Biomedical Engineering Reference
In-Depth Information
3. Our ability to modify the human genome through systemically administered
novel targeted vectors.
4. The continued miniaturisation of surgical intervention through robotics, nan-
otechnology and precise imaging.
5. Computer-driven interactive devices to help with everyday living.
6. The use of virtual reality systems which together with novel mood control drugs
will create the illusion of wellness.
Over the last 20 years, a large amount of detailed data has been amassed concern-
ing the basic biological processes that are disturbed by the onset of cancer. Today, we
know the key elements involved in growth factor binding, signal transduction, gene
transcription control, cell cycle checkpoints, apoptosis and angiogenesis (Sikora,
2002). These have become fertile areas to hunt for rationally based anti-cancer
drugs. This approach has already led to a record number of novel compounds cur-
rently in trials. Targeted drugs such as rituximab, Herceptin ® , imatinib, gefitinib,
Avastin ® and Erbitux ® are all now in routine clinical use. Over the next decade,
there will be a marked shift in the types of agents that are used for the systemic
treatment of cancer.
Since we know the precise targets of these new agents, there will be a revolu-
tion in the way that we prescribe cancer therapy. Instead of defining drugs for use
empirically and relatively ineffectively for different types of cancer, we will iden-
tify a series of molecular lesions in tumour biopsies. Future patients will receive
drugs that directly target these lesions. The human genome project provides vast
comparative information about normal and malignant cells. New therapies will be
more selective and less toxic, and will be given for prolonged periods of time, even
in some cases for the rest of a patient's life. This will lead to a radical overhaul in
how we provide cancer care (The Stationery Office, 2003).
Investment in more sophisticated diagnostics is now required. Holistic systems
such as genomics, proteomics, metabolomics and methylomics provide fascinating
clues that will help us find the needle in the haystack of disturbed growth. By
developing simple, reproducible and cheap assays for specific biomarkers, a battery
of companion diagnostics will emerge (Nicolette and Miller, 2003). In the next
decade, it is likely that these diagnostics will be firmly rooted in tissue pathology,
making today's histopathologist essential to the forward movement of this exciting
field. Ultimately, the fusion of tissue analysis with imaging technologies might make
it possible to do virtual biopsies on any part of the body, normal and diseased alike
(Adam et al. , 2002).
Individual risk assessment for cancer will lead to tailored prevention mes-
sages and a specific screening programme designed to pick up early cancer, with
far-reaching consequences for public health. Cancer-preventive drugs will be devel-
oped to reduce the risk of further genetic deterioration. The use of gene arrays to
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