Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA.
J Clin Oncol. 2010 May 20;28(15):2635-40. doi: 10.1200/JCO.2009.27.2443. Epub 2010 Apr 20.
Clinical investigators in oncology are increasingly interested in using molecular analysis of cancer tissue to understand the biologic bases of response or resistance to novel interventions and to develop prognostic and predictive biomarkers that will guide clinical decision making. Some scientific questions of this nature can only be addressed, or may best be addressed, through the conduct of a clinical trial in which research biopsies are obtained from all participants. However, trial designs with mandatory research biopsies have raised ethical concerns related to the risk of harm to participants, the adequacy of voluntary informed consent, and the potential for misunderstanding among research participants when access to an experimental intervention is linked to the requirement to undergo a research biopsy. In consideration of the ethical and scientific issues at stake in this debate, the Cancer and Leukemia Group B Ethics Committee proposes guidelines for clinical trials involving mandatory research biopsies. Any cancer clinical trial that requires research biopsies of participants must be well designed to address the scientific question, obtain the biopsy in a way that minimizes risk, and ensure that research participants are fully informed of the risks, rationale, and requirements of the study, as well as of treatment alternatives. Further guidelines and discussions of this issue are specified in this position paper. We feel that if these principles are respected, an informed adult with cancer can both understand and voluntarily consent to participation in a clinical trial involving mandatory research biopsy for scientific end points.
肿瘤学临床研究人员越来越有兴趣利用癌症组织的分子分析来了解新型干预措施的反应或耐药的生物学基础,并开发能够指导临床决策的预后和预测生物标志物。某些此类性质的科学问题只能通过进行临床试验来解决,或者可能最好通过临床试验来解决,其中所有参与者都要获得研究活检。然而,强制性研究活检的试验设计引起了与以下方面相关的伦理问题:对参与者造成伤害的风险、自愿知情同意的充分性,以及当获得实验性干预措施与进行研究活检的要求相关联时,研究参与者之间可能产生误解。考虑到这场辩论中涉及的伦理和科学问题,癌症和白血病小组 B 伦理委员会提出了涉及强制性研究活检的临床试验指南。任何需要对参与者进行研究活检的癌症临床试验都必须精心设计,以解决科学问题,以最小化风险的方式获取活检,并确保研究参与者充分了解研究的风险、基本原理和要求,以及替代治疗方法。本立场文件详细说明了进一步的指南和对此问题的讨论。我们认为,如果这些原则得到尊重,那么患有癌症的知情成年人就能够理解并自愿同意参与涉及强制性研究活检的临床试验,以达到科学终点。