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  • Discontinuing Bevacizumab i...
    Kesselheim, Jennifer C.; Norden, Andrew D.; Wen, Patrick Y.; Joffe, Steven

    The oncologist (Dayton, Ohio), October 2011, Letnik: 16, Številka: 10
    Journal Article

    Learning Objectives After completing this course, the reader will be able to: Explain the considerations of beneficence, nonmaleficence, autonomy, and justice necessary to the care and counseling of patients with glioblastoma receiving treatment with bevacizumab. Identify the ethical issues inherent to bevacizumab discontinuation in patients with glioblastoma whose tumors have progressed on the drug. This article is available for continuing medical education credit at CME.TheOncologist.com Glioblastoma (GBM) is a highly lethal malignant brain tumor that expresses proangiogenic factors, including vascular endothelial growth factor (VEGF). Bevacizumab (Avastin®; Genentech, Inc., South San Francisco, CA), a monoclonal antibody against VEGF, is routinely used in the U.S. to treat GBM patients whose tumors have progressed following initial therapy. The Ethics Advisory Committee at the Dana‐Farber Cancer Institute was asked to provide consultation on two cases involving patients with recurrent GBM who were receiving bevacizumab. Despite evidence of disease progression, family members advocated for the continued use of bevacizumab because of its mild toxicity profile and concern that discontinuation would impair quality of life. However, continuing bevacizumab in this setting posed physical and financial risks to the patients and raised ethical concerns about resource allocation and justice. We analyze the ethical questions regarding bevacizumab discontinuation in the setting of progressive GBM. We articulate the potential benefits and harms of continuing the drug and identify guiding principles for drug discontinuation that should be made transparent to patients and families. With the increasing availability of new, modestly toxic, expensive drugs for patients with advanced cancer, questions of when to stop these drugs will become increasingly relevant. 摘要 胶质母细胞瘤(GBM)是一种高度致死的恶性脑部肿瘤,并且能表达包括血管内皮生长因子(VEGF)在内的促血管生成因子。贝伐珠单抗(Avastin®;Genentech, Inc., South San Francisco, CA)是一种抗VEGF单克隆抗体,在美国常规用于经初始治疗后肿瘤出现进展的GBM患者。Dana‐Farber癌症研究所伦理咨询委员会应邀为两例接受贝伐珠单抗的复发性GBM患者提供建议。尽管有证据显示疾病进展,但家属主张继续使用贝伐珠单抗,因为其毒性轻,且考虑停药可能影响生活质量。然而,在这种情况下继用贝伐珠单抗会为患者带来生理和经济方面的风险,并可引发对资源分配与公平性的伦理担忧。 研究者分析了关于在进展性GBM情况下停用贝伐珠单抗的伦理问题,表述了继续使用该药的潜在效益与风险,并确定了患者及其家属明确易懂的停药指导原则。随着可用于晚期癌症患者的毒性适度但价格昂贵的新药增多,何时停用这些药物的问题将日益多见。 Ethical questions regarding bevacizumab discontinuation in the setting of progressive glioblastoma are evaluated.