Diversifying and specifying palliative care for patients with metastatic cancer by therapeutic implementation of non-normative boundary conditions

Clinical scientific progress is the result of three main factors, i.e., a yet unmet medical need (systemically pretreated patients with metastatic tumors), a hypothesis-driven vision (a formal pragmatic communication theory), and technological advances to pursue that vision (biomodulatory therapy approaches, clinical proteomics, epigenetics and molecular imaging techniques). The therapeutic relevance of situative validity claims of tumor systems objects (cells, modules, oncogene-addicted targets, etc.) may be substantiated by the replicability of a formal pragmatic communication theory. Such a theory needs to be based on reconstructive activities that integrate clinical and laboratory surrogate parameters, which are derived from the long-term implementation of non-normative boundary conditions, into a metastatic tumor's holistic and normatively structured communicative system (i.e., morphological structures, the hallmarks of cancer as action norms and decision maxims). The implementation of non-normative boundary conditions may be achieved via non-oncogene-addicted therapeutic targets (biomodulatory therapies). Therapy-derived clinical and laboratory surrogates, whose validity has been shown in histologically rather different metastatic tumor types (e.g., C-reactive protein, ECOG status, etc.), confirm the usefulness of reconstructive activities for exploring 'universal' response parameters that indicate the changes in a tumor's normative systems structures. Such reconstructive activities allow the depiction and specific targeting of a tumor's normative systems structures, defined as cellular therapy in situ. Tumor-associated disease traits may now be targeted to substantially attenuate tumor growth or even to induce continuous complete remission. This way, communication-derived tumor pathophysiology decisively broadens the therapeutic options in the palliative care of patients with metastatic tumor diseases.