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Garcia Barrado L, Burzykowski T. Using an early outcome as the sole source of information of interim decisions regarding treatment effect on a long-term endpoint: The non-Gaussian case. Pharm Stat 2024. [PMID: 38837876 DOI: 10.1002/pst.2398] [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: 04/26/2023] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024]
Abstract
In randomized clinical trials that use a long-term efficacy endpoint, the follow-up time necessary to observe the endpoint may be substantial. In such trials, an attractive option is to consider an interim analysis based solely on an early outcome that could be used to expedite the evaluation of treatment's efficacy. Garcia Barrado et al. (Pharm Stat. 2022; 21: 209-219) developed a methodology that allows introducing such an early interim analysis for the case when both the early outcome and the long-term endpoint are normally-distributed, continuous variables. We extend the methodology to any combination of the early-outcome and long-term-endpoint types. As an example, we consider the case of a binary outcome and a time-to-event endpoint. We further evaluate the potential gain in operating characteristics (power, expected trial duration, and expected sample size) of a trial with such an interim analysis in function of the properties of the early outcome as a surrogate for the long-term endpoint.
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Affiliation(s)
- Leandro Garcia Barrado
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Institute of Statistics, Biostatistics, and Actuarial Sciences (ISBA), Louvain Institute for Data Analysis and Modeling, Louvain-la-Neuve, Belgium
| | - Tomasz Burzykowski
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
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Fokas E, Smith JJ, Garcia-Aguilar J, Glynne-Jones R, Buyse M, Rödel C. Early Efficacy End Points in Neoadjuvant Rectal Cancer Trials: Surrogacy Revisited. J Clin Oncol 2024; 42:872-875. [PMID: 37890124 DOI: 10.1200/jco.23.01196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/07/2023] [Accepted: 09/13/2023] [Indexed: 10/29/2023] Open
Abstract
Trial-level surrogacy is critical before early response endpoints are used to approve new therapies.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site: Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt, Germany
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - J Joshua Smith
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, United Kingdom
| | - Marc Buyse
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- International Drug Development Institute, San Francisco, CA
| | - Claus Rödel
- Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site: Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt, Germany
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Squifflet P, Saad ED, Loibl S, van Mackelenbergh MT, Untch M, Rastogi P, Gianni L, Schneeweiss A, Conte P, Piccart M, Bonnefoi H, Jackisch C, Nekljudova V, Tang G, Valagussa P, Neate C, Gelber R, Poncet C, Heinzmann D, Denkert C, Geyer CE, Cortes J, Guarneri V, de Azambuja E, Cameron D, Ismael G, Wolmark N, Cortazar P, Buyse M. Re-Evaluation of Pathologic Complete Response as a Surrogate for Event-Free and Overall Survival in Human Epidermal Growth Factor Receptor 2-Positive, Early Breast Cancer Treated With Neoadjuvant Therapy Including Anti-Human Epidermal Growth Factor Receptor 2 Therapy. J Clin Oncol 2023; 41:2988-2997. [PMID: 36977286 DOI: 10.1200/jco.22.02363] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/16/2022] [Accepted: 02/09/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Pathologic complete response (pCR) has prognostic importance and is frequently used as a primary end point, but doubts remain about its validity as a surrogate for event-free survival (EFS) and overall survival (OS) in human epidermal growth factor receptor 2 (HER2)-positive, early breast cancer. METHODS We obtained individual-patient data from randomized trials of neoadjuvant anti-HER2 therapy that enrolled at least 100 patients, had data for pCR, EFS, and OS, and a median follow-up of at least 3 years. We quantified the patient-level association between pCR (defined as ypT0/Tis ypN0) and both EFS and OS using odds ratios (ORs, with ORs >1.00 indicating a benefit from achieving a pCR). We quantified the trial-level association between treatment effects on pCR and on EFS and OS using R2 (with values above 0.75 considered as indicating strong associations). RESULTS Eleven of 15 eligible trials had data for analysis (3,980 patients, with a median follow-up of 62 months). Considering all trials, we found strong patient-level associations, with ORs of 2.64 (95% CI, 2.20 to 3.07) for EFS and 3.15 (95% CI, 2.38 to 3.91) for OS; however, trial-level associations were weak, with an unadjusted R2 of 0.23 (95% CI, 0 to 0.66) for EFS and 0.02 (95% CI, 0 to 0.17) for OS. We found qualitatively similar results when grouping trials according to different clinical questions, when analyzing only patients with hormone receptor-negative disease, and when using a more stringent definition of pCR (ypT0 ypN0). CONCLUSION Although pCR may be useful for patient management, it cannot be considered as a surrogate for EFS or OS in neoadjuvant trials of HER2-positive, operable breast cancer.
