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Michaeli DT, Michaeli T, Albers S, Michaeli JC. Clinical trial design and treatment effects: a meta-analysis of randomised controlled and single-arm trials supporting 437 FDA approvals of cancer drugs and indications. BMJ Evid Based Med 2024:bmjebm-2023-112544. [PMID: 38760158 DOI: 10.1136/bmjebm-2023-112544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES This study aims to analyse the association between clinical trial design and treatment effects for cancer drugs with US Food and Drug Administration (FDA) approval. DESIGN Cross-sectional study and meta-analysis. SETTING Data from Drugs@FDA, FDA labels, ClincialTrials.gov and the Global Burden of Disease study. PARTICIPANTS Pivotal trials for 170 drugs with FDA approval across 437 cancer indications between 2000 and 2022. MAIN OUTCOME MEASURES Treatment effects were measured in HRs for overall survival (OS) and progression-free survival (PFS), and in relative risk for tumour response. Random-effects meta-analyses and meta-regressions explored the association between treatment effect estimates and clinical trial design for randomised controlled trials (RCTs) and single-arm trials. RESULTS Across RCTs, greater effect estimates were observed in smaller trials for OS (ß=0.06, p<0.001), PFS (ß=0.15, p<0.001) and tumour response (ß=-3.61, p<0.001). Effect estimates were larger in shorter trials for OS (ß=0.08, p<0.001) and PFS (ß=0.09, p=0.002). OS (ß=0.04, p=0.006), PFS (ß=0.10, p<0.001) and tumour response (ß=-2.91, p=0.004) outcomes were greater in trials with fewer centres. HRs for PFS (0.54 vs 0.62, p=0.011) were lower in trials testing the new drug to an inactive (placebo/no treatment) rather than an active comparator. The analysed efficacy population (intention-to-treat, per-protocol, or as-treated) was not consistently associated with treatment effects. Results were consistent for single-arm trials and in multivariable analyses. CONCLUSIONS Pivotal trial design is significantly associated with measured treatment effects. Particularly small, short, single-centre trials testing a new drug compared with an inactive rather than an active comparator could overstate treatment outcomes. Future studies should verify results in unsuccessful trials, adjust for further confounders and examine other therapeutic areas. The FDA, manufacturers and trialists must strive to conduct robust clinical trials with a low risk of bias.
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Affiliation(s)
- Daniel Tobias Michaeli
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Michaeli
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- German Cancer Research Center-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Sebastian Albers
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Julia Caroline Michaeli
- Department of Obstetrics and Gynaecology, LMU University Hospital, LMU Munich, Munich, Germany
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Magbanua MJM, Li W, van ’t Veer LJ. Integrating Imaging and Circulating Tumor DNA Features for Predicting Patient Outcomes. Cancers (Basel) 2024; 16:1879. [PMID: 38791958 PMCID: PMC11120531 DOI: 10.3390/cancers16101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Biomarkers for evaluating tumor response to therapy and estimating the risk of disease relapse represent tremendous areas of clinical need. To evaluate treatment efficacy, tumor response is routinely assessed using different imaging modalities like positron emission tomography/computed tomography or magnetic resonance imaging. More recently, the development of circulating tumor DNA detection assays has provided a minimally invasive approach to evaluate tumor response and prognosis through a blood test (liquid biopsy). Integrating imaging- and circulating tumor DNA-based biomarkers may lead to improvements in the prediction of patient outcomes. For this mini-review, we searched the scientific literature to find original articles that combined quantitative imaging and circulating tumor DNA biomarkers to build prediction models. Seven studies reported building prognostic models to predict distant recurrence-free, progression-free, or overall survival. Three discussed building models to predict treatment response using tumor volume, pathologic complete response, or objective response as endpoints. The limited number of articles and the modest cohort sizes reported in these studies attest to the infancy of this field of study. Nonetheless, these studies demonstrate the feasibility of developing multivariable response-predictive and prognostic models using regression and machine learning approaches. Larger studies are warranted to facilitate the building of highly accurate response-predictive and prognostic models that are generalizable to other datasets and clinical settings.
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Affiliation(s)
- Mark Jesus M. Magbanua
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94115, USA;
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94115, USA;
| | - Laura J. van ’t Veer
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94115, USA;
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Naci H, Zhang Y, Woloshin S, Guan X, Xu Z, Wagner AK. Overall survival benefits of cancer drugs initially approved by the US Food and Drug Administration on the basis of immature survival data: a retrospective analysis. Lancet Oncol 2024:S1470-2045(24)00152-9. [PMID: 38754451 DOI: 10.1016/s1470-2045(24)00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/24/2024] [Accepted: 03/14/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND New cancer drugs can be approved by the US Food and Drug Administration (FDA) on the basis of surrogate endpoints while data on overall survival are still incomplete or immature, with too few deaths for meaningful analysis. We aimed to evaluate whether clinical trials with immature survival data generated evidence of overall survival benefit during the period after marketing authorisation, and where that evidence was reported. METHODS In this retrospective analysis, we searched Drugs@FDA to identify cancer drug indications approved between Jan 1, 2001, and Dec 31, 2018, on the basis of immature survival data. We systematically collected publicly available data on postapproval overall survival results in labelling (Drugs@FDA), journal publications (MEDLINE via PubMed), and clinical trial registries (ClinicalTrials.gov). The primary outcome was availability of statistically significant overall survival benefits during the period after marketing authorisation (until March 31, 2023). Additionally, we evaluated the availability and timing of overall survival findings in labelling, journal publications, and ClinicalTrials.gov records. FINDINGS During the study period, the FDA granted marketing authorisation to 223 cancer drug indications, 95 of which had overall survival as an endpoint. 39 (41%) of these 95 indications had immature survival data. After a minimum of 4·3 years of follow-up during the period after marketing authorisation (and median 8·2 years [IQR 5·3-12·0] since FDA approval), additional survival data from the pivotal trials became available in either revised labelling or publications, or both, for 38 (97%) of 39 indications. Additional data on overall survival showed a statistically significant benefit in 12 (32%) of 38 indications, whereas mature data yielded statistically non-significant overall survival findings for 24 (63%) indications. Statistically significant evidence of overall survival benefit was reported in either labelling or publications a median of 1·5 years (IQR 0·8-2·3) after initial approval. The median time to availability of statistically non-significant overall survival results was 3·3 years (2·2-4·5). The availability of overall survival results on ClinicalTrials.gov varied considerably. INTERPRETATION Fewer than a third of indications approved with immature survival data showed a statistically significant overall survival benefit after approval. Notable inconsistencies in timing and availability of information after approval across different sources emphasise the need for better reporting standards. FUNDING None.
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Affiliation(s)
- Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK; The Lisa Schwartz Foundation for Truth in Medicine, Norwich, VT, USA.
| | - Yichen Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Steven Woloshin
- The Lisa Schwartz Foundation for Truth in Medicine, Norwich, VT, USA; The Center for Medicine in the Media, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Ziyue Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Anita K Wagner
- The Lisa Schwartz Foundation for Truth in Medicine, Norwich, VT, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Signorovitch J, Zhang J, Brown D, Dunnmon P, Xiu L, Done N, Hsu K, Barbachano Y, Lousada I. Pathway for Development and Validation of Multi-domain Endpoints for Amyloid Light Chain (AL) Amyloidosis. Ther Innov Regul Sci 2024:10.1007/s43441-024-00641-6. [PMID: 38632158 DOI: 10.1007/s43441-024-00641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/08/2024] [Indexed: 04/19/2024]
Abstract
Immunoglobin light chain (AL) amyloidosis is a rare disease in which a plasma cell dyscrasia leads to deposition of insoluble amyloid fibrils in multiple organs. To facilitate development of new therapies for this heterogenous disease, a public-private partnership was formed between the nonprofit Amyloidosis Research Consortium and the US Food and Drug Administration Center for Drug Evaluation and Research. In 2020, the Amyloidosis Forum launched an initiative to identify clinical trial endpoints and analytic strategies across affected organ systems and life impacts via specialized working groups. This review summarizes the proceedings of the Statistical Group and proposes a pathway for development and validation of multi-domain endpoints (MDEs) for potential use in AL amyloidosis clinical trials. Specifically, drawing on candidate domain-specific endpoints recommended by each organ-specific working group, different approaches to constructing MDEs were considered. Future studies were identified to assess the validity, meaningfulness and performance of MDEs through use of natural history and clinical trial data. Ultimately, for drug development, the context of use in a regulatory evaluation, the specific patient population, and the investigational therapeutic mechanism should drive selection of appropriate endpoints. MDEs for AL amyloidosis, once developed and validated, will provide important options for advancing patient-focused drug development in this multi-system disease.
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Affiliation(s)
| | - Jialu Zhang
- US Food and Drug Administration, Silver Spring, USA
| | - David Brown
- UK Medicines & Healthcare Products Regulatory Agency, London, UK
| | | | - Liang Xiu
- Janssen Research & Development, Raritan, USA
| | | | - Kristen Hsu
- Amyloidosis Research Consortium, 320 Nevada Street, Suite 210, Newton, MA, 02460, USA
| | | | - Isabelle Lousada
- Amyloidosis Research Consortium, 320 Nevada Street, Suite 210, Newton, MA, 02460, USA.
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Elbaz J, Haslam A, Prasad V. An empirical analysis of overall survival in drug approvals by the US FDA (2006-2023). Cancer Med 2024; 13:e7190. [PMID: 38659418 PMCID: PMC11043668 DOI: 10.1002/cam4.7190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/18/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The US Food and Drug Administration (FDA) has expanded the use of surrogate markers in drugs approved for oncology/hematology indications. This has likely resulted in a greater number of approvals and possibly drugs coming to market faster, but it is unknown whether these drugs also improve overall survival (OS) for patients taking them. METHODS We sought to estimate the percentage of oncology drugs that have shown to improve OS in a cross-sectional analysis of US FDA oncology drug approvals (2006-2023). We searched for OS data in registration trials and the peer-reviewed literature. RESULTS We found 392 oncology drug approvals. Eighty-seven (22%) drug approvals were based on OS, 147 drug approvals were later tested for OS benefit (38% of all approvals and 48% of drugs approved on a surrogate), and 130 (33%) have yet to be tested for OS benefit. Of the 147 drug approvals later tested for OS, 109 (28% of all approvals and 74% of drugs later tested for OS) have yet to show OS benefit, whereas 38 (10% of all approvals and 26% of drugs later tested for OS benefit) were later shown to have OS benefit. In total, 125 out of 392 (32%) drugs approved for any indication have been shown to improve OS benefit at some point, and 267 (68%) have yet to show approval. CONCLUSION About 32% of all oncology drug approvals have evidence for an improvement in OS. Higher standards are needed in drug regulation to ensure that approved drugs are delivering better patient outcomes, specifically in regards to survival.
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Affiliation(s)
| | - Alyson Haslam
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Vinay Prasad
- University of California San FranciscoSan FranciscoCaliforniaUSA
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6
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Nieto-Gómez P, Castaño-Amores C, Rodríguez-Delgado A, Álvarez-Sánchez R. Analysis of oncological drugs authorised in Spain in the last decade: association between clinical benefit and reimbursement. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:257-267. [PMID: 36995531 DOI: 10.1007/s10198-023-01584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Our study aimed to assess whether there was a relationship between clinical benefits and reimbursement decisions as well as the inclusion of economic evaluations in therapeutic positioning reports (IPTs) and to explore factors influencing reimbursement decisions. MATERIALS AND METHODS We analysed all anti-cancer drugs approved in Spain from 2010 to September 2022. The clinical benefit of each drug were evaluated using the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) 1.1. The characteristics of these drugs were obtained from the Spanish Agency of Medicines and Medical Devices. Reimbursement status information was obtained using BIFIMED, a web resource available in Spanish and consulted the agreements of the Interministerial Committee on Pricing of Medicines (CIPM). RESULTS In total, 73 drugs were included involving 197 indications. Almost half of the indications had substantial clinical benefit (49.8% yes vs. 50.3% no). Of the 153 indications with a reimbursement decision, 61 (56.5%) reimbursed indications had substantial clinical benefit compared to 14 (31.1%) of the non-reimbursed (p < 0.01). The median gain of overall survival was 4.9 months (2.8-11.2) for reimbursed indications and 2.9 months (1.7-5) in non-reimbursed (p < 0.05). Only six (3%) indications had an economic evaluation in the IPT. CONCLUSION Our study revealed that there is a relationship between substantial clinical benefit and the reimbursement decision in Spain. However, we also found that the overall survival gain was modest, and a significant proportion of the reimbursed indications had no substantial clinical benefit. Economic evaluations in IPTs are infrequent and cost-effectiveness analysis is not provided by CIPM.
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Affiliation(s)
- P Nieto-Gómez
- Pharmacy Unit, Hospital Santa Bárbara, Street Malagón S/N, 13500, Puertollano, Spain.
