Faced with a therapeutic impasse, don’t leave patients faced with a “choice through money” – Liberation

Chronicle “With little care”

In an opinion published last week, the Ethics and Cancer Committee reconsidered the choice of women, suffering from triple negative breast cancer, to go abroad, at their own expense, to have access to innovative therapy but still not evaluated.

It’s a drop in the bucket, certainly only about fifty patients, but their story is anything but anecdotal, revealing the ambiguities around access to innovative therapies. Last week, the ethics committee of the National League against Cancer gave an opinion on the situation “of people with cancer and for them, in France, no medical treatment is offered “. Sometimes these patients go to private clinics abroad, usually in Europe, paying exorbitant fees for treatments that are still uncertain.

These are called, or rather they are called, the triplets. The reasons for this ridiculous qualifier: they are suffering from breast cancer, known as triple negative. Cancers that mainly affect young women (under 40), representing approximately 15% of all this type of cancer. These are aggressive cancers with limited therapeutic options, frequent recurrence, and for which there is no standard second-line treatment.

“Choosing by Money”

In recent years, treatments around immunotherapy are still showing, showing promise, but uncertainty. Two oncologists from the Gustave-Roussy Institute contacted the Ethics and Cancer Committee about a German clinic caring for these women in a situation of therapeutic impasse, who had been recruited in France and other countries. This clinic promises to help them “to deal with a very difficult situation”, offer them “a personalized treatment plan” rests on “the most modern immunotherapy protocols and precision medicine approaches currently available”. Small flat, these patients are called upon to pay enormous amounts to themselves. Our French doctors wonder about the practices of this clinic, which are close to therapeutic relentness, and point to a “choice by money”. Question: are we facing a scandalous drift where doctors will abuse the huge vulnerability of patients? The whole point of the Ethics and Cancer Committee’s response is that it is nuanced.

Faced with these cancers with limited treatment options, the committee notes: “A wide variety of drugs are being tested, one of them, atezolizumab, which gained European marketing authorization in August 2019 on this indication. But a year later, negative results of a trial led to closing this possibility in France. Another drug exists, trodelvy, but the industry is struggling to do so. Faced with this deficiency, many patients feel neglected. “The patients interviewed by the Committee expressed a sense of complete abandonment on the part of the medical and health authorities. These views increased when these people discovered, through the Internet and social media, that atezolizumab and other immunotherapy drugs are offered by private clinics abroad, specifically in Germany. »

Treatment at 20,000 euros

In this context, the Ethics and Cancer Committee took an interest in one of these clinics, the Hallwang clinic, a private establishment with no agreement on health insurance systems. It accepts almost exclusively foreign patients. And for the latter, the costs are very high. “One patient indicated that he paid € 4,800 for each injection of the clinic’s therapeutic vaccine. Another explained that his treatment cost him approximately 20,000 euros every three weeks. According to the Committee, the three patients interviewed indicated that they, at the time of their testimony, “because of remission from their triple negative breast cancer.” And they declared “their satisfaction when nothing in the discourse held by oncologists consulted in France allows them to hope for such a situation”. They suggest “Not to regret their approach to the clinic, even though they and their family are in a difficult financial situation”. They also have “expressed their disapproval of the lack of access to immunotherapy drugs in France”.

What can be deduced? The Ethics and Cancer Committee is measured. It recalls an unsatisfactory situation in France with regard to these treatments currently being evaluated. Believe “that it is unethical to oppose to these patients a request not to be accepted for access to a drug that is under review, even preliminary, because it is for them in last-ditch treatment. Finally, if the walk of these patients “is likely to put the health care professionals who care for them in an uncomfortable situation”, the committee insisted that “there is no justification for the attitudes of denial that may have been faced by the interviewees who testified here”. In other words, in the face of a therapeutic impasse, tolerance is essential, and patient choice should be privileged.

Leave a Comment