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Discontinuing Bevacizumab in Patients with Glioblastoma: An Ethical Analysis

2011; AlphaMed Press; Volume: 16; Issue: 10 Linguagem: Inglês

10.1634/theoncologist.2011-0047

1549-490X

Jennifer C. Kesselheim, Andrew D. Norden, Patrick Y. Wen, Steven Joffe,

Biomedical Ethics and Regulation

Abstract 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. CME 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.