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Nadir U, Ahmed A, Yi MD, Hisham FI, Dave L, Kottner J, Ezzedine K, Garg A, Ingram JR, Jemec GBE, Spuls PI, Kirkham JJ, Cahn B, Alam M. Protocol of a scoping review of outcome domains in dermatology. BMJ Open 2024; 14:e079632. [PMID: 38320843 PMCID: PMC10860027 DOI: 10.1136/bmjopen-2023-079632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Core outcome sets (COSs) are agreed outcomes (domains (subdomains) and instruments) that should be measured as a minimum in clinical trials or practice in certain diseases or clinical fields. Worldwide, the number of COSs is increasing and there might be conceptual overlaps of domains (subdomains) and instruments within disciplines. The aim of this scoping review is to map and to classify all outcomes identified with COS projects relating to skin diseases. METHODS AND ANALYSIS We will conduct a scoping review of outcomes of skin disease-related COS initiatives to identify all concepts and their definitions. We will search PubMed, Embase and Cochrane library. The search dates will be 1 January 2010 (the point at which Core Outcome Measures in Effectiveness Trials (COMET) was established) to 1 January 2024. We will also review the COMET database and C3 website to identify parts of COSs (domains and/or instruments) that are being developed and published. This review will be supplemented by querying relevant stakeholders from COS organisations, dermatology organisations and patient organisations for additional COSs that were developed. The resulting long lists of outcomes will then be mapped into conceptually similar concepts. ETHICS AND DISSEMINATION This study was supported by departmental research funds from the Department of Dermatology at Northwestern University. An ethics committee review was waived since this protocol was done by staff researchers with no involvement of patient care. Conflicts of interests, if any, will be addressed by replacing participants with relevant conflicts or reassigning them. The results will be disseminated through publication in peer-reviewed journals, social media posts and promotion by COS organisations.
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Affiliation(s)
- Umer Nadir
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Areeba Ahmed
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael D Yi
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Loma Dave
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jan Kottner
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - K Ezzedine
- Service de Dermatologie, AP-HP, Henri Mondor Hospital, Paris, France
| | - Amit Garg
- Department of Dermatology, Hofstra Northwell School of Medicine, Long Island, New York, USA
| | | | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, Netherlands
| | | | - Brian Cahn
- Department of Dermatology, University of Illinois, Chicago, Illinois, USA
| | - Murad Alam
- Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Fey M. The GLOW trial in chronic lymphocytic leukaemia. Lancet Oncol 2024; 25:e54. [PMID: 38301696 DOI: 10.1016/s1470-2045(23)00620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Martin Fey
- University of Bern, 3010 Bern, Switzerland.
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Zhou J, Lan T, Lu H, Pan J. Price negotiation and pricing of anticancer drugs in China: An observational study. PLoS Med 2024; 21:e1004332. [PMID: 38166148 DOI: 10.1371/journal.pmed.1004332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/17/2024] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND While China has implemented reimbursement-linked drug price negotiation annually since 2017, emphasizing value-based pricing to achieve a value-based strategic purchase of medical insurance, whether drug prices became better aligned with clinical value after price negotiation has not been sufficiently established. This study aimed to assess the changes in prices and their relationship with the clinical value of anticancer drugs after the implementation of price negotiations in China. METHODS AND FINDINGS In this observational study, anticancer drug indications that were negotiated successfully between 2017 and 2022 were identified through National Reimbursement Drug Lists (NRDL) of China. We excluded extensions of indications for drugs already listed in the NRDL, indications for pediatric use, and indications lacking corresponding clinical trials. We identified pivotal clinical trials for included indications by consulting review reports or drug labels issued by the Center for Drug Evaluation, National Medical Products Administration. We calculated treatment costs as outcome measures based on publicly available prices and collected data on clinical value including safety, survival, quality of life, and overall response rate (ORR) from publications of pivotal clinical trials. The associations between drug costs and clinical value, both before and after negotiation, were analyzed using regression analyses. We also examined whether price negotiation has led to a reduction in the variation of treatment costs for a given value. We included 103 anticancer drug indications, primarily for the treatment of blood cancer, lung cancer, and breast cancer, with 76 supported by randomized controlled trials and 27 supported by single-arm clinical trials. The median treatment costs over the entire sample have been reduced from US$34,460.72 (interquartile range (IQR): 19,990.49 to 55,441.66) to US$13,688.79 (IQR: 7,746.97 to 21,750.97) after price negotiation (P < 0.001). Before price negotiation, each additional month of survival gained was associated with an increase in treatment costs of 3.4% (95% confidence interval (CI) [2.1, 4.8], P < 0.001) for indications supported by randomized controlled trials, and a 10% increase in ORR was associated with a 6.0% (95% CI [1.6, 10.3], P = 0.009) increase in treatment costs for indications supported by single-arm clinical trials. After price negotiation, the associations between costs and clinical value may not have changed significantly, but the variation of drug costs for a given value was reduced. Study limitations include the lack of transparency in official data, missing data on clinical value, and a limited sample size. CONCLUSIONS In this study, we found that the implementation of price negotiation in China has led to drug pricing better aligned with clinical value for anticancer drugs even after substantial price reductions. The achievements made in China could shed light on the price regulation in other countries, particularly those with limited resources and increasing drug expenditures.
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Affiliation(s)
- Jing Zhou
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Tianjiao Lan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Hao Lu
- School of Public Health, Imperial College London, London, United Kingdom
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- School of Public Administration, Sichuan University, Chengdu, China
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Brundage MD, Booth CM, Eisenhauer EA, Galica J, Kankesan J, Karim S, Koven R, McDonald V, Ng T, O’Donnell J, ten Hove J, Robinson A. Patients' attitudes and preferences toward delayed disease progression in the absence of improved survival. J Natl Cancer Inst 2023; 115:1526-1534. [PMID: 37458509 PMCID: PMC10699849 DOI: 10.1093/jnci/djad138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Cancer patients' attitudes toward progression-free survival (PFS) gains offered by treatment are not well understood, particularly in the absence of overall survival (OS) gains. The objectives were to describe patients' willingness to accept treatment that offers PFS gains without OS gains, to compare these findings with treatments offering OS gains, and to qualitatively summarize patients' reasons for their preferences. METHODS A multicenter, cross-sectional, convergent mixed-methods study design recruited patients who had received at least 3 months of systemic therapy for incurable solid tumors. A treatment trade-off exercise determined the gains in imaging PFS that patients require to prefer additional systemic treatment for a scenario of a newly diagnosed, asymptomatic, incurable abdominal tumor. A qualitative, descriptive, thematic analysis explored factors influencing patients' decisions, and a narrative method integrated the quantitative and qualitative findings. RESULTS In total, 100 patients participated (63% were older than 60 years of age). If additional treatment with added toxicity offered no OS advantage, 17% would prefer it for no PFS benefit; 26% for some PFS benefit (range, 3-9 months), whereas 51% would decline it regardless of PFS benefit. Similarly, 71% preferred additional treatment offering a 6-month OS advantage dependent on described toxicity levels (P = .03). A spectrum of reasons for these preferences reflected the complexity of participants' attitudes and values. CONCLUSIONS Prolongation of time to progression was not universally valued. Most patients did not prefer treatments that negatively affect quality of life for PFS gains alone. Implications for individual decision making, policy, and trials research are discussed.
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Affiliation(s)
- Michael D Brundage
- Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | | | - Jacqueline Galica
- Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | | | | | - Rachel Koven
- Patient Advocate on behalf of Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | - Valerie McDonald
- Patient Advocate on behalf of Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | - Terry Ng
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer O’Donnell
- Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | - Julia ten Hove
- Cancer Care and Epidemiology, Queen’s University, Cancer Research Institute, Kingston, ON, Canada
| | - Andrew Robinson
- Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON, Canada
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Shahnam A, Nindra U, Desai J, Hui R, Buyse M, Hopkins AM, Sorich MJ. Time to deterioration of patient-reported outcomes as a surrogate of overall survival: a meta-analysis. J Natl Cancer Inst 2023; 115:1475-1482. [PMID: 37540222 DOI: 10.1093/jnci/djad152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Overall survival is the optimal marker of treatment efficacy in randomized clinical trials (RCTs) but can take considerable time to mature. Progression-free survival (PFS) has served as an early surrogate of overall survival but is imperfect. Time to deterioration in quality of life (QOL) measures could be a surrogate for overall survival. METHODS Phase 3 RCTs in solid malignancies that reported overall survival, PFS, and time to deterioration in QOL or physical function published between January 1, 2010, and June 30, 2022, were evaluated. Weighted regression analysis was used to assess the relationship between PFS, time to deterioration in QOL, and time to deterioration in physical function with overall survival. The coefficient of determination (R2) was used to quantify surrogacy. RESULTS In total, 138 phase 3 RCTs were included. Of these, 47 trials evaluated immune checkpoint inhibitors and 91 investigated non-immune checkpoint inhibitor agents. Time to deterioration in QOL (137 RCTs) and time to deterioration in physical function (75 RCTs) performed similarly to PFS as surrogates for overall survival (R2 = 0.18 vs R2 = 0.19 and R2 = 0.10 vs R2 = 0.09, respectively). For immune checkpoint inhibitor studies, time to deterioration in physical function had a higher association with overall survival than with PFS (R2 = 0.38 vs R2 = 0.19), and PFS and time to deterioration in physical function did not correlate with each other (R2 = 0). When time to deterioration in physical function and PFS are used together, the coefficient of determination increased (R2 = 0.57). CONCLUSIONS Time to deterioration in physical function appears to be an overall survival surrogate measure of particular importance for immune checkpoint inhibitor treatment efficacy. The combination of time to deterioration in physical function with PFS may enable better prediction of overall survival treatment benefit in RCTs of immune checkpoint inhibitors than either PFS or time to deterioration in physical function alone.
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Affiliation(s)
- Adel Shahnam
- Department of Medical Oncology, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Udit Nindra
- Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jayesh Desai
- Department of Medical Oncology, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rina Hui
- Centre of Cancer Medicine, University of Hong Kong, Hong Kong
| | - Marc Buyse
- International Drug Development Institute, Brussels, Belgium
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Booth CM, Eisenhauer EA, Gyawali B, Tannock IF. Progression-Free Survival Should Not Be Used as a Primary End Point for Registration of Anticancer Drugs. J Clin Oncol 2023; 41:4968-4972. [PMID: 37733981 DOI: 10.1200/jco.23.01423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | | | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Ian F Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
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13
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García-Fumero R, Fernández-López C, Calleja-Hernández MÁ, Expósito-Ruiz M, Espín J, Expósito-Hernández J. Clinical Outcomes of First-line Therapies for Advanced Non-Small Cell Lung Cancer: A Systematic Review of Trials Published Between 2010 and 2020. Am J Clin Oncol 2023; 46:433-438. [PMID: 37522643 DOI: 10.1097/coc.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To analyze the evolution of clinical outcomes derived from clinical trials on first-line therapies for advanced or metastatic non-small cell lung cancer (NSCLC) published between 2010 and 2020, focusing on how these outcomes impact survival rates and management of patients. METHODS A systematic review of phase III and pivotal phase II clinical trials was conducted by a structured search on Medline and Embase. A comprehensive set of variables was collected to assess their influence on survival rates. We also estimated the clinical benefit by applying the ESMO-MCBS v1.1 and extracted the authors' conclusions. RESULTS Sixty-six studies involving 34,951 patients were included. Best survival outcomes were found for nonsquamous non-small cell lung cancer (OS and progression-free survival medians: 19.4 and 10.2 mo) and for those expressing molecular targets (OS and progression-free survival medians: 23.8 and 11.0 mo). No significant influence on survival rates was observed for industry funding and disease stage (IIIB/IV vs. IV). ESMO-MCBS v1.1 was applied in 45 positive studies and resulted in a meaningful clinical benefit score in 37.8%. Quality of life (QoL) was reported in 57.6% of the original publications and showed statistical significance favoring the experimental arm in 33.3%. Positive authors' conclusions (75.7% of trials) were based on OS and/or QoL in 34% and on surrogate endpoints in 66%. CONCLUSIONS Extended survival times and a steady improvement in QoL have been observed. However, there were more than twice as many studies reporting positive authors' conclusions as studies meeting the ESMO threshold for meaningful clinical benefit.
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Affiliation(s)
| | | | | | | | - Jaime Espín
- Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
- Instituto de Investigación Biosanitaria ibs
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14
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Chauca Strand G, Johansson N, Jakobsson N, Bonander C, Svensson M. Cancer Drugs Reimbursed with Limited Evidence on Overall Survival and Quality of Life: Do Follow-Up Studies Confirm Patient Benefits? Clin Drug Investig 2023; 43:621-633. [PMID: 37505421 PMCID: PMC10480259 DOI: 10.1007/s40261-023-01285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Cancer drug costs have increased considerably within healthcare systems, but many drugs lack quality-of-life (QoL) and overall survival (OS) data at the time of reimbursement approval. This study aimed to review the extent of subsequent literature documenting improvements in OS and QoL for cancer drug indications where no such evidence existed at the time of reimbursement approval. METHODS Drug indications with claims of added therapeutical value but a lack of evidence on OS and QoL that were reimbursed between 2010 and 2020 in Sweden were included for review. Searches were conducted in PubMed and ClinicalTrial.gov for randomized controlled trials examining OS and QoL. RESULTS Of the 22 included drug indications, seven were found to have at least one trial with conclusive evidence of improvements in OS or QoL after a mean follow-up of 6.6 years. The remaining 15 drug indications either lacked subsequent randomized controlled trial data on OS or QoL (n = 6) or showed no statistically significant improvements (n = 9). Only one drug demonstrated evidence of improvement in both OS and QoL for its indication. CONCLUSIONS A considerable share of reimbursed cancer drug indications continue to lack evidence of improvement in both OS and QoL. With limited healthcare resources and an increasing cancer burden, third-party payers have strong incentives to require additional post-reimbursement data to confirm any improvements in OS and QoL.