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Affiliation(s)
- Pierre Squifflet
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Everardo D Saad
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | | | | | | | | | - Luca Gianni
- San Raffaele Scientific Institute, Milan, Italy
| | | | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Martine Piccart
- Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Hervé Bonnefoi
- Institut Bergonié and Université de Bordeaux INSERM U916, Bordeaux, France
| | | | | | - Gong Tang
- University of Pittsburgh, Pittsburgh, PA
| | | | - Colin Neate
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Richard Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science and Technology Research Foundation, Boston, MA
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Dominik Heinzmann
- Product Development-Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg, Marburg, Germany
| | | | - Javier Cortes
- IOB Institute of Oncology, Quiron Group, Madrid & Barcelona and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - David Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh and NHS Lothian, Edinburgh, United Kingdom
| | | | | | | | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
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Garcia Barrado L, Burzykowski T, Legrand C, Buyse M. Using an interim analysis based exclusively on an early outcome in a randomized clinical trial with a long-term clinical endpoint. Pharm Stat 2021; 21:209-219. [PMID: 34505395 DOI: 10.1002/pst.2165] [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: 01/07/2021] [Revised: 06/04/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022]
Abstract
In RCTs with an interest in a long-term efficacy endpoint, the follow-up time necessary to observe the endpoint may be substantial. In order to reduce the expected duration of such trials, early-outcome data may be collected to enrich an interim analysis aimed at stopping the trial early for efficacy. We propose to extend such a design with an additional interim analysis using solely early-outcome data in order to expedite the evaluation of treatment's efficacy. We evaluate the potential gain in operating characteristics (power, expected trial duration, and expected sample size) when introducing such an early interim analysis, in function of the properties of the early outcome as a surrogate for the long-term endpoint. In the context of a longitudinal age-related macular degeneration (ARMD) ophthalmology trial, results show potentially substantial gains in both the expected trial duration and the expected sample size. A prerequisite, though, is that the treatment effect on the early outcome has to be strongly correlated with the treatment effect on the long-term endpoint, that is, that the early outcome is a validated surrogate for the long-term endpoint.
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Affiliation(s)
- Leandro Garcia Barrado
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium.,Institute of Statistics, Biostatistics, and Actuarial Sciences (ISBA), Louvain Institute for Data Analysis and Modeling, Louvain-la-Neuve, Belgium
| | - Tomasz Burzykowski
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium.,Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
| | - Catherine Legrand
- Institute of Statistics, Biostatistics, and Actuarial Sciences (ISBA), Louvain Institute for Data Analysis and Modeling, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium.,Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
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Saad ED, Squifflet P, Burzykowski T, Quinaux E, Delaloge S, Mavroudis D, Perez E, Piccart-Gebhart M, Schneider BP, Slamon D, Wolmark N, Buyse M. Disease-free survival as a surrogate for overall survival in patients with HER2-positive, early breast cancer in trials of adjuvant trastuzumab for up to 1 year: a systematic review and meta-analysis. Lancet Oncol 2019; 20:361-370. [PMID: 30709633 PMCID: PMC7050571 DOI: 10.1016/s1470-2045(18)30750-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although frequently used as a primary endpoint, disease-free survival has not been validated as a surrogate for overall survival in early breast cancer. We investigated this surrogacy in the adjuvant setting of treatment with anti-HER2 antibodies. METHODS In a systematic review and meta-analysis, we identified published and non-published randomised controlled trials with completed accrual and available disease-free survival and overall survival results for the intention-to-treat population as of September 2016. Bibliographic databases (MEDLINE, Embase, and Cochrane Central Register of Controlled Trials), clinical trial registries (Clinicaltrials.gov, EU Clinical Trials Register, WHO International Clinical Trials Registry Platform, and PharmNet.Bund), and trial registries from relevant pharmaceutical companies were searched. Eligibility for treatment of HER2-positive early breast cancer required at least one group to have an anti-HER antibody treatment (ie, trastuzumab, pertuzumab, or trastuzumab emtansine) planned for 12 months, and at least one control arm with chemotherapy without the antibody, a lower total dose or duration of the antibody, or observation alone. Units of analysis were contrasts: two-group trials gave rise to one contrast, whereas trials with more than two groups gave rise to more than one contrast. We excluded trials enrolling patients with recurrent, metastatic, or non-invasive disease, and those testing neoadjuvant therapy exclusively. Our primary objective was to estimate patient-level and trial-level correlations between disease-free survival and overall survival. We measured the association between disease-free survival and overall survival using Spearman's correlation coefficient (rs), and the association between hazard ratios (HRs) for disease-free survival and overall survival using R2. We computed the surrogate threshold effect, the maximum HR for disease-free survival that statistically predicts an HR for overall survival less than 1·00 in a future trial. FINDINGS Eight trials (n=21 480 patients) gave rise to a full set (12 contrasts). Patient-level associations between disease-free and overall survival were strong (rs=0·90 [95% CI 0·89-0·90]). Trial-level associations gave rise to values of R2 of 0·75 (95% CI 0·50-1·00) for the full set. Subgroups defined by nodal status and hormone receptor status yielded qualitatively similar results. Depending on the expected number of deaths in a future trial, the surrogate threshold effects ranged from 0·56 to 0·81, based on the full set. INTERPRETATION These findings suggest that it is appropriate to continue to use disease-free survival as a surrogate for overall survival in trials in HER-2-positive, early breast cancer. The key limitation of this study is the dependence of its results on the trials included and on the existence of an outlying trial. FUNDING Roche Pharma AG.
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Affiliation(s)
- Everardo D Saad
- International Drug Development Institute, Louvain-la-Neuve, Belgium.
| | - Pierre Squifflet
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Tomasz Burzykowski
- International Drug Development Institute, Louvain-la-Neuve, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Emmanuel Quinaux
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | | | | | | | | | | | - Dennis Slamon
- University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Marc Buyse
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium; International Drug Development Institute, San Francisco, CA, USA
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