Oncologist Accused of Inappropriate Treatment 'Brilliant', Tribunal Hears

Ian Leonard

September 03, 2021

MANCHESTER—Cancer Professor Karol Sikora has defended leading oncologist Justin Stebbing, describing his treatment of one patient as "brilliant" and an "amazing story", a medical tribunal heard.

Prof Sikora, who's been described as a leading world authority on cancer, claimed the treatment had enabled the patient to live for another 3 years and see the birth of his child. (Prof Sikora also comments on cancer issues for Medscape UK.)

Prof Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice in Harley Street, has an international reputation for his innovative treatments which has led to wealthy, terminally-ill cancer patients from around the world turning to him in the hope of extending their lives.

He's appearing before a Medical Practitioners Tribunal Service (MPTS) fitness to practise hearing and is accused of failing to provide good clinical care to 12 patients between March 2014 and March 2017.

In some cases, he's accused of inappropriately treating patients given their advanced cancer or poor prognosis, overstating life expectancy and the benefits of chemotherapy, and continuing to treat patients when it was futile and they had just weeks to live.

Prof Justin Stebbing

Patient B

Expert witness Prof Sikora was asked about one lung cancer patient - Patient B - who was treated by Prof Stebbing between May 2014 and October 2015.

Prof Stebbing is accused of offering double chemotherapy beyond six cycles, despite evidence of the patient's deteriorating renal function, failing to discuss the risks and benefits of treatment, and failing to keep adequate records.

He's also accused of recommending the same treatment beyond 10 cycles despite a lack of efficacy, evidence of harm emerging and exposing the patient to risks "without any conceivable prospect of improving health".

Sharon Beattie QC, for the GMC, claimed Prof Stebbing's treatment of Patient B was a clear departure from guidelines and if he intended being an "innovator" or a "crusader" he should have documented his rationale.

But Prof Sikora argued that Prof Stebbing had exercised his clinical judgment and prescribed chemotherapy as a "bridging" treatment, which had kept the patient alive until he received immunotherapy.

He told the tribunal: "Immunotherapy wasn't available for essentially bureaucratic reasons.

"It hadn't been licensed," he said. "The only thing available was chemotherapy.

"We knew docetaxel - another good drug for lung cancer - partially worked but caused severe toxicity.

"So giving a full dose of platinum was logical.

"It was brilliant because a week later pembo [pembrolizumab] was licensed and the guy lived for 2 years and he came out of renal failure.

"What more could you ask for? And now your pillorying Prof Stebbing because he succeeded with this patient - in the short term albeit.

"But it was very worthwhile. The patient was able to able to see his child.

"It's just an amazing story."

Performance Status

Professsor Sikora also claimed that the patient had met the criteria for further chemotherapy beyond four to six cycles.

He said Patient B had responded to treatment, shown good performance status (PS), and would have died otherwise.

"First of all, he was flying backwards and forwards from Spain to receive chemotherapy, which isn't an easy feat if you're not feeling well so I would say his PS is no greater than one," he said.

"The second thing was he responded to two cycles, albeit a very partial and mixed response in [that] some lesions shrunk and others stayed the same.

"Then the third thing, which is the proof of the pudding, was he lived 3 years onwards and wouldn't have lived if you'd stopped the chemotherapy.

"OK, he responded to immunotherapy and that's why he lived so long. But if the chemo had been stopped, as Ms Beattie implies, the man would never have seen his baby."

Ms Beattie said there was evidence of disease progression and renal toxicity following the patient's six courses of chemotherapy and in October 2015 he'd been admitted to hospital with possible sepsis and kidney injury as a result of treatment.

Clinical Judgment

Prof Sikora claimed it was "exactly a situation" where clinical judgment kicked in and "you throw out all the guidelines and all the textbooks" because you know the patient was showing a partial response to treatment.

He said Prof Stebbing would have monitored any renal damage and "balanced toxicity with benefit" in a patient who had a rapidly-growing disease.

But he agreed with Ms Beattie's assertion that if treatment was outside the guidelines it was important that rational was documented and the patient should be aware of and understand it.

Ms Beattie said records failed to show that was the case and Prof Stebbing had prescribed further chemotherapy after ten cycles despite evidence of harm and a lack of efficacy.

But Prof Sikora claimed many oncologists would have tried full-dose treatment having seen a partial response and Prof Stebbing would have been aware of the patient's renal failure.

He said Prof Stebbing had switched to pembrolizumab, an immunotherapy treatment which by chance had only just been approved by the US Food and Drug Administration (FDA), once he realised the chemotherapy wasn't working.

Professor Sikora said it was "easy with hindsight" to argue that Prof Stebbing should not have continued chemotherapy beyond 10 cycles because, as Ms Beattie claimed, it was "inappropriate".

The hearing is continuing.

Ian Leonard is a freelance journalist experienced in covering MPTS hearings.

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