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Affiliation(s)
- Gabriella Chauca Strand
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Västra Götalands Län, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Medicinaregatan 18 A, PO Box 463, 405 30, Gothenburg, Västra Götalands Län, Sweden.
| | - Naimi Johansson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Västra Götalands Län, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Örebro Län, Sweden
| | - Niklas Jakobsson
- Karlstad Business School, Faculty of Arts and Social Sciences, Karlstads Business School, Karlstad University, Karlstad, Värmlands Län, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Västra Götalands Län, Sweden
- Centre for Societal Risk Management, Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Värmlands Län, Sweden
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Västra Götalands Län, Sweden
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
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15
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Servetto A, Di Maio M, Salomone F, Napolitano F, Paratore C, Di Costanzo F, Viscardi G, Santaniello A, Formisano L, Bianco R. Analysis of phase III clinical trials in metastatic NSCLC to assess the correlation between QoL results and survival outcomes. BMC Med 2023; 21:234. [PMID: 37400832 DOI: 10.1186/s12916-023-02953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND In addition to improving survival outcomes, new oncology treatments should lead to amelioration of patients' quality of life (QoL). Herein, we examined whether QoL results correlated with PFS and OS outcomes in phase III randomized controlled trials (RCTs) investigating new systemic treatments in metastatic non-small cell lung cancer (NSCLC). METHODS The systematic search of PubMed was conducted in October 2022. We identified 81 RCTs testing novel drugs in metastatic NSCLC and published in the English language in a PubMed-indexed journal between 2012 and 2021. Only trials reporting QoL results and at least one survival outcome between OS and PFS were selected. For each RCT, we assessed whether global QoL was "superior," "inferior," or with "non-statistically significant difference" in the experimental arm compared to the control arm. RESULTS Experimental treatments led to superior QoL in 30 (37.0%) RCTs and inferior QoL in 3 (3.7%) RCTs. In the remaining 48 (59.3%) RCTs, a statistically significant difference between the experimental and control arms was not found. Of note, we found a statistically significant association between QoL and PFS improvements (X2 = 3.93, p = 0.0473). In more detail, this association was not significant in trials testing immunotherapy or chemotherapy. On the contrary, in RCTs testing target therapies, QoL results positively correlated with PFS outcomes (p = 0.0196). This association was even stronger in the 32 trials testing EGFR or ALK inhibitors (p = 0.0077). On the other hand, QoL results did not positively correlate with OS outcomes (X2 = 0.81, p = 0.368). Furthermore, we found that experimental treatments led to superior QoL in 27/57 (47.4%) trials with positive results and in 3/24 (12.5%) RCTs with negative results (p = 0.0028). Finally, we analyzed how QoL data were described in publications of RCTs in which QoL outcomes were not improved (n = 51). We found that a favorable description of QoL results was associated with sponsorship by industries (p = 0.0232). CONCLUSIONS Our study reveals a positive association of QoL results with PFS outcomes in RCTs testing novel treatments in metastatic NSCLC. This association is particularly evident for target therapies. These findings further emphasize the relevance of an accurate assessment of QoL in RCTs in NSCLC.
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Affiliation(s)
- Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Chiara Paratore
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
- Department of Oncology, ASL TO4, Ivrea Community Hospital, Ivrea, Italy
| | - Fabrizio Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, AORN Ospedali Dei Colli-Monaldi, Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy.
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16
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Agapow P, Mulla R, Markuzon N, Ottesen LH, Meulendijks D. Systematic review of time to subsequent therapy as a candidate surrogate endpoint in advanced solid tumors. Future Oncol 2023; 19:1627-1639. [PMID: 37589145 DOI: 10.2217/fon-2022-0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Aim: Time to subsequent therapy (TST) is an end point that may complement progression-free survival (PFS) and overall survival (OS) in determining the treatment effect of anticancer drugs and may be a potential surrogate for PFS and OS. We systematically reviewed the correlation between TST and both PFS and OS in published phase 2/3 studies in advanced solid tumors. Materials & methods: Trial-level correlational analyses were performed for TST versus PFS (by investigator and/or central review) and TST versus OS. Results: Of 21 included studies, nine (43%) used 'time to first subsequent therapy or death' (TFST) as the TST end point; 11 (57%) used different definitions ('other TST end points'). There was a strong correlation between TFST and PFS by investigator (medians: R2 = 0.88; hazard ratio [HR]: R2 = 0.91) and TFST versus PFS by central review (medians: R2 = 0.86; HRs: R2 = 0.84). For TFST versus OS there was medium/poor correlation for medians (R2 = 0.64) and HRs (R2 = 0.02). Conclusion: TFST strongly correlates with PFS, but not with OS.
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Affiliation(s)
- Paul Agapow
- Oncology R&D ML & AI, AstraZeneca, City House, 130 Hills Rd, Cambridge, Cambridgeshire, CB2 1RE, UK
| | - Rob Mulla
- Oncology R&D ML & AI, AstraZeneca, City House, 130 Hills Rd, Cambridge, Cambridgeshire, CB2 1RE, UK
| | - Natasha Markuzon
- Oncology Data Science, AstraZeneca, 35 Gatehouse Drive, Waltham, MA 02451, USA
| | - Lone H Ottesen
- Late Development Oncology, AstraZeneca, City House, 130 Hills Rd, Cambridge, Cambridgeshire, CB2 1RE, UK
| | - Didier Meulendijks
- Late Development Oncology, AstraZeneca, City House, 130 Hills Rd, Cambridge, Cambridgeshire, CB2 1RE, UK
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17
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Gloy V, Schmitt AM, Düblin P, Hirt J, Axfors C, Kuk H, Pereira TV, Locher C, Caquelin L, Walter-Claudi M, Lythgoe MP, Herbrand A, Kasenda B, Hemkens LG. The evidence base of US Food and Drug Administration approvals of novel cancer therapies from 2000 to 2020. Int J Cancer 2023; 152:2474-2484. [PMID: 36779785 DOI: 10.1002/ijc.34473] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
Concerns have been raised that regulatory programs to accelerate approval of cancer drugs in cancer may increase uncertainty about benefits and harms for survival and quality of life (QoL). We analyzed all pivotal clinical trials and all non-pivotal randomized controlled trials (RCTs) for all cancer drugs approved for the first time by the FDA between 2000 and 2020. We report regulatory and trial characteristics. Effects on overall survival (OS), progression-free survival and tumor response were summarized in meta-analyses. Effects on QoL were qualitatively summarized. Between 2000 and 2020, the FDA approved 145 novel cancer drugs for 156 indications based on 190 clinical trials. Half of indications (49%) were approved without RCT evidence; 82% had a single clinical trial only. OS was primary endpoint in 14% of trials and QoL data were available from 25%. The median OS benefit was 2.55 months (IQR, 1.33-4.28) with a mean hazard ratio for OS of 0.75 (95%CI, 0.72-0.79, I2 = 42). Improvement for QoL was reported for 7 (4%) of 156 indications. Over time, priority review was used increasingly and the mean number of trials per indication decreased from 1.45 to 1.12. More trials reported results on QoL (19% in 2000-2005; 41% in 2016-2020). For 21 years, novel cancer drugs have typically been approved based on one single, often uncontrolled, clinical trial, measuring surrogate endpoints. This leaves cancer patients without solid evidence that novel drugs improve their survival or QoL and there is no indication towards improvement.
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Affiliation(s)
- Viktoria Gloy
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Andreas M Schmitt
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
- Department of Medical Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Pascal Düblin
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Julian Hirt
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
- International Graduate Academy, Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Cathrin Axfors
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Hanna Kuk
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tiago V Pereira
- Applied Health Research Centre (AHRC) Li Ka Shing Knowledge Institute of St. Michael's Hospital University of Toronto Canada
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clara Locher
- Univ Rennes, CHU Rennes, Inserm, Centre d'investigation clinique de Rennes (CIC1414), service de pharmacologie clinique, Institut de recherche en santé, environnement et travail (Irset), Rennes, France
| | - Laura Caquelin
- Univ Rennes, CHU Rennes, Inserm, Centre d'investigation clinique de Rennes (CIC1414), service de pharmacologie clinique, Institut de recherche en santé, environnement et travail (Irset), Rennes, France
| | | | - Mark P Lythgoe
- Department of Surgery & Cancer, Hammersmith Hospital, Imperial College London, London, UK
| | - Amanda Herbrand
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Benjamin Kasenda
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Lars G Hemkens
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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18
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Sengar M, Hopman WM, Mohyuddin GR, Goodman AM, Gyawali B, Mukherji D, Hammad N, Pramesh CS, Aggarwal A, Sullivan R, Booth CM. Randomised controlled trials evaluating anticancer therapies in haematological cancers: an overview of global research activity. Ecancermedicalscience 2023; 17:1558. [PMID: 37396096 PMCID: PMC10310333 DOI: 10.3332/ecancer.2023.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Indexed: 07/04/2023] Open
Abstract
Background Design, results, and interpretation of oncology randomised controlled trials (RCTs) have changed substantially over the past decade. In this study, we describe all RCTs evaluating anticancer therapies in haematological cancers published globally during 2014-2017 with comparisons with solid tumours RCTs. Methods A PubMed literature search identified all phase 3 RCTs of anticancer therapy for haematological cancers and solid tumours published globally during 2014-2017. Descriptive statistics, chi-square tests and the Kruskal-Wallis test were used to compare RCT design results, and output between haematological cancers and solid tumours as well as for different haematological cancer subtypes. Results 694 RCTs were identified; 124 in haematological cancers and 570 in solid tumours. Overall survival (OS) was the primary endpoint in only 12% (15/124) of haematological cancer trials compared to 35% (200/570) in solid tumours (p < 0.001). Haematological cancer RCTs evaluated the systemic novel therapy more often than the solid tumour RCT (98% versus 84%, p = 0.002). Use of surrogate endpoints like progression-free survival (PFS) and time to treatment failure (TTF) were more common in haematological cancers than solid tumours (47% versus 31%, p < 0.001). Within haematological cancers, the use of PFS and TTF was more prevalent in chronic lymphocytic leukaemia and multiple myeloma as compared to others (80%-81% versus 0%-41%, p < 0.001). Seventy-eight percent of haematologic trials were funded by industry as compared to 70% of solid tumour trials. Only 4% (5/124) of haematologicalcancer trials were led by investigators in upper-middle and lower-middle-income countries as compared to the 9% of solid tumour trials. Conclusion The fact that only 12% of haematological cancer RCTs are designed to show improvements in OS is of grave concern for the field and the care of future patients. This is further compounded by the highly prevalent use of alternative primary endpoints that are rarely valid surrogates for OS in haematological cancers.
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Affiliation(s)
- Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Wilma M Hopman
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Haematological Malignancies, University of Utah, Salt Lake City, UT 84112, USA
| | - Aaron M Goodman
- Division of Blood and Marrow Transplantation, University of California, San Diego, CA 92093, USA
| | - Bishal Gyawali
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON K7L 3N6, Canada
| | - Deborah Mukherji
- American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Nazik Hammad
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
| | - CS Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Ajay Aggarwal
- Institute of Cancer Policy, King’s College London, WC2R 2LS London, UK
- London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, WC2R 2LS London, UK
| | - Christopher M Booth
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON K7L 3N6, Canada
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19
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Parke EC, Plutynski A. Going big by going small: Trade-offs in microbiome explanations of cancer. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2023; 97:101-110. [PMID: 36645963 DOI: 10.1016/j.shpsa.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 09/29/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Microbial factors have been implicated in cancer risk, disease progression, treatment and prevention. The key word, however, is "implicated." Our aim in this paper is to map out some of the tensions between competing methods, goals, and standards of evidence in cancer research with respect to the causal role of microbial factors. We discuss an array of pragmatic and epistemic trade-offs in this research area: prioritizing coarse-grained versus fine-grained explanations of the roles of microbiota in cancer; explaining general versus specific cancer targets; studying model organisms versus human patients; and understanding and explaining cancer versus developing diagnostic tools and treatments. In light of these trade-offs and the distinctive complexity and heterogeneity on both sides of the microbiome-cancer relationship, we suggest that it would be more productive and intellectually honest to frame much of this work, at least currently, in terms of generating causal hypotheses to investigate further. Claims of established causal connections between the microbiome and cancer are in many cases overstated. We also discuss the value of "black boxing" microbial causal variables in this research context and draw some general cautionary lessons for ongoing discussions of microbiomes and cancer.
