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Freedom to choose a cure: how safe is a deadly cancer?

The Korean Journal of Hematology
Korean Society of Hematology; Korean Society of Blood and Marrow Transplantation; Korean Society of Pediatric Hematology-Oncology; Korean Society on Thrombosis and Hemostasis (KAMJE)
Publication Date
DOI: 10.5045/kjh.2010.45.3.145
  • Perspective
  • Medicine
  • Philosophy


untitled This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 145 DOI: 10.5045/kjh.2010.45.3.145 The Korean Journal of Hematology Volume 45ㆍNumber 3ㆍSeptember 2010 Perspective Freedom to choose a cure: how safe is a deadly cancer? Vladia Monsurró, Ph.D. Department of Pathology and Diagnostic, University of Verona Medical School, Verona, Italy “A 56-year-old woman with advanced, incurable ovarian cancer was invited to be the first patient, in the first dose level, of a phase I trial of a new drug that was being given to patients for the first time. The patient information sheet stated that she was unlikely to benefit from her participation in the trial, and she was told that when phase I trials are initiated, the drug concentration is usually significantly less than the final recommended dose or maximum tolerated dose of the compound. The patient was concerned about not obtaining a tumour response with the lower dose level, and asked if she could delay participation until higher dose cohorts had opened for accrual” [1]. This episode is emblematic and poses, in my opinion, a number of key ethical questions. Are, for example, phase I trials always in the patient’s interest? Is the safety require- ment that is tested in phase I trials really an advantage for patients? Perhaps, instead of a dose escalation, the best guess approach for cancer patients would be more in their interest? Should it not be the patient who, after being fully informed, decides and tailors the therapy according to a risk evaluation that encompasses his or her specific situation (emotional, familiar, and clinical)? Why shouldn’t a patient with an incurable terminal disease be able to choose for himself or herself the level of risk to take i

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