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?
"Immunotherapy is a particularly nuanced problem," said Dr. Paul Helft, an ethicist and oncologist at Indiana University School of Medicine.