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Affiliation(s)
- Emily C Parke
- Philosophy, School of Humanities, University of Auckland, New Zealand.
| | - Anya Plutynski
- Philosophy, Washington University in St. Louis, United States
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20
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Gu J, Hu M, Chen Y, Yu J, Ji Y, Wei G, Huo J. Bibliometric analysis of global research on physical activity and sedentary behavior in the context of cancer. Front Oncol 2023; 13:1095852. [PMID: 36776335 PMCID: PMC9909561 DOI: 10.3389/fonc.2023.1095852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Objective Numerous studies focusing on sedentary behavior (SB) and physical activity (PA) in the context of cancer have been reported in recent years. We analyzed and visualized studies on SB and PA in patients with cancer over the last 20 years using scientometric methods, to provide insights on gaps and deficiencies in the literature, and to inform future research guidelines. Methods All relevant studies in the field from 2001 to October 2022 were reviewed using bibliometric tools, including VOSviewer, Bibliometric online analysis platform, and biblioshiny, to determine the most influential countries, institutions, journals, and authors. We explored current research hotpots and potential research trends, based on keyword clustering and dynamic changes. Our research focuses on PA, SB, and cancer across the entire cancer continuum, from primary prevention to treatment to cancer survivorship. Results Scientometric analysis identified 4,382 relevant manuscripts on SB and PA in the context of cancer, with a 10-fold increase in articles over the past 20 years. The United States, Canada, and Australia were the most influential countries. The journal, Supportive Care in Cancer, had the highest number of publications, while Clinical Oncology had the highest H-index. K.S. Courneya was the most influential author in this field, with the highest number of publications, total citations, and H-index. Keyword analysis revealed that current research is focused on PA and SB in patients with breast cancer, quality of life, and aerobic exercise. Future frontiers include cancer prehabilitation programs and cardiorespiratory fitness, and remote intervention and social support. Conclusion By using bibliometrics, we conducted a comprehensive review of SB and PA in cancer-related studies. The current research focused on exercise and sedentariness in breast cancer patients and the role of PA in improving quality of life in survivorship. Emerging research foci were generally around cancer prehabilitation programs and remote intervention issues for PA. In addition, some publication deficits are noted: studies of PA and SB in less common cancers; the recommended doses and intensities of exercise for cancer; the timing of interventions for prehabilitation and the establishment of individualized exercise protocols. These deficiencies align with the needs for future research topics.
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Affiliation(s)
- Jialin Gu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Miao Hu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yonglin Chen
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jialin Yu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yi Ji
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Guoli Wei
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Guoli Wei, ; Jiege Huo,
| | - Jiege Huo
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Department of Oncology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Guoli Wei, ; Jiege Huo,
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21
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Pola-R-CHP for DLBCL: cost-effective at first glance. Blood 2022; 140:2654-2655. [PMID: 36548016 DOI: 10.1182/blood.2022017342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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22
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Golden SE, Disher N, Dieckmann NF, Eden KB, Matlock D, Vranas KC, Slatore CG, Sullivan DR. Show me the roads and give me a road map: Development of a patient conversation tool to improve lung cancer treatment decision-making. PEC INNOVATION 2022; 1:100094. [PMID: 37213736 PMCID: PMC10194168 DOI: 10.1016/j.pecinn.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 05/23/2023]
Abstract
Objective Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM). Methods We conducted a multi-site study among patients with stage I-IV non-small cell lung cancer (NSCLC) who completed or had ongoing lung cancer treatment using semi-structured, cognitive qualitative interviews to assess participant understanding of content. We used an integrated approach of deductive and inductive thematic analysis. Results Twenty-seven patients with NSCLC participated. Participants with prior cancer experiences or those with family members with prior cancer experiences reported better preparedness for cancer treatment decision-making. All participants agreed the conversation tool would be helpful to clarify their thinking about values, comparisons, and goals of treatment, and to help patients communicate more effectively with their clinicians. Conclusion Participants reported that the tool may empower them with confidence and agency to actively participate in cancer treatment SDM. The conversation tool was acceptable, comprehensible, and usable. Next steps will test effectiveness on patient-centered and decisional outcomes. Innovation A personalized conversation tool using consequence tables and core SDM components is novel in that it can encourage a tailored, conversational dynamic and includes patient-centered values along with traditional decisional outcomes.
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Affiliation(s)
- Sara E. Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Corresponding author at: 3710 SW US Veterans Hospital Rd. R&D 66, Portland, OR 97239, USA.
| | - Natalie Disher
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
| | - Nathan F. Dieckmann
- School of Nursing, Oregon Health and Science University (OHSU), Portland, OR, USA
- Division of Psychology, School of Medicine, OHSU, Portland, OR, USA
| | - Karen B. Eden
- Department of Medical Informatics and Clinic Epidemiology, OHSU, Portland, OR, USA
| | - Daniel Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, VAPORHCS, Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, VAPORHCS, Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
| | - Donald R. Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
- Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, Portland, OR, USA
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Salomone F, Di Costanzo F, Pecoraro G, Viscardi G, Viggiano A, Napolitano F, Santaniello A, Formisano L, Bianco R, Servetto A. Health-related quality of life is underestimated and underreported in phase III clinical trials in NSCLC. Lung Cancer 2022; 174:36-44. [PMID: 36302311 DOI: 10.1016/j.lungcan.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Major associations of medical oncologists remark that novel anticancer treatments should guarantee improvement of survival outcomes as well as of patients' quality of life (QoL). Herein, we investigated QoL assessment and reporting in phase III randomized controlled trials (RCTs) testing new drugs in metastatic non-small cell lung cancer (NSCLC), published between 2010 and 2021. We selected 172 RCTs for further analysis. Only 2/172 (1.2%) trial included QoL among primary study endpoints. Of note, 40/172 (23.3%) trials did not include QoL assessment among endpoints. The majority of RCTs (102/172, 59.3%) did not report QoL results in primary publications. Particularly, RCTs testing immunotherapy, target therapy and chemotherapy did not disclose QoL data in primary publications in 97.0%, 51.5% and 46.5% of cases, respectively. Next, we found that only 43/95 (45.3%) positive studies reported QoL results in primary articles. Of the 102 trials missing QoL data in primary manuscripts, only 21 (20.6%) disclosed QoL results in a secondary publication. Finally, we found a common fail in adherence to CONSORT-PROs items in publications reporting QoL results. In summary, our study reveals a relevant inadequate assessment and under-reporting of QoL in RCTs of novel systemic treatments for patients with metastatic NSCLC.
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Affiliation(s)
- Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Di Costanzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giovanna Pecoraro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Angela Viggiano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
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24
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Ecker BL, Lee J, Saadat LV, Aparicio T, Buisman FE, Balachandran VP, Drebin JA, Hasegawa K, Jarnagin WR, Kemeny NE, Kingham TP, Groot Koerkamp B, Kokudo N, Matsuyama Y, Portier G, Saltz LB, Soares KC, Wei AC, Gonen M, D'Angelica MI. Recurrence-free survival versus overall survival as a primary endpoint for studies of resected colorectal liver metastasis: a retrospective study and meta-analysis. Lancet Oncol 2022; 23:1332-1342. [PMID: 36058227 DOI: 10.1016/s1470-2045(22)00506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recurrence-free survival has been used as a surrogate endpoint for overall survival in trials involving patients with resected colorectal liver metastases. We aimed to assess the correlation between recurrence-free survival and overall survival after resection of colorectal liver metastases to determine the adequacy of this surrogate endpoint. METHODS In this retrospective study and meta-analysis, we compiled an institutional cohort of consecutive patients who had complete resection of colorectal liver metastases from the Memorial Sloan Kettering Cancer Center (New York, NY, USA) prospective database. Patients were eligible for inclusion if they were aged 18 years or older, and underwent hepatectomy, with or without operative ablation, between Jan 1, 1991, and April 30, 2019. We estimated overall survival and recurrence-free survival probabilities at various timepoints using the Kaplan-Meier method, and we assessed pairwise associations between these endpoints using Spearman's rank correlation. We also did a meta-analysis of adjuvant phase 3 clinical trials for colorectal liver metastases to assess the correlation between hazard ratios (HRs) for recurrence-free survival and overall survival. We searched MEDLINE for articles of phase 3 randomised controlled trials analysing adjuvant treatment strategies for resected colorectal metastases from database inception to Jan 1, 2022. The titles and abstracts of identified studies were screened before full-text screening and summary data were either recalculated or extracted manually from the published Kaplan-Meier curves (depending on data availability). FINDINGS Data were available for 3299 patients in the institutional database, of whom 2983 were eligible for inclusion in our cohort. Median follow-up was 8·4 years (95% CI 7·9-9·1) , during which time there were 1995 (67%) disease recurrences and 1684 (56%) deaths. Median recurrence-free survival was 1·3 years (95% CI 1·3-1·4) and median overall survival was 5·2 years (95% CI 5·0-5·5). 1428 (85%) of 1684 deaths were preceded by recurrence, and median time from recurrence to death was 2·0 years (IQR 1·0-3·4). Pairwise correlations between recurrence-free survival and overall survival were low to moderate, with a correlation estimate ranging from 0·30 (SD 0·17) to 0·56 (0·13). In the meta-analysis of adjuvant clinical trials, the Spearman's correlation coefficient between recurrence-free survival HR and overall survival HR was r=0·20 (p=0·71). INTERPRETATION We found a minimal correlation between recurrence-free survival and overall survival after resection of colorectal liver metastases. Recurrence-free survival is an inadequate surrogate endpoint for overall survival in this disease setting. FUNDING US National Cancer Institute.
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Affiliation(s)
- Brett L Ecker
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily V Saadat
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Centre Hospitalo-Universitaire Saint Louis, Paris, France
| | - Florian E Buisman
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Norihiro Kokudo
- Department of Hepato-Biliary-Pancreatic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | | | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Guggenbickler AM, Barr HK, Hoch JS, Dewa CS. Rapid Review of Real-World Cost-Effectiveness Analyses of Cancer Interventions in Canada. Curr Oncol 2022; 29:7285-7304. [PMID: 36290851 PMCID: PMC9600856 DOI: 10.3390/curroncol29100574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Cost-effectiveness analysis (CE Analysis) provides evidence about the incremental gains in patient outcomes costs from new treatments and interventions in cancer care. The utilization of "real-world" data allows these analyses to better reflect differences in costs and effects for actual patient populations with comorbidities and a range of ages as opposed to randomized controlled trials, which use a restricted population. This rapid review was done through PubMed and Google Scholar in July 2022. Relevant articles were summarized and data extracted to summarize changes in costs (in 2022 CAD) and effectiveness in cancer care once funded by the Canadian government payer system. We conducted statistical analyses to examine the differences between means and medians of costs, effects, and incremental cost effectiveness ratios (ICERs). Twenty-two studies were selected for review. Of those, the majority performed a CE Analysis on cancer drugs. Real-world cancer drug studies had significantly higher costs and effects than non-drug therapies. Studies that utilized a model to project longer time-horizons saw significantly smaller ICER values for the treatments they examined. Further, differences in drug costs increased over time. This review highlights the importance of performing real-world CE Analysis on cancer treatments to better understand their costs and impacts on a general patient population.
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Affiliation(s)
- Andrea M. Guggenbickler
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Heather K. Barr
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Center for Healthcare Policy and Research, University of California, Davis, CA 95820, USA
- Correspondence:
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95817, USA
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26
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Tang W, Li Y, Zou Z, Cui J, Wang F, Zheng Y, Hou L, Pan L, Xiang B, Chang H, Zhang L, Niu T. A stratified therapeutic model incorporated with studies on regulatory B cells for elderly patients with newly diagnosed multiple myeloma. Cancer Med 2022; 12:3054-3067. [PMID: 36127626 PMCID: PMC9939179 DOI: 10.1002/cam4.5228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Despite the availability of new agents, elderly patients with multiple myeloma (MM) usually present with poor outcomes due to the heterogeneity of disease conditions, especially immune deficiency. Regulatory B cells (Bregs) can be involved in immune defects by exerting immune regulatory functions in MM. In order to provide more evidence-based practice for the elderly MM, the study established and assessed a stratified therapeutic model with studies on Bregs for Chinese Elderly Multiple Myeloma in 2021 (CEMM2021). METHODS In this open-label, non-interventional, prospective study in the real world, 159 newly diagnosed MM (NDMM) patients over 65 years old were sequentially recruited and bone marrow aspirates prior to treatment were obtained to detect the ratios of Bregs by flow cytometry. RESULTS Based on the CEMM2021 model, 147 patients had received at least one cycle of induction therapy, including bortezomib/dexamethasone (Bd) (n = 80), lenalidomide/dexamethasone (Rd) (n = 27), Bd with a third agent X (Bd + X) (n = 27), and other regimens (n = 13). The proportions of patients achieving very good partial response or better were comparable among Bd, Bd + X, and Rd groups (41.9% vs. 54.5% vs. 44.0%, p = 0.472). Besides, the progression-free survival (PFS) and overall survival (OS) were not significantly different among Rd, Bd, and Bd + X groups. Multivariable analysis showed that induction efficacy less than partial response (PR) were poor prognostic factors for PFS, while Revised-International Staging System (R-ISS) III and efficacy less than PR were poor prognostic factors for OS. This study also found that the ratios of bone marrow Bregs <10% (p = 0.036) and SUVmax of PET-CT scan >4.2 (p = 0.000) were closely correlated with OS in the elderly MM. CONCLUSIONS For the elderly NDMM, the CEMM2021 algorithm in our center might provide a valuable reference for the guidance of therapeutic strategies, with the combination of Bregs resulting in an effective and clinically meaningful prediction in contemporary treatment.
