Cancer drugs, survival, and ethics
Cet article analyse les enjeux éthiques et économiques liés aux bénéfices apportés par les chimiothérapies dans l'amélioration de la survie des patients atteints de cancer
Key messages : Advances in chemotherapy have contributed little to population cancer survival Responses in clinical trials may not apply to patients treated in the community Evaluation outside trial centres is essential to ensure that scarce resources are not squandered Stricter approval criteria are needed to achieve ethical treatment and reduce cancer costs Ethical informed consent and empowerment of patients must be promoted Cancer survival has improved in recent decades. Trends in the US show that five year relative survival in adults with solid cancer has increased from 49% to 68% over 40 years.1 There have been important advances in chemotherapy in recent years, including for melanoma, medullary thyroid cancer, and prostate cancer. Immunotherapy, together with targeted and precision (personalised) approaches guided by patient and tumour biomarkers, also produces benefit in subgroups of the more common cancers.2 But how much of the improvement in cancer survival can we attribute to drugs?