Chemotherapy is central to oncology, perceived to operate only on prolific cancerous tissue. Yet, many non-neoplastic tissues are more prolific compared with typical tumors. Chemotherapies achieve sufficient therapeutic windows to exert antineoplastic activity because they are prodrugs that are bioactivated in cancer-specific environments. The advent of precision medicine has obscured this concept, favoring the development of high-potency kinase inhibitors. Inhibitors of essential mitotic kinases exemplify this paradigm shift, but intolerable on-target toxicities in more prolific normal tissues have led to repeated failures in the clinic. Proliferation rates alone cannot be used to achieve cancer specificity. Here, we discuss integrating the cancer specificity of prodrugs from classical chemotherapeutics and the potency of mitotic kinase inhibitors to generate a class of highprecision cancer therapeutics.
Genotoxic Chemotherapies Have High Impact in the Clinic, but Research Efforts now Focus on Molecular Targeted TherapiesChemotherapies inducing DNA damage remain the mainstay of cancer treatment. Such damage leads to double-stranded breaks, which trigger apoptosis during cell division [1-3]. It sometimes not fully appreciated how clinically impactful and transformative chemotherapeutic agents truly are, especially when used in combination. For example, the combination of cyclophosphamide with rituximab, vincristine, doxorubicin, and prednisone (R-CHOP) yields long-term remissions and even complete cures in certain cancers [4][5][6][7][8]. For glioblastoma (GBM), before the advent of temozolomide (TMZ), long-term survivorship was unheard of; now it is possible, even if only for a few patients [9].