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Affiliation(s)
- Wenjiao Tang
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Yan Li
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Zhongqing Zou
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina,Department of HematologyClinical Medical College & Affiliated Hospital of Chengdu University, Chengdu UniversityChengduSichuanChina
| | - Jian Cui
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Fangfang Wang
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Yuhuan Zheng
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Li Hou
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Ling Pan
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Bing Xiang
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Hong Chang
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Li Zhang
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Ting Niu
- Department of HematologyInstitute of Hematology, West China Hospital, Sichuan UniversityChengduSichuanChina
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27
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Shengnan D, Zixuan L, Na Z, Weikai Z, Yuanyuan Y, Jiasu L, Ni Y. Using 5 consecutive years of NICE guidance to describe the characteristics and influencing factors on the economic evaluation of orphan oncology drugs. Front Public Health 2022; 10:964040. [PMID: 36187695 PMCID: PMC9519130 DOI: 10.3389/fpubh.2022.964040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Orphan oncology drugs used in this article were defined by the type of disease treated by drugs, as drugs used to treat rare diseases with a prevalence of ≤ 500 per million people per year. In this article, our concern was to explore focus on the economic evaluation of the National Institute for Health and Care Excellence (NICE), when orphan oncology drugs were appraised for reimbursement, and provide advice and suggestions to decision-makers. Methods A retrospective study was used in this study. Thirty guidance were gathered as our subject by NICE from 2016 to 2020, excluded drugs were not identified as orphan by European Medicines Agency (EMA) and orphan drugs were not used for cancer, and orphan oncology drugs were terminated at the time of data collection at NICE. Qualitative analysis, descriptive statistics, and Fisher's exact test were conducted. Results Of all guidance, the partitioned survival model was used most to appraise orphan oncology drugs, and every drug had a kind of commercial arrangement such as patient access scheme (PAS), managed access arrangements (MAAs), and commercial access agreement (CAAs). End of life is an important indicator that had been defined by NICE in the methods of technology appraisal in 2013, and drugs that met the criterion would be given a higher threshold of ICER. In addition, we found that potential health benefits were increasingly concerned such as drug delivery. Conclusion In the setting of uncertain clinical and cost efficacy, orphan oncology drugs are comprehensively evaluated in multiple additional dimensions, which include life-extending benefits, and innovation. NICE uses a combination of special considerations for incomplete data, appropriate economic models, and appropriate health technology assessment (HTA) methods during the assessment process, besides, orphan oncology drugs with insufficiency evidence were recommended Cancer Drugs fund (CDF) to afford for patients, which would obtain more availability and accessibility, based on which, high-quality drugs for treating rare cancers can fall within the scope of affordable healthcare provided by the English medical insurance fund.
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Affiliation(s)
- Duan Shengnan
- School of Public Health, Dalian Medical University, Dalian, China
| | - Lv Zixuan
- School of Public Health, Dalian Medical University, Dalian, China
| | - Zhou Na
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Zhu Weikai
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Yuanyuan
- Department of Respiratory Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liu Jiasu
- Department of Ophthalmology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuan Ni
- School of Public Health, Dalian Medical University, Dalian, China,*Correspondence: Yuan Ni
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28
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Atkins MB, Abu-Sbeih H, Ascierto PA, Bishop MR, Chen DS, Dhodapkar M, Emens LA, Ernstoff MS, Ferris RL, Greten TF, Gulley JL, Herbst RS, Humphrey RW, Larkin J, Margolin KA, Mazzarella L, Ramalingam SS, Regan MM, Rini BI, Sznol M. Maximizing the value of phase III trials in immuno-oncology: A checklist from the Society for Immunotherapy of Cancer (SITC). J Immunother Cancer 2022; 10:jitc-2022-005413. [PMID: 36175037 PMCID: PMC9528604 DOI: 10.1136/jitc-2022-005413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/03/2022] Open
Abstract
The broad activity of agents blocking the programmed cell death protein 1 and its ligand (the PD-(L)1 axis) revolutionized oncology, offering long-term benefit to patients and even curative responses for tumors that were once associated with dismal prognosis. However, only a minority of patients experience durable clinical benefit with immune checkpoint inhibitor monotherapy in most disease settings. Spurred by preclinical and correlative studies to understand mechanisms of non-response to the PD-(L)1 antagonists and by combination studies in animal tumor models, many drug development programs were designed to combine anti-PD-(L)1 with a variety of approved and investigational chemotherapies, tumor-targeted therapies, antiangiogenic therapies, and other immunotherapies. Several immunotherapy combinations improved survival outcomes in a variety of indications including melanoma, lung, kidney, and liver cancer, among others. This immunotherapy renaissance, however, has led to many combinations being advanced to late-stage development without definitive predictive biomarkers, limited phase I and phase II data, or clinical trial designs that are not optimized for demonstrating the unique attributes of immune-related antitumor activity-for example, landmark progression-free survival and overall survival. The decision to activate a study at an individual site is investigator-driven, and generalized frameworks to evaluate the potential for phase III trials in immuno-oncology to yield positive data, particularly to increase the number of curative responses or otherwise advance the field have thus far been lacking. To assist in evaluating the potential value to patients and the immunotherapy field of phase III trials, the Society for Immunotherapy of Cancer (SITC) has developed a checklist for investigators, described in this manuscript. Although the checklist focuses on anti-PD-(L)1-based combinations, it may be applied to any regimen in which immune modulation is an important component of the antitumor effect.
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Affiliation(s)
- Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione "G Pascale", Napoli, Italy
| | - Michael R Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, Illinois, USA
| | - Daniel S Chen
- Engenuity Life Sciences, Burlingame, California, USA
| | - Madhav Dhodapkar
- Center for Cancer Immunology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Leisha A Emens
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Marc S Ernstoff
- DCTD/DTP-IOB, ImmunoOncology Branch, NCI, Bethesda, Maryland, USA
| | | | - Tim F Greten
- Gastrointestinal Malignancies Section, National Cancer Institue CCR Liver Program, Bethesda, Maryland, USA
| | - James L Gulley
- Center for Immuno-Oncology, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | - Kim A Margolin
- St. John's Cancer Institute, Santa Monica, California, USA
| | - Luca Mazzarella
- Experimental Oncology, New Drug Development, European Instititue of Oncology IRCCS, Milan, Italy
| | | | - Meredith M Regan
- Dana-Farber/Harvard Cancer Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mario Sznol
- Yale School of Medicine, New Haven, Connecticut, USA
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Chen C, Wang Z, Qin Y. Health-related quality of life in stage III-IV melanoma treated with targeted therapy or immunotherapy: A systematic review on the adequacy of reporting and clinical issues in phase III randomized controlled trials. Cancer Med 2022; 12:2262-2280. [PMID: 36030506 PMCID: PMC9939121 DOI: 10.1002/cam4.5183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/09/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
Abstract
Cutaneous melanoma represents around over 90% of all melanoma. With more effective treatments able to extend patients' survival, health-related quality of life (HRQOL) is increasingly becoming an important endpoint in cancer clinical trials. They are often secondary outcomes measured in phase III randomized controlled trials and their implementation, collection, analysis, and reporting can be challenging methodologically. For these reasons, an increasing number of international recommendations introduced the standards regarding the conduct of HRQOL. In this systematic review, we appraise the adequacy of HRQOL reporting in phase III randomized controlled trials of stage III-IV cutaneous melanoma and the clinical issues of immunotherapy and small-molecular-targeted therapy on HRQOL. Our search strategy totally got 55 articles, and only 13 studies met all inclusion criteria. Findings suggest that most treatments did not yield significant improvements in HRQOL but kept baseline levels, accompanied by prolonged survival and acceptable toxicity. Except for some existing limitations, reporting of HRQOL has made encouraging progress during the period covered by our search, but some aspects still need further optimization.
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Affiliation(s)
- Chen Chen
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Cancer Institute, University College LondonLondonUK
| | - Zehua Wang
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yan‐Ru Qin
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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30
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Zhang Y, Naci H, Wagner AK, Xu Z, Yang Y, Zhu J, Ji J, Shi L, Guan X. Overall Survival Benefits of Cancer Drugs Approved in China From 2005 to 2020. JAMA Netw Open 2022; 5:e2225973. [PMID: 35947385 PMCID: PMC9366546 DOI: 10.1001/jamanetworkopen.2022.25973] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Of approximately 9 million patients with cancer in China in 2020, more than half were diagnosed with late-stage cancers. Recent regulatory reforms in China have focused on improving the availability of new cancer drugs. However, evidence on the clinical benefits of new cancer therapies authorized in China is not available. OBJECTIVE To characterize the clinical benefits of cancer drugs approved in China, as defined by the availability and magnitude of statistically significant overall survival (OS) results. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods study comprising a systematic review and cross-sectional analysis identified antineoplastic agents approved in China between January 1, 2005, and December 31, 2020, using publicly available data and regulatory review documents issued by the National Medical Products Administration. The literature published up to June 30, 2021, was reviewed to collect results on end points used in pivotal trials supporting cancer drug approvals. MAIN OUTCOMES AND MEASURES The primary outcome measure was a documented statistically significant positive OS difference between a new cancer therapy and a comparator treatment. Secondary outcome measures were the magnitude of OS benefit and other primary efficacy measures in pivotal trials. RESULTS Between 2005 and 2020, 78 cancer drugs corresponding to 141 indications were authorized in China, including 20 drugs (25.6%) (for 30 indications) approved in China only. Of all indications, 26 (18.4%) were evaluated in single-arm or dose-optimization trials, most of which were authorized after 2017. By June 30, 2021, 34 drug indications (24.1%) had a documented lack of OS gain. For 68 indications (48.2%) that had documented evidence of OS benefit, the median magnitude of OS improvement was 4.1 (range, 1.0-35.0) months. After a median follow-up of 1.9 (range, 1.0-11.1) years from approval, OS data for 13 indications (9.2%) were either not reported or were still not mature. Fewer than one-third of cancer drug indications approved in China only had documented evidence of OS benefits (9 of 30 [30.0%]), whereas more than one-half of the cancer drug indications also available in the US or Europe had OS benefits (59 of 111 [53.1%]). CONCLUSIONS AND RELEVANCE In this study, almost half of cancer drug indications approved in China had demonstrated OS gain. With the increase of cancer drug approvals based on single-arm trials or immature survival data in recent years, these findings highlight the need to routinely monitor the clinical benefits of new cancer therapies in China.
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Affiliation(s)
- Yichen Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Huseyin Naci
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Anita K. Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ziyue Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yu Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jun Zhu
- Beijing Cancer Hospital, Beijing, China
| | - Jiafu Ji
- Beijing Cancer Hospital, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Centre for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Centre for Medicinal Administration, Peking University, Beijing, China
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Strzebonska K, Blukacz M, Wasylewski MT, Polak M, Gyawali B, Waligora M. Risk and benefit for umbrella trials in oncology: a systematic review and meta-analysis. BMC Med 2022; 20:219. [PMID: 35799149 PMCID: PMC9264503 DOI: 10.1186/s12916-022-02420-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Umbrella clinical trials in precision oncology are designed to tailor therapies to the specific genetic changes within a tumor. Little is known about the risk/benefit ratio for umbrella clinical trials. The aim of our systematic review with meta-analysis was to evaluate the efficacy and safety profiles in cancer umbrella trials testing targeted drugs or a combination of targeted therapy with chemotherapy. METHODS Our study was prospectively registered in PROSPERO (CRD42020171494). We searched Embase and PubMed for cancer umbrella trials testing targeted agents or a combination of targeted therapies with chemotherapy. We included solid tumor studies published between 1 January 2006 and 7 October 2019. We measured the risk using drug-related grade 3 or higher adverse events (AEs), and the benefit by objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). When possible, data were meta-analyzed. RESULTS Of the 6207 records identified, we included 31 sub-trials or arms of nine umbrella trials (N = 1637). The pooled overall ORR was 17.7% (95% confidence interval [CI] 9.5-25.9). The ORR for targeted therapies in the experimental arms was significantly lower than the ORR for a combination of targeted therapy drugs with chemotherapy: 13.3% vs 39.0%; p = 0.005. The median PFS was 2.4 months (95% CI 1.9-2.9), and the median OS was 7.1 months (95% CI 6.1-8.4). The overall drug-related death rate (drug-related grade 5 AEs rate) was 0.8% (95% CI 0.3-1.4), and the average drug-related grade 3/4 AE rate per person was 0.45 (95% CI 0.40-0.50). CONCLUSIONS Our findings suggest that, on average, one in five cancer patients in umbrella trials published between 1 January 2006 and 7 October 2019 responded to a given therapy, while one in 125 died due to drug toxicity. Our findings do not support the expectation of increased patient benefit in cancer umbrella trials. Further studies should investigate whether umbrella trial design and the precision oncology approach improve patient outcomes.
