L'intérêt des thérapies ciblées chez le patient atteint de cancer au stade palliatif

The emergence of targeted therapies in the oncology therapeutic arsenal leads the medical professionals to think not only on a medical and scientific basis but also on an ethical dimension. We were interested in the use of these new treatments in the patient with an evolved cancer. In the first instance, we recap the different available molecules, their indication, and their side effects, and, in particular, we detail the gefitinib, erlotinib, bevacizumab, sorafenib, and trastazumab.They all result in significant increase in life span. However, they trigger variable side effects which are different from the ones encountered under conventional chemotherapy, with the most frequent being rashes and diarrhoea, rarely reaching the level of toxicity IV, which would imply having to stop the therapeutics. The current economic health policy leads us to consider the cost of such treatments on the one hand and their social and ethical impact on the other hand. Studies were conducted to measure not only the gain of life span but also the ratio of cost/efficiency and the quality of life. These studies tend to plead for the introduction of targeted therapies for patients with advanced diseases, when considering in particular quality of life and the decrease in tiresome symptoms, such as pains and dyspnoea. Simultaneously, the good tolerance of a targeted therapy and its ease to administer either orally or parenterally should not prevent raising the question of stopping when the targeted therapy becomes less efficient, which links with the issue of announcing a worsening of the disease.