Leading oncologist
Prof. Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice on Harley Street, claimed the patient would have died without the chemotherapy, and immunotherapy treatment led to him living for another 2 years.
He’s appearing before a Medical Practitioners Tribunal Service (MPTS) fitness-to-practice hearing and is accused of failing to provide good clinical care to 12 patients between March 2014 and March 2017.
In some cases, Prof. Stebbing is 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.
The 36 charges – 21 of which he’s admitted – also include failing to keep proper records and failing to gain informed consent for treatment from patients.
Patient B
Prof. Stebbing’s international reputation for innovative treatments has led to wealthy, terminally ill cancer patients from around the world turning to him in the hope of extending their lives.
The tribunal heard about one lung cancer patient – known only as Patient B – from Spain he treated between May 2014 and October 2015.
Prof. Stebbing is accused of offering doublet chemotherapy to the patient beyond six cycles, despite evidence emerging that he was developing impaired renal function.
He’s also accused of continuing the treatment at a higher dose after 10 cycles despite a “lack of efficacy” and “evidence of harm emerging.”
It’s alleged the chemotherapy would have exposed the patient to risks “without any conceivable prospect of improving health.”
However, Prof. Stebbing defended his actions, saying he’d explained to the patient that if he stopped chemotherapy at any time, “his disease would progress rapidly and he would die.”
He said immunotherapy “typically took 3 months to work,” and because the patient’s lung cancer hadn’t progressed, it was evident that the chemotherapy had worked.
It was possible to provide chemotherapy in cases of renal failure, he said, and he’d only given it in small doses.
“This is one of two patients in the bundle who has an exceptional standard of care,” he said.
“If you look at the problem with his kidneys, this was the minimus in my terms.
“I think I made some very, very difficult decisions that other people may not have made, but I got them right and, as a result, he lived very happily for another 2 years.”
‘Guidelines are a guide’
But Sharon Beattie, for the General Medical Council (GMC), claimed he’d ignored guidelines, and there was no data to support the position he’d taken.
Prof. Stebbing replied: “The guidelines are a guide; they are helpful. They do not replace the skill of an individual doctor.”
“There were no guidelines for a patient like this. I’m absolutely amazed you’re saying, ‘You should have just let him die because there were no guidelines.’”
Ms. Beattie pointed out that Prof. Stebbing had accepted that he’d stopped the chemotherapy treatment in October 2015 because it was clear there was evidence of “toxicity and waning efficacy.”
But he claimed there were only “grade one” levels of toxicity and “mild” disease progression.
At that stage, he said, he realized he was approaching the “end of the line” with the treatment and he was “thinking out of the box” to get immunotherapy for the patient.
Earlier, Prof. Stebbing said the chemotherapy had been “a bridge” to the patient’s immunotherapy treatment, but it had “never been clear” it would be available.
He said: “The whole point of the extended duration chemotherapy was to try to get him to immunotherapy if it was available.”
“It was a very exciting, new possibility. I didn’t know if it was going to be available, but I wanted the patient to have every chance of it being available.”
“The longer he lived for with stable disease the more likelihood it had of becoming available.”
Prof. Stebbing denies failing to discuss the risks and benefits of chemotherapy with the patient and failing to maintain adequate records.
He told the tribunal that he had discussed both the chemotherapy and immunotherapy, but he accepted he’d had “problems” with documenting his decisions.
The tribunal continues.
A version of this article first appeared on Medscape.com.