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Affiliation(s)
- Karolina Strzebonska
- Research Ethics in Medicine Study Group (REMEDY), Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Blukacz
- Institute of Psychology, University of Silesia, Katowice, Poland
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz T. Wasylewski
- Research Ethics in Medicine Study Group (REMEDY), Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Polak
- Research Ethics in Medicine Study Group (REMEDY), Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
- Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Bishal Gyawali
- Department of Oncology and the Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Marcin Waligora
- Research Ethics in Medicine Study Group (REMEDY), Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
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Luo B, Yang M, Han Z, Que Z, Luo T, Tian J. Establishment of a Nomogram-Based Prognostic Model (LASSO-COX Regression) for Predicting Progression-Free Survival of Primary Non-Small Cell Lung Cancer Patients Treated with Adjuvant Chinese Herbal Medicines Therapy: A Retrospective Study of Case Series. Front Oncol 2022; 12:882278. [PMID: 35875082 PMCID: PMC9304868 DOI: 10.3389/fonc.2022.882278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Nowadays, Jin-Fu-Kang oral liquid (JFK), one of Chinese herbal medicines (CHMs) preparations, has been widely used as an adjuvant therapy for primary non-small cell lung cancer (PNSCLC) patients with the syndrome of deficiency of both Qi and Yin (Qi–Yin deficiency pattern) based on Traditional Chinese Medicine (TCM) theory. However, we found insufficient evidence of how long-term CHM treatment influence PNSCLC patients’ progression-free survival (PFS). Thus, using electronic medical records, we established a nomograph-based prognostic model for predicting PNSCLC patients’ PFS involved with JFK supplementary formulas (JFK-SFs) over 6 months, in order to preliminarily investigate potential predictors highly related to adjuvant CHMs therapies in theoretical epidemiology. In our retrospective study, a series of 197 PNSCLC cases from Long Hua Hospital were enrolled by non-probability sampling and divided into 2 datasets at the ratio of 5:4 by Kennard–Stone algorithm, as a result of 109 in training dataset and 88 in validation dataset. Besides, TNM stage, operation history, sIL-2R, and CA724 were considered as 4 highly correlated predictors for modeling based on LASSO-Cox regression. Additionally, we respectively used training dataset and validation dataset for establishment including internal validation and external validation, and the prediction performance of model was measured by concordance index (C-index), integrated discrimination improvement, and net reclassification indices (NRI). Moreover, we found that the model containing clinical characteristics and bio-features presented the best performance by pairwise comparison. Next, the result of sensitivity analysis proved its stability. Then, for preliminarily examination of its discriminative power, all eligible cases were divided into high-risk or low-risk progression by the cut-off value of 57, in the light of predicted nomogram scores. Ultimately, a completed TRIPOD checklist was used for self-assessment of normativity and integrity in modeling. In conclusion, our model might offer crude probability of uncertainly individualized PFS with long-term CHMs therapy in the real-world setting, which could discern the individuals implicated with worse prognosis from the better ones. Nevertheless, our findings were prone to unmeasured bias caused by confounding factors, owing to retrospective cases series.
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Affiliation(s)
- Bin Luo
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming Yang
- Department of Good Practice Criterion, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zixin Han
- School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zujun Que
- Cancer Institute of Traditional Chinese Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianle Luo
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianhui Tian
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Cancer Institute of Traditional Chinese Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jianhui Tian,
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Adam R, Tibau A, Molto Valiente C, Šeruga B, Ocaña A, Amir E, Templeton AJ. Clinical benefit of cancer drugs approved in Switzerland 2010–2019. PLoS One 2022; 17:e0268545. [PMID: 35687539 PMCID: PMC9187080 DOI: 10.1371/journal.pone.0268545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background
It is unknown to what extent cancer drugs approved in Switzerland by the Swissmedic fulfil criteria of clinical benefit according to the European Society of Medical Oncology Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS), the American Society of Clinical Oncology Value Framework version 2 (ASCO-VF) and the Swiss OLUtool v2 (OLUtool).
Patients and methods
An electronic search identified studies that led to marketing authorisations in Switzerland 2010–2019. Studies were evaluated according to ESMO-MCBS, ASCO-VF and OLUtool. Substantial benefit for ESMO-MCBS, was defined as a grade A or B for (neo)adjuvant intent and 4 or 5 for palliative intent. For ASCO-VF and OLUtool clinical benefit was defined as score ≥45 and A or B, respectively. Concordance between the frameworks was calculated with Cohen’s Kappa (κ). Factors associated with clinical benefit were evaluated by logistic regression.
Results
In the study period, 48 drugs were approved for 92 evaluable indications, based on 100 studies. Ratings for ESMO-MCBS, ASCO-VF and OLUtool could be performed for 100, 86, and 97 studies, respectively. Overall, 39 (39%), 44 (51%), 45 (46%) of the studies showed substantial clinical benefit according to ESMO-MCBS v1.1, ASCO-VF, OLUtool criteria, respectively. There was fair concordance between ESMO-MCBS and ASCO-VF in the palliative setting (κ = 0.31, P = 0.004) and moderate concordance between ESMO-MCBS and OLUtool (κ = 0.41, P<0.001). There was no significant concordance between ASCO-VF and OLUtool (κ = 0.18, P = 0.12). Factors associated with substantial clinical benefit in multivariable analysis were HRQoL benefit reported as secondary outcome for ESMO-MCBS and the ASCO-VF and blinded studies for OLUtool.
Conclusions
At the time of approval, only around half of the trials supporting marketing authorisation of recently approved cancer drugs in Switzerland meet the criteria for substantial clinical benefit when evaluated with ESMO-MCBS, ASCO-VF or OLUtool. There was at best only moderate concordance between the grading systems.
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Affiliation(s)
- Roman Adam
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ariadna Tibau
- Oncology Department, Departament de Medicina de la Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Consolación Molto Valiente
- Oncology Department, Departament de Medicina de la Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Boštjan Šeruga
- Institute of Oncology Ljubljana and Faculty of Medicine, Department of Medical Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Alberto Ocaña
- Experimental Therapeutics Unit, Medical Oncology Department, Hospital Clínico Universitario San Carlos and IdISSC, Madrid, Spain
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center and the University of Toronto, Toronto, ON, Canada
| | - Arnoud J. Templeton
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Medical Oncology, St. Claraspital, Basel, Switzerland
- St. Clara Research Ltd., Basel, Switzerland
- * E-mail:
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Silveira A, Sequeira T, Gonçalves J, Lopes Ferreira P. Patient reported outcomes in oncology: changing perspectives-a systematic review. Health Qual Life Outcomes 2022; 20:82. [PMID: 35597948 PMCID: PMC9124403 DOI: 10.1186/s12955-022-01987-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
In public health context, oncology is associated with severe negative impact on patients and on their relatives’ quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver’s adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver–patient–physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.
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Affiliation(s)
- Augusta Silveira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
| | - Teresa Sequeira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
| | - Joaquim Gonçalves
- 2Ai - Applied Artificial Intelligence Laboratory, School of Technology of Polytechnic Institute of Cávado and Ave, R. de São Martinho, 4750-810, Vila Frescainha, Barcelos, Portugal
| | - Pedro Lopes Ferreira
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal. .,Faculty of Economics, University of Coimbra, Av. Dr. Dias da Silva, 165, 3004-512, Coimbra, Portugal.
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Samuel JN, Booth CM, Eisenhauer E, Brundage M, Berry SR, Gyawali B. Association of Quality-of-Life Outcomes in Cancer Drug Trials With Survival Outcomes and Drug Class. JAMA Oncol 2022; 8:879-886. [PMID: 35482347 PMCID: PMC9052107 DOI: 10.1001/jamaoncol.2022.0864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Although quality of life (QOL) is an important clinical end point, cancer drugs are often approved based on overall survival (OS) or putative surrogate end points such as progression-free survival (PFS) without QOL data. Objective To ascertain whether cancer drug trials that show improvement in OS or PFS also improve global QOL of patients with cancer compared with the control treatment, as well as to assess how unchanged or detrimental QOL outcomes are reported in trial publications. Design, Setting, and Participants This retrospective cohort study included all patients with cancer in the advanced setting who were enrolled into phase 3 randomized clinical trials (RCTs) of cancer drugs reporting QOL data and published in English language in a PubMed-indexed journal in the calendar year 2019. The systematic search of PubMed was conducted in July 2020. Main Outcomes and Measures Association of QOL outcomes with OS and PFS, framing of unchanged QOL outcomes in trial publications, and the association of favorable framing with industry funding of the trials. Results A total of 45 phase 3 RCTs enrolling 24 806 participants (13 368 in the experimental arm and 11 438 in the control arm) met the inclusion criteria and were included in the study analyses. Improvement in global QOL with the experimental agent was reported in 11 (24%) RCTs. The RCTs with improved QOL were more likely to also show improved OS vs trials with unimproved QOL (7 of 11 [64%] trials vs 10 of 34 [29%] trials; χ2 = 4.13; P = .04); there was no such association observed for PFS (6 of 11 [55%] trials vs 17 of 34 [50%] trials, χ2 = 0.03; P = .87). Six trials reported worsening QOL, of which 3 (50%) were trials of targeted drugs, and 11 trials reported improvement in QOL, of which 6 (55%) were trials of immunotherapy drugs. Of the 34 trials in which QOL was not improved compared with controls, 16 (47%) reported these results in a positive frame, an observation statistically significantly associated with industry funding (χ2 = 6.35; P = .01). Conclusions and Relevance In this cohort study, a small proportion of RCTs of cancer drugs showed benefit in global QOL with the experimental agent. These results showed an association between QOL benefit and OS benefit but no such association with PFS benefit. Trials that failed to show improved QOL often reported their QOL outcomes more favorably. Non-immunotherapy-targeted drugs led to worse QOL more often than did cytotoxic agents.
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Affiliation(s)
- Joseph N Samuel
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Oncology, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Elizabeth Eisenhauer
- Department of Oncology, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Cancer Research Institute, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Oncology, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Scott R Berry
- Department of Oncology, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Cancer Research Institute, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Oncology, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Li J, Cheng Y, Bai C, Xu J, Shen L, Li J, Zhou Z, Li Z, Chi Y, Yu X, Li E, Xu N, Liu T, Lou W, Bai Y, Yuan X, Wang X, Yuan Y, Chen J, Guan S, Fan S, Su W. Health-related quality of life in patients with advanced well-differentiated pancreatic and extrapancreatic neuroendocrine tumors treated with surufatinib versus placebo: Results from two randomized, double-blind, phase III trials (SANET-p and SANET-ep). Eur J Cancer 2022; 169:1-9. [PMID: 35489301 DOI: 10.1016/j.ejca.2022.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/08/2023]
Abstract
AIM To investigate the health-related quality of life (HRQoL) of patients who had neuroendocrine tumors (NETs) from SANET trials. METHODS Eligible patients were randomized in a 2:1 ratio to receive surufatinib or placebo. HRQoL questionnaires, including the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-G.I.NET21, were collected. The prespecified HRQoL outcome was the mean change of scores from baseline to the last available visit for each domain. Time until definitive deterioration (TUDD) was defined as the time from randomization to deterioration of ≥10 points from baseline in domain score, disease progression, or death. RESULTS 370 patients were enrolled and randomly assigned to surufatinib (n = 242) or placebo (n = 128). No significant difference in mean scores change from baseline to the last available visit was observed for QLQ-C30 and QLQ- G.I.NET21 domains, with the exception of diarrhea. The mean score of diarrhea increased 11.7 points from baseline in the surufatinib arm and decreased 1.2 points in the placebo arm, and the between-group difference was 12.9 points. Compared with placebo, surufatinib treated patients had a significantly longer TUDD for dyspnea (hazard ratio [HR] 0.58; 95% confidence interval [CI], 0.39-0.86; P = 0.0058) and a significantly shorter TUDD for diarrhea (HR 2.91; 95% CI, 1.66-5.10; P < 0.0001). There were no significant differences in TUDD for the remaining domains of QLQ-C30 and G.I.NET-21. CONCLUSIONS HRQoL was similar in patients treated with surufatinib and placebo except for diarrhea. The preservation of HRQoL supports surufatinib as a treatment option fo r NETs. CLINICAL TRIAL INFORMATION ClinicalTrials.gov: NCT02589821, NCT02588170.
