The “Rules of Desperation Oncology” Allow Oncologists to Throw Dying Patients a Hail Mary Immunotherapy Drug

(p. D1) Dr. Oliver Sartor has a provocative question for patients who are running out of time.

Most are dying of prostate cancer. They have tried every standard treatment, to no avail. New immunotherapy drugs, which can work miracles against a few types of cancer, are not known to work for this kind.

Still, Dr. Sartor, assistant dean for oncology at Tulane Medical School, asks a diplomatic version of this: Do you want to try an immunotherapy drug before you die?

The chance such a drug will help is vanishingly small — but not zero. “Under rules of desperation oncology, you engage in a different kind of oncology than the rational guideline thought,” Dr. Sartor said.

The promise of immunotherapy has drawn cancer specialists into a conundrum. When the drugs work, a cancer may seem to melt away overnight. But little is known about which patients might benefit, and from which drugs.

Some oncologists choose not to mention immunotherapy to dying patients, arguing that scientists first must gather rigorous evidence about the benefits and pitfalls, and that treating patients experimentally outside a clinical trial is perilous business.

But others, like Dr. Sartor, are offering the drugs to some terminal patients as a roll of the dice. If the patient is dying and there’s a remote chance the drug will help, then why not?

. . .

(p. D6) . . . there is Clark Gordin, 67, who lives in Ocean Springs, Miss. He had metastatic prostate cancer, “a bad deck of cards,” he said in an interview.

Dr. Sartor tried conventional treatments, but they didn’t work for Mr. Gordin. Finally, the doctor suggested immunotherapy.

Mr. Gordin’s insurer refused. But then the lab that had analyzed his tumor discovered it had made a mistake.

There was a chance Mr. Gordin might respond to immunotherapy, because he had a rare mutation. So his insurer agreed to pay.

Immediately after taking the drugs, Mr. Gordin’s PSA level — an indicator of the cancer’s presence — went down to nearly zero.

“Makes my heart nearly stop every time I think about it,” Dr. Sartor said. “Life sometimes hangs on a thin thread.”

For the full story see:

Gina Kolata. “A Life’s One Last Chance.” The New York Times (Tuesday, May 1, 2018 [sic]): D1 & D6.

(Note: ellipses added.)

(Note: the online version of the story has the date April 26, 2018 [sic], and has the title “‘Desperation Oncology’: When Patients Are Dying, Some Cancer Doctors Turn to Immunotherapy.”)

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