The impact of radiological assessment schedules on progression-free survival in metastatic breast cancer: A systemic review and meta-analysis

The Effect of Staging Intervals on Progression-Free Survival in Registration Studies of Oncologic Drugs: A Meta-Analysis

BACKGROUND/OBJECTIVES

To study whether shorter restaging intervals are associated with lower hazard ratios (HRs) for progression-free survival (PFS), as suggested in breast cancer.

METHODS

Studies supporting the registration of oncologic drugs in Switzerland from 2010 to 2022 were analyzed. HRs and 95% confidence intervals (CIs) for PFS were pooled in a meta-analysis using the generic inverse-variance method and a random-effects model in RevMan v5.4. The HRs were stratified by restaging intervals (

RESULTS

A total of 112 studies comprising 69,579 patients were included. The median restaging interval was 8 weeks, with a range of 4 to 18 weeks. Longer restaging intervals (≥8 weeks) were associated with lower HRs compared to shorter intervals (<8 weeks), with pooled HRs of 0.48 (95% CI: 0.44-0.52) and 0.58 (95% CI: 0.53-0.63), respectively. The difference between the groups was statistically significant (p = 0.005), with a substantial heterogeneity (Cochran's Q p < 0.001; I2 = 90%). Subgroup analyses based on treatment type, including immunotherapy, monoclonal antibodies, and tyrosine kinase inhibitors, did not show any statistically significant differences in HRs. Studies of melanoma with shorter staging intervals were associated with lower HRs (0.44 vs. 0.58, p = 0.02), whereas shorter interval studies of kidney cancer had higher HRs (0.67 vs. 0.44, p = 0.01). Sensitivity analyses with other cut-offs and a meta-regression yielded similar results.

CONCLUSIONS

Studies leading to the authorization of drugs to treat incurable solid tumors applying restaging intervals ≥ 8 weeks were associated with lower HRs for PFS. The potential impact of restaging intervals on the results for PFS warrants further investigation.

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Key Words

• meta-analysis
• oncologic drug
• registration trial
• staging

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Affiliation(s)

Jonas A. Zuellig Faculty of Medicine, University of Basel, 4001 Basel, Switzerland; (J.A.Z.); (R.A.); (F.U.)
Roman Adam Faculty of Medicine, University of Basel, 4001 Basel, Switzerland; (J.A.Z.); (R.A.); (F.U.)
Filomena Udry Faculty of Medicine, University of Basel, 4001 Basel, Switzerland; (J.A.Z.); (R.A.); (F.U.)
Ariadna Tibau Oncology Department, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, 08041 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain
Bostjan Šeruga Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
Alberto Ocaña Experimental Therapeutics Unit, Medical Oncology Department, Hospital Clínico Universitario San Carlos IdISSC, 28040 Madrid, Spain; Instituto de Investiagción Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
Eitan Amir Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, Toronto, ON M5S 1A1, Canada; Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
Arnoud J. Templeton Faculty of Medicine, University of Basel, 4001 Basel, Switzerland; (J.A.Z.); (R.A.); (F.U.) Department of Medical Oncology, St. Claraspital, 4058 Basel, Switzerland St. Clara Research, 4058 Basel, Switzerland

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Current Resources for Evidence-Based Practice, March 2022

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of systemic racism and its effect on maternal health in the United States and commentaries on reviews focused on barriers and facilitators to HPV vaccination and delayed cord clamping in preterm infants.