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Affiliation(s)
- Jiarui Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejuan Cheng
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianming Xu
- Department of Gastrointestinal Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
| | - Jie Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiping Li
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yihebali Chi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianjun Yu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Enxiao Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nong Xu
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Tianshu Liu
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Wenhui Lou
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yuxian Bai
- Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuwen Wang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan
| | - Ying Yuan
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Chen
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing, China
| | - Sha Guan
- Department of Clinical and Regulatory Affairs, HUTCHMED, Shanghai, China
| | - Songhua Fan
- Department of Clinical and Regulatory Affairs, HUTCHMED, Shanghai, China
| | - Weiguo Su
- Department of Clinical and Regulatory Affairs, HUTCHMED, Shanghai, China
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Pharmacoepidemiology for oncology clinical practice: Foundations, state of the art and perspectives. Therapie 2022; 77:229-240. [DOI: 10.1016/j.therap.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
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38
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Hui Y, Li N, Yu Z, Li C, Wang X, Li Y, Sun M, Yang W, Guo G, Fan X, Lin L, Cui B, Chen X, Wang B, Zhang J, Sun C. Health-Related Quality of Life and Its Contributors According to a Preference-Based Generic Instrument in Cirrhosis. Hepatol Commun 2022; 6:610-620. [PMID: 34558226 PMCID: PMC8870013 DOI: 10.1002/hep4.1827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 01/13/2023] Open
Abstract
It is essential to determine contributors around impairment in health-related quality of life (HRQoL) in patients with cirrhosis aiming at improving health care and therapeutic strategy. Studies simultaneously incorporating disease severity based on biochemical parameters and other physical/psychological effects (i.e., sleep disturbance and frailty) are heterogeneous and the subject of the present study. We analyzed and compared HRQoL, using the EuroQol Group 5 Dimension (EQ-5D) questionnaire and the utility index retrieved, in patients with cirrhosis and across groups stratified by sleep disturbance or frailty phenotype. Sleep disturbance and frailty were determined by the Pittsburgh Sleep Quality Index (PSQI) and Frailty Index, respectively. Multiple linear regression was implemented to clarify contributors of poor HRQoL. In this cohort of 227 patients with mean age of 61.7 years and 47.2% male, more than half of the study population represented impairment in HRQoL in at least one domain, according to EQ-5D. Furthermore, sleep disturbance and frailty have proved to be independently associated with poor HRQoL in two separate regression models, whereas conventional scoring systems such as Child-Pugh classification and Model for End-Stage Liver Disease are not closely relevant. Intriguingly, not all health domains within EQ-5D correlated well with PSQI and Frailty Index, with the exception of usual activities. Pain and anxiety/depression were the most frequently affected HRQoL domains even in patients without sleep disturbance or frailty. Conclusion: Impaired HRQoL is prevalent in patients with decompensated cirrhosis. Sleep disturbance and frailty are independently associated with poor HRQoL. It is imperative to timely intervene with these symptoms and deliver tailored health care.
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Affiliation(s)
- Yangyang Hui
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Nan Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina
| | - Zihan Yu
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Chaoqun Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Department of Internal MedicineTianjin Hexi HospitalTianjinChina
| | - Xiaoyu Wang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Yifan Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Mingyu Sun
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Wanting Yang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Gaoyue Guo
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Xiaofei Fan
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Lin Lin
- Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
| | - Binxin Cui
- Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
| | - Xin Chen
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Bangmao Wang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Jie Zhang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Chao Sun
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina.,Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
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Tattersall A, Ryan N, Wiggans AJ, Rogozińska E, Morrison J. Poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of ovarian cancer. Cochrane Database Syst Rev 2022; 2:CD007929. [PMID: 35170751 PMCID: PMC8848772 DOI: 10.1002/14651858.cd007929.pub4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ovarian cancer is the sixth most common cancer in women world-wide. Epithelial ovarian cancer (EOC) is the most common; three-quarters of women present when disease has spread outside the pelvis (stage III or IV). Treatment consists of a combination of surgery and platinum-based chemotherapy. Although initial responses to chemotherapy are good, most women with advanced disease will relapse. PARP (poly (ADP-ribose) polymerase) inhibitors (PARPi), are a type of anticancer treatment that works by preventing cancer cells from repairing DNA damage, especially in those with breast cancer susceptibility gene (BRCA) variants. PARPi offer a different mechanism of anticancer treatment from conventional chemotherapy. OBJECTIVES To determine the benefits and risks of poly (ADP-ribose) polymerase) inhibitors (PARPi) for the treatment of epithelial ovarian cancer (EOC). SEARCH METHODS We identified randomised controlled trials (RCTs) by searching the Cochrane Central Register of Controlled Trials (Central 2020, Issue 10), Cochrane Gynaecological Cancer Group Trial Register, MEDLINE (1990 to October 2020), Embase (1990 to October 2020), ongoing trials on www.controlled-trials.com/rct, www.clinicaltrials.gov, www.cancer.gov/clinicaltrials, the National Research Register (NRR), FDA database and pharmaceutical industry biomedical literature. SELECTION CRITERIA We included trials that randomised women with EOC to PARPi with no treatment, or PARPi versus conventional chemotherapy, or PARPi together with conventional chemotherapy versus conventional chemotherapy alone. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Two review authors independently assessed whether studies met the inclusion criteria. We contacted investigators for additional data. Outcomes included overall survival (OS), objective response rate (ORR), quality of life (QoL) and rate of adverse events. MAIN RESULTS We included 15 studies (6109 participants); four (3070 participants) with newly-diagnosed, advanced EOC and 11 (3039 participants) with recurrent EOC. The studies varied in types of comparisons and evaluated PARPi. Eight studies were judged as at low risk of bias in most of the domains. Quality of life data were generally poorly reported. Below we present six key comparisons. The majority of participants had BRCA mutations, either in their tumour (sBRCAmut) and/or germline (gBRCAmut), or homologous recombination deficiencies (HRD) in their tumours. Newly diagnosed EOC Overall, four studies evaluated the effect of PARPi in newly-diagnosed, advanced EOC. Two compared PARPi with chemotherapy and chemotherapy alone. OS data were not reported. The combination of PARPi with chemotherapy may have little to no difference in progression-free survival (PFS) (two studies, 1564 participants; hazard ratio (HR) 0.82, 95% confidence interval (CI 0).49 to 1.38; very low-certainty evidence)(no evidence of disease progression at 12 months' 63% with PARPi versus 69% for placebo). PARPi with chemotherapy likely increases any severe adverse event (SevAE) (grade 3 or higher) slightly (45%) compared with chemotherapy alone (51%) (two studies, 1549 participants, risk ratio (RR) 1.13, 95% CI 1.07 to 1.20; high-certainty evidence). PARPi combined with chemotherapy compared with chemotherapy alone likely results in little to no difference in the QoL (one study; 744 participants, MD 1.56 95% CI -0.42 to 3.54; moderate-certainty evidence). Two studies compared PARPi monotherapy with placebo as maintenance after first-line chemotherapy in newly diagnosed EOC. PARPi probably results in little to no difference in OS (two studies, 1124 participants; HR 0.81, 95%CI 0.59 to 1.13; moderate-certainty evidence) (alive at 12 months 68% with PARPi versus 62% for placebo). However, PARPi may increase PFS (two studies, 1124 participants; HR 0.42, 95% CI 0.19 to 0.92; low-certainty evidence) (no evidence of disease progression at 12 months' 55% with PARPi versus 24% for placebo). There may be an increase in the risk of experiencing any SevAE (grade 3 or higher) with PARPi (54%) compared with placebo (19%)(two studies, 1118 participants, RR 2.87, 95% CI 1.65 to 4.99; very low-certainty evidence), but the evidence is very uncertain. There is probably a slight reduction in QoL with PARPi, although this may not be clinically significant (one study, 362 participants; MD -3.00, 95%CI -4.48 to -1.52; moderate-certainty evidence). Recurrent, platinum-sensitive EOC Overall, 10 studies evaluated the effect of PARPi in recurrent platinum-sensitive EOC. Three studies compared PARPi monotherapy with chemotherapy alone. PARPi may result in little to no difference in OS (two studies, 331 participants; HR 0.95, 95%CI 0.62 to 1.47; low-certainty evidence) (percentage alive at 36 months 18% with PARPi versus 17% for placebo). Evidence is very uncertain about the effect of PARPi on PFS (three studies, 739 participants; HR 0.88, 95%CI 0.56 to 1.38; very low-certainty evidence)(no evidence of disease progression at 12 months 26% with PARPi versus 22% for placebo). There may be little to no difference in rates of any SevAE (grade 3 or higher) with PARPi (50%) than chemotherapy alone (47%) (one study, 254 participants; RR 1.06, 95%CI 0.80 to 1.39; low-certainty evidence). Four studies compared PARPi monotherapy as maintenance with placebo. PARPi may result in little to no difference in OS (two studies, 560 participants; HR 0.88, 95%CI 0.65 to 1.20; moderate-certainty evidence)(percentage alive at 36 months 21% with PARPi versus 17% for placebo). However, evidence suggests that PARPi as maintenance therapy results in a large PFS (four studies, 1677 participants; HR 0.34, 95% CI 0.28 to 0.42; high-certainty evidence)(no evidence of disease progression at 12 months 37% with PARPi versus 5.5% for placebo). PARPi maintenance therapy may result in a large increase in any SevAE (51%) (grade 3 or higher) than placebo (19%)(four studies, 1665 participants, RR 2.62, 95%CI 1.85 to 3.72; low-certainty evidence). PARPi compared with chemotherapy may result in little or no change in QoL (one study, 229 participants, MD 1.20, 95%CI -1.75 to 4.16; low-certainty evidence). Recurrent, platinum-resistant EOC Two studies compared PARPi with chemotherapy. The certainty of evidence in both studies was graded as very low. Overall, there was minimal information on the QoL and adverse events. AUTHORS' CONCLUSIONS PARPi maintenance treatment after chemotherapy may improve PFS in women with newly-diagnosed and recurrent platinum-sensitive EOC; there may be little to no effect on OS, although OS data are immature. Overall, this is likely at the expense of an increase in SevAE. It is disappointing that data on quality of life outcomes are relatively sparse. More research is needed to determine whether PARPi have a role to play in platinum-resistant disease.
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Affiliation(s)
| | - Neil Ryan
- The Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol, UK, Bristol, UK
| | - Alison J Wiggans
- Department of Gynaecological Oncology, Cheltenham General Hospital, Glocestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | | | - Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
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Laviano A. The good physician and the great physician: why a physician should consider the ESMO guidelines on the management of cancer cachexia? ESMO Open 2022; 7:100383. [PMID: 35091232 PMCID: PMC8801345 DOI: 10.1016/j.esmoop.2022.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
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Laviano A. Current guidelines for nutrition therapy in cancer: The arrival of a long journey or the starting point? JPEN J Parenter Enteral Nutr 2021; 45:12-15. [PMID: 34897734 DOI: 10.1002/jpen.2288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/11/2022]
Abstract
Large epidemiological data reveal that cancer is progressively becoming a chronic and disabling disease. Implementation in daily practice of early therapies aiming at addressing patients' needs is imperative. Nutrition is a major determinant of patients' quality of life, yet it is frequently neglected. Hopefully, reverting this skeptical clinical approach to nutrition, clinical practice guidelines of nutrition care in patients with cancer have been developed and published by international oncology and nutrition societies. By analyzing the more recent guidelines, it appears that a number of issues may contribute to their insufficient implementation in daily practice. Among them are heterogeneity of recommendations across different guidelines and insufficient robustness of evidence, as well as questionable generalization of recommendations. Future guidelines should aim at providing tumor-specific recommendations for the whole clinical journey of patients with cancer. Also, new, interesting areas should be covered, including fasting metabolism and circadian rhythmicity.
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Affiliation(s)
- Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Patient perspectives of value of delayed disease progression on imaging (imaging PFS). A treatment trade-off experiment. J Cancer Policy 2021; 30:100301. [DOI: 10.1016/j.jcpo.2021.100301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/19/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
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Strohbehn GW, Kacew AJ, Goldstein DA, Feldman RC, Ratain MJ. Combination therapy patents: a new front in evergreening. Nat Biotechnol 2021; 39:1504-1510. [PMID: 34880460 DOI: 10.1038/s41587-021-01137-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Garth W Strohbehn
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA.,Optimal Cancer Care Alliance, Ann Arbor, MI, USA.,Veterans Affairs Center for Clinical Management and Research, Ann Arbor, MI, USA
| | - Alec J Kacew
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Daniel A Goldstein
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA.,Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Robin C Feldman
- Center for Innovation, University of California Hastings College of the Law, San Francisco, CA, USA.
| | - Mark J Ratain
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA. .,Optimal Cancer Care Alliance, Ann Arbor, MI, USA.
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Schnog JJB, Samson MJ, Gans ROB, Duits AJ. An urgent call to raise the bar in oncology. Br J Cancer 2021; 125:1477-1485. [PMID: 34400802 PMCID: PMC8365561 DOI: 10.1038/s41416-021-01495-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.
