Departure from evidence-restricted medicine

[ABSTRACT] Evidence-Based Medicine (EBM) is at the height of its prosperity in modern clinical medicine. EBM ranks published evidence according to the design of clinical studies and the supremacy of randomized controlled trials (RCTs) has been established. Recently, immune checkpoint inhibitors (ICIs) have attracted attention for lung cancer treatment. Combination therapy with nivolumab, anti-programmed death 1 antibody, and ipilimumab, anti-cytotoxic T-lymphocyte antigen 4 antibody, in non-small-cell lung cancer was approved in the United States and Japan in 2020. This combination therapy is logically expected to be effective for a certain number of patients who previously received chemotherapy or ICI monotherapy. However, because the RCT, which became the basis of approval, was performed in the first-line setting, this combination therapy can be used as first-line treatment only. As ICI combination therapy has the possibility of radical cure, this limitation for use is precisely the issue of critical importance for patients. Taking away a potential treatment opportunity from patients is definitely not the purpose of EBM. This can no longer be referred to as EBM, but should be termed evidence-restricted medicine. We should not be restrained by superficial details of a particular RCT, and it is important to have flexible thinking that enables us to capture the essence of each RCT and utilize the knowledge gained from any evidence.

https://opac.ll.chiba-u.jp/da/curator/900119980/

https://opac.ll.chiba-u.jp/da/curator/900119980/S03035476-97E-4-P71.pdf

The Chiba Medical Society

千葉医学会

学術雑誌論文

AN00142148

Chiba medical journal

97E

4-5

71

73

2021-10-10

10.20776/S03035476-97E-4-P71

publisher

Chiba Medical Journal (ONLINE ISSN 2433-4235)