Over a decade ago hydroxyurea was shown to selectively kill cells in the S phase in a proliferating cell population and to block cells at the G 1-S border. Consequently, blocked cells became sensitized to irradiation and were further sensitized when the drug was present after exposure. These features were identified initially in Chinese hamster cells in culture. They seemed to indicate that, in circumstances where tumor cells are proliferating more rapidly than the surrounding normal tissues, hydroxyurea might be an effective agent for use in combination therapy with X or gamma radiation. In the ensuing decade, many in vivo studies on hydroxyurea have confirmed that the main properties of hydroxyurea identified in the dish are also evident in vivo. During a period of about ten years, a considerable number of clinical studies have been performed, the results of which have been mixed, ranging from indeterminate to encouraging, depending to some extent on the site treated and whether careful randomized studies were done. Some clinicians have abandoned hydroxyurea in favor of other drugs or procedures, but others find the agent useful and perhaps especially so in the treatment of carcinoma of the cervix. Definitive, quantitative information on the value of the drug in combination therapy seems to be available in only a few instances. Thus, its value is still debatable. The question then arises whether the clinical studies have represented adequate tests, by laboratory standards, of the likely effectiveness of the drug in clinical circumstances. The clinical studies with hydroxyurea have been examined in this light, since the results might also bear on the use of many other such agents in combination therapy. This examination revealed that no attempts have been made to determine the concentration of hydroxyurea in the tumor and other relevant tissues as a function of time or to assess the cell kinetic features of the tumor and thus estimate the appropriate dose regimen. It would seem that a wide gap still exists between laboratory research and clinical application. While the difficulties of the latter are well known, it may be more important to adequately exploit, in the clinic, the laboratory properties of the drugs we know rather well than to continue searching for a miracle panacea while repeating similar errors in translating from laboratory to clinic.
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