemotherapy as highly questionable. Physicians loath to assign patients randomly to competing treatments also expressed their outright opposition to the randomized clinical trials that were then relatively rare. And yet today these trials form the basis of medical oncology. How did such a spectacular change occur? How did medical oncology move from a non-entity and in some regards a reviled practice to the central position it now occupies in modern medicine?and#160;Cancer on Trialand#160;answers these questions by exploring how practitioners established a new style of practice, at the center of which lies the cancer clinical trial.
About the Author
Peter Keating is professor of history at the Universitandeacute; du Quandeacute;bec andagrave; Montrandeacute;al.
Alberto Cambrosio is professor in the Department of Social Studies of Medicine at McGill University. Together, they are the authors of Exquisite Specificity: The Monoclonal Antibody Revolution and Biomedical Platforms: Realigning the Normal and the Pathological in Late Twentieth-Century Medicine.
Table of Contents
CHAPTER 1. From and#8220;Nonentityand#8221; to Global Network: The Rise of a New Style of Biomedical Practice
An Early Career in Clinical Oncology
About This Book
A Capsule History of Cancer Clinical Trials
Cancer Clinical Trials as a New Style of Practice
PRELUDE. Before There Were Trials
Cancer Hospitals and Cancer Institutes
PART 1. The Emergence of Clinical Cancer Research (1955and#8211;66)
CHAPTER 2. A Landmark Clinical Trial
Curing Leukemia: The VAMP Trial
A Collective Undertaking
The Elements of Innovation
What about the Patients?
CHAPTER 3. The Collective Turn: Cooperative Groups as Epistemic Organizations
Assembling the US Cooperative System
Screening for Drugs: From Mice to Humans
Tinkering with the Cooperative Group Structure
Meanwhile in Europe . . .
FIRST INTERLUDE. Clinical Trial Statistics
What Is a Random Sample?
What Is Statistical Significance?
CHAPTER 4. Statisticians, Statistics, and Early Cooperative Clinical Trials
Statisticians at the NIH
Statisticians in Paris
Fabricating the Tools of the Trade
The Emergence of the Phase System
CHAPTER 5. Criticism and the Redefinition of Clinical Cancer Trials as an Autonomous Form of Research
Clinical Cancer Research under Fire
The Reorganization of Screening and Clinical Trials in the United States
Surgery and Radiotherapy in the Cooperative Groups
PART 2. An Avalanche of Numbers from the New Style of Practice (1965and#8211;89)
CHAPTER 6. A Web of Trials
Breast Cancer and Its Trials
The Lessons of the Breast Cancer Trials
The Emergence of Combination Chemotherapy
The Multiple Meanings of Breast Cancer Trials
CHAPTER 7. Statisticians, Data Centers, and the Organization of Large-Scale Clinical Trials
Centers of Calculation: US Statisticians and the Data Center
The Mechanics of Data Production
Meanwhile in Europe, Take Two
Back in the USA: Group Statisticians and NCI Statisticians
Insidersand#8217; Dissent: The Randomization Debate
CHAPTER 8. A Relational Space of Substances and Regimens
The Clinical Evaluation of Substances
Screening Substances: The Animal Screen
CHAPTER 9. Oncopolitics? Reshaping Collaborative Research
Centralization or Coordination? The European Debate
Clinical Trials as Clinical Research: The US Debate
Oncology in the Community
PART 3. Targeted Therapy, Targeted Trials (1990and#8211;2006)
SECOND INTERLUDE. Molecular Biology and Oncogenes
The Rise of Molecular Biology
Cancer and Molecular Biology: 1960and#8211;80
The Clinical Isolation of Human Oncogenes
Oncogenes and Oncoproteins since 1982
CHAPTER 10. Magic Bullets? The Gleevec Trials
Molecular Biology and Targeted Substances
The Trials of a Targeted Therapy
Where Did Gleevec Come From?
Monitoring Data, Managing Risks
A Medical Oncologist and His Patients
Patients and Activists
CHAPTER 11. Targeted Therapy and Clinical Cancer Research
Introduction: Molecular Biology and Translational Research
Molecular Biology and the US Cooperative Groups
The Reorganization of the Drug Discovery Process and the Transformation of the NCI Screen
Clinical Trials in a Targeted Age
CHAPTER 12. Looking Back and Looking Forward
The Observational Alternative to Clinical Cancer Trials
Comparative Effectiveness and Clinical Trials
What Our Readers Are Saying
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