The goal of all medical activity is to preserve health in fit people, and to restore the sick into a state of complete physical, mental and social wellbeing. In an effort to determine whether we are achieving this last goal in oncol- ogy, herein we review the biological and clinical framework that has led to the foundations of the current anti- cancer treatment paradigm. Currently, cancer therapy is still based on the ancient axiom that states that the com- plete eradication of the tumor burden is the only way to achieve a cure. This strategy has led to a substantial im- provement in survival rates as cancer mortality rates have dropped in an unprecedented way. Despite this pro- gress, more than 9 million people still die from cancer every year, indicating that the current treatment strategy is not leading to a cancer cure, but to a cancer remission, that is “the temporary absence of manifestations of a par- ticular disease”; after months or years of remission, in most patients, cancer will inevitably recur. Our critical analysis indicates that it is time to discuss about the new key challenges and future directions in clinical oncolo- gy. We need to generate novel treatment strategies more suited to the current clinical reality.
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