Is there Clinical Relevance for Therapies which Disrupt the Metastatic Cascade?

Abstract

It is perplexing that while emphasis has been placed on the study of factors involved in carcinogenesis and treatment of established cancers, less effort is spent on the study of invasion and metastasis (1). Obviously, it is this element of the disease which is responsible for the majority of the morbidity and mortality of malignant cancer. “Is there clinical relevance for therapies which disrupt the metastatic cascade?” This is an intriguing question and addresses an area of clinical oncology which has not been a popular area for research. A wealth of biological and clinical information is available regarding carcinogenesis and, more recently, chemoprevention of neoplastic transformation. Research in cancer treatment has generated a vast body of knowledge dealing with the ablation of cancers once they are established. There are limited efforts in clinical investigation to develop therapies that have the potential for altering the metastatic cascade; most of these studies concentrate on aspects of the coagulation or fibrinolysis scheme. Coagulation, platelet aggregation and other factors involved in hemostasis have been clearly incriminated as contributing to steps in the metastatic cascade, but the details of their involvement are not completely understood (2).