Off-Label Uses of Anticancer Drugs

To the Editor. —Dr Laetz and Mr Silberman1summarized the findings of a US General Accounting Office survey that clearly demonstrates that off-label drug use by oncologists is quite common, particularly in the palliative therapy of advanced malignancies, ie, the cases that are most difficult to treat and for which the therapeutic results are modest at best. The General Accounting Office report further indicates that a shifting and increasing array of reimbursement policies cause oncologists to alter preferred treatments and sites of care. In an editorial in the same issue, Dr Moertel2mistakenly equates the off-label categorization of these uses of anticancer drugs with lack of evidence of effectiveness. Moertel chastises oncologists, patient-activist groups, the pharmaceutical industry, and National Cancer Institute officials for contributing to the soaring costs of medical care in this country by questionable off-label uses of anticancer drugs. Although the General Accounting Office report did