Do You Always Follow Clinical Guidelines?

December 04, 2019

In 2017, oncologist Talal Hilal, MD, treated a patient who had hepatocellular cancer that was progressing despite the best available therapies. A recently updated and influential guideline for cancer care offered an additional option: nivolumab, an immune checkpoint inhibitor.

Hilal offered the patient the new drug, but it didn't work. The patient died soon after, and later a large study failed to show that nivolumab improved outcomes for patients with hepatocellular cancer in the front-line setting.

"Guidelines convey a false sense of certainty," Hilal wrote in a Medscape perspective article. "In science, there is no absolute certainty. Today's best practice may be abandoned tomorrow. Guidelines that propagate treatments without acknowledging their uncertainty can be harmful."

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