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Affiliation(s)
- John-John B. Schnog
- Department of Hematology-Medical Oncology, Curaçao Medical Center, Willemstad, Curaçao ,Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Michael J. Samson
- Department of Radiation Oncology, Curaçao Medical Center, Willemstad, Curaçao
| | - Rijk O. B. Gans
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J. Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao ,grid.4494.d0000 0000 9558 4598Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands ,Red Cross Blood Bank Foundation, Willemstad, Curaçao
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Kazmi F, Shrestha N, Booth S, Dodwell D, Aroldi F, Foord T, Nicholson BD, Heesen P, Lord S, Yeoh KW, Blagden S. Next-generation sequencing for guiding matched targeted therapies in people with relapsed or metastatic cancer. Hippokratia 2021. [DOI: 10.1002/14651858.cd014872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farasat Kazmi
- Department of Oncology; University of Oxford; Oxford UK
| | - Nipun Shrestha
- Department of Primary Care and Mental Health; University of Liverpool; Liverpool UK
| | - Stephen Booth
- Department of Oncology; University of Oxford; Oxford UK
| | - David Dodwell
- Nuffield Department of Population Health; University of Oxford; Oxford UK
| | | | | | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | | | - Simon Lord
- Department of Oncology; University of Oxford; Oxford UK
| | - Kheng-Wei Yeoh
- Radiation Oncology; National Cancer Centre; Singapore Singapore
| | - Sarah Blagden
- Department of Oncology; University of Oxford; Oxford UK
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Bujosa A, Moltó C, Hwang TJ, Tapia JC, Vokinger KN, Templeton AJ, Gich I, Barnadas A, Amir E, Tibau A. Associations With Definitive Outcomes and Clinical Benefit of Cancer Drugs at the Time of Marketing Approval and in the Postmarketing Period. J Natl Compr Canc Netw 2021; 19:1-9. [PMID: 34560672 DOI: 10.6004/jnccn.2021.7003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most anticancer drugs are approved by regulatory agencies based on surrogate measures. This article explores the variables associated with overall survival (OS), quality of life (QoL), and substantial clinical benefit among anticancer drugs at the time of approval and in the postmarketing period. METHODS Anticancer drugs approved by the FDA between January 2006 and December 2015 and with postmarketing follow-up until April 2019 were identified. We evaluated trial-level data supporting approval and any updated OS and/or QoL data. We applied the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) and the ASCO Value Framework (ASCO-VF) to initial and follow-up studies. RESULTS We found that 58 drugs were approved for 96 indications based on 96 trials. At registration, approval was based on improved OS in 39 trials (41%) and improved QoL in 16 of 45 indications (36%). Postmarketing data showed an improvement in OS for 28 of 59 trials (47%) and in QoL for 22 of 48 indications (46%). At the time of approval, 25 of 94 (27%) and 26 of 80 scorable trials (33%) met substantial benefit thresholds using the ESMO-MCBS and ASCO-VF, respectively. In the postmarketing period, 37 of 69 (54%) and 35 of 65 (54%) trials met the substantial benefit thresholds. Drugs with companion diagnostics and immune checkpoint inhibitors were associated significantly with substantial clinical benefit. CONCLUSIONS Compared with the time of approval, more anticancer drugs showed improved OS and QoL and met the ESMO-MCBS or ASCO-VF thresholds for substantial benefit over the course of postmarketing time. However, only approximately half of the trials met the threshold for substantial benefit. Companion diagnostic drugs and immunotherapy seemed to be associated with greater clinical benefit.
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Affiliation(s)
- Aida Bujosa
- 1Oncology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, and Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Consolación Moltó
- 1Oncology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, and Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Thomas J Hwang
- 2Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - José Carlos Tapia
- 1Oncology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, and Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Kerstin N Vokinger
- 3Institute for Primary Care and Health Outcomes Research, University of Zürich, Zürich, Switzerland
| | - Arnoud J Templeton
- 4Department of Medical Oncology, St. Claraspital Basel, and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ignasi Gich
- 5Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, and Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; and
| | - Agustí Barnadas
- 1Oncology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, and Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Eitan Amir
- 6Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada
| | - Ariadna Tibau
- 1Oncology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, and Departament de Medicina de la Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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Lindqvist Bagge AS, Wesslau H, Cizek R, Holmberg CJ, Moncrieff M, Katsarelias D, Carlander A, Olofsson Bagge R. Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: A systematic review. Eur J Surg Oncol 2021; 48:312-319. [PMID: 34600786 DOI: 10.1016/j.ejso.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since there are no formal definition of health-related quality of life (HRQOL) there may be a lack of coherence and understanding of how to interpret HRQOL-data. The aim of this study is to summarize HRQOL-results that have used the FACT-M questionnaire in patients with melanoma, and specifically to summarize FACT-M between tumor stage. METHODS This review was conducted in accordance with the PRISMA guidelines. INCLUSION CRITERIA original studies on cutaneous melanoma between 2005 and 2020, written in English, containing "Functional Assessment of Cancer Therapy Melanoma" OR "Functional Assessment of Cancer Therapy M" OR FACT-M OR FACT/M OR FACTM OR "FACT M" OR FACT-melanoma OR "FACT Melanoma" together with FACT-M numbered data and basic patient characteristics, using the databases Scopus, Web of Science, PubMed and PsycINFO. RESULTS 16 articles describing 14 patient cohorts published 2008-2020 were included. The majority of the studies did not report subscale scores in accordance with FACT-M guidelines. The results did indicate that FACT-M total scores were inversely correlated with AJCC stage. Subscale analysis demonstrated varying degrees of correlation with AJCC stage. The Melanoma Surgery Subscale score was lowest in stage III patients, probably reflecting more advanced surgical procedures in this group of patients. CONCLUSIONS Though this review is based on a questionnaire limited to the assessment of melanoma patients, it highlights the universal need for clinical studies to describe their selected HRQOL-questionnaires, its definition of HRQOL and its dimensions, as well as comply with the questionnaire's guidelines when reporting HRQOL-data.
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Affiliation(s)
- Ann-Sophie Lindqvist Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Psychology, Gothenburg University, Gothenburg, Sweden.
| | - Hanna Wesslau
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Roza Cizek
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Carl Jacob Holmberg
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Marc Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Dimitrios Katsarelias
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Carlander
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; SOM Institute. University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Dawoud D, Naci H, Ciani O, Bujkiewicz S. Raising the bar for using surrogate endpoints in drug regulation and health technology assessment. BMJ 2021; 374:n2191. [PMID: 34526320 DOI: 10.1136/bmj.n2191] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Dalia Dawoud
- Science, Evidence and Analytics Directorate, Science Policy and Research Programme, National Institute for Health and Care Excellence, London, UK
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi, Milan, Italy
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
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Tsaur I, Heidegger I, Bektic J, Kafka M, van den Bergh RCN, Hunting JCB, Thomas A, Brandt MP, Höfner T, Debedde E, Thibault C, Ermacora P, Zattoni F, Foti S, Kretschmer A, Ploussard G, Rodler S, von Amsberg G, Tilki D, Surcel C, Rosenzweig B, Gadot M, Gandaglia G, Dotzauer R. A real-world comparison of docetaxel versus abiraterone acetate for metastatic hormone-sensitive prostate cancer. Cancer Med 2021; 10:6354-6364. [PMID: 34374489 PMCID: PMC8446402 DOI: 10.1002/cam4.4184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background Docetaxel (D) or secondary hormonal therapy (SHT) each combined with androgen deprivation therapy (ADT) represent possible treatment options in males with metastasized hormone‐sensitive prostate cancer (mHSPC). Real‐world data comparing different protocols are lacking yet. Thus, our objective was to compare the efficacy and safety of abiraterone acetate (AA)+ADT versus D+ADT in mHSPC. Methods In a retrospective multicenter analysis including males with mHSPC treated with either of the aforementioned protocols, overall survival (OS), progression‐free survival 1 (PFS1), and progression‐free survival 2 (PFS2) were assessed for both cohorts. Median time to event was tested by Kaplan–Meier method and log‐rank test. The Cox‐proportional hazards model was used for univariate and multivariate regression analyses. Results Overall, 196 patients were included. The AA+ADT cohort had a longer PFS1 in the log‐rank testing (23 vs. 13 mos., p < 0.001), a longer PFS2 (48 vs. 33 mos., p = 0.006), and longer OS (80 vs. 61 mos., p = 0.040). In the multivariate analyses AA+ADT outperformed D+ADT in terms of PFS1 (HR = 0.34, 95% CI = 0.183–0.623; p = 0.001) and PFS2 (HR = 0.33 95% CI = 0.128–0.827; p = 0.018), respectively, while OS and toxicity rate were similar between both groups. Conclusions AA+ADT is mainly associated with a similar efficacy and overall toxicity rate as D+ADT. Further prospective research is required for validation of the clinical value of the observed benefit of AA+ADT for progression‐free end‐points.
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Affiliation(s)
- Igor Tsaur
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Jarmo C B Hunting
- Department of Urology, St Antonius Hospital, Utrecht, The Netherlands
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Eliott Debedde
- Department of Medical Oncology, European Georges Pompidou Hospital, Assistance Publique des Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Constance Thibault
- Department of Medical Oncology, European Georges Pompidou Hospital, Assistance Publique des Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Paola Ermacora
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center Hospital, Udine, Italy
| | - Fabio Zattoni
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center Hospital, Udine, Italy
| | - Silvia Foti
- Division of Oncology/Unit of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France.,Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Severin Rodler
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gunhild von Amsberg
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital-Hamburg Eppendorf, Hamburg, Germany
| | - Christian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Barak Rosenzweig
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Gadot
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
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Shameer K, Zhang Y, Jackson D, Rhodes K, Neelufer IKA, Nampally S, Prokop A, Hutchison E, Ye J, Malkov VA, Liu F, Sabin A, Weatherall J, Duran C, Iacona RB, Khan FM, Mukhopadhyay P. Correlation Between Early Endpoints and Overall Survival in Non-Small-Cell Lung Cancer: A Trial-Level Meta-Analysis. Front Oncol 2021; 11:672916. [PMID: 34381708 PMCID: PMC8351517 DOI: 10.3389/fonc.2021.672916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Early endpoints, such as progression-free survival (PFS), are increasingly used as surrogates for overall survival (OS) to accelerate approval of novel oncology agents. Compiling trial-level data from randomized controlled trials (RCTs) could help to develop a predictive framework to ascertain correlation trends between treatment effects for early and late endpoints. Through trial-level correlation and random-effects meta-regression analysis, we assessed the relationship between hazard ratio (HR) OS and (1) HR PFS and (2) odds ratio (OR) PFS at 4 and 6 months, stratified according to the mechanism of action of the investigational product. Using multiple source databases, we compiled a data set including 81 phase II-IV RCTs (35 drugs and 156 observations) of patients with non-small-cell lung cancer. Low-to-moderate correlations were generally observed between treatment effects for early endpoints (based on PFS) and HR OS across trials of agents with different mechanisms of action. Moderate correlations were seen between treatment effects for HR PFS and HR OS across all trials, and in the programmed cell death-1/programmed cell death ligand-1 and epidermal growth factor receptor trial subsets. Although these results constitute an important step, caution is advised, as there are some limitations to our evaluation, and an additional patient-level analysis would be needed to establish true surrogacy.
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Affiliation(s)
- Khader Shameer
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development (R&D), AstraZeneca, Gaithersburg, MD, United States
| | - Youyi Zhang
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development (R&D), AstraZeneca, Gaithersburg, MD, United States
| | - Dan Jackson
- Oncology Biometrics, Oncology Research and Development, AstraZeneca, Cambridge, United Kingdom
| | - Kirsty Rhodes
- Oncology Biometrics, Oncology Research and Development, AstraZeneca, Cambridge, United Kingdom
| | - Imran Khan A Neelufer
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development, AstraZeneca, Macclesfield, United Kingdom
| | - Sreenath Nampally
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development (R&D), AstraZeneca, Gaithersburg, MD, United States
| | - Andrzej Prokop
- Oncology Biometrics, Oncology Research and Development, AstraZeneca, Warsaw, Poland
| | - Emmette Hutchison
- Digital Health, Oncology Research and Development, AstraZeneca, Cambridge, United Kingdom
| | - Jiabu Ye
- Oncology Biometrics, Oncology R&D, AstraZeneca, Gaithersburg, MD, United States
| | - Vladislav A Malkov
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development (R&D), AstraZeneca, Gaithersburg, MD, United States
| | - Feng Liu
- Oncology Biometrics, Oncology R&D, AstraZeneca, Gaithersburg, MD, United States
| | - Antony Sabin
- Oncology Biometrics, Oncology Research and Development, AstraZeneca, Cambridge, United Kingdom
| | - Jim Weatherall
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development, AstraZeneca, Macclesfield, United Kingdom
| | - Cristina Duran
- Digital Health, Oncology Research and Development, AstraZeneca, Cambridge, United Kingdom
| | - Renee Bailey Iacona
- Oncology Biometrics, Oncology R&D, AstraZeneca, Gaithersburg, MD, United States
| | - Faisal M Khan
- Data Science and Artificial Intelligence, BioPharmaceuticals Research and Development (R&D), AstraZeneca, Gaithersburg, MD, United States
| | - Pralay Mukhopadhyay
- Oncology Biometrics, Oncology R&D, AstraZeneca, Gaithersburg, MD, United States
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