Wednesday, January 14, 2009

Never give up?

The indispensible Olga of the Sarcoma Alliance bulletin board recently posted a link to an article with a dry title, "The Role of Investigational Therapy in Management of Patients With Advanced Metastatic Malignancy," but an inspiring message. An excerpt:

In many fields of medicine there is continuing progress, improvement, and opportunities, and as physicians in advising our patients, we have to be prepared for success. When patients receive hopeless diagnoses, it is important for the physician to discuss palliative care,1 but it is equally important—and perhaps more so—for the physician to be knowledgeable about, and to discuss frankly and positively with the patient, the options for participating in clinical research at major research centers where new therapies are being developed.

Many patients are advised that participation in early clinical trials has a record of a low frequency of benefit, perhaps 3%. Is 3% too low a probability of success to participate in such trials? The answer is that for the 3% it was certainly worthwhile, particularly for those patients who have long-term benefit. Furthermore, benefit rates from even the earliest experimental trials in the most dismal setting—advanced, refractory cancer—may have been underestimated. Indeed, a meta-analysis showed that the complete and partial remission rate for phase I cancer trials was 10.6% among almost 12,000 patients, with approximately a 44% benefit rate if less than partial remission and disease stabilization were included.

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