Delays in the Publication of Important Clinical Trial Findings in Oncology

Preferred study designs to support a comparative therapeutic strategy question in oncology: a vignette study

OBJECTIVES

Some therapeutic strategy questions in oncology could be answered with studies using observational data. Target trial emulation is the application of design principles from randomized controlled trials (RCTs) to the analysis of observational data, to reduce design-induced biases. Our objective was to determine which type of study physicians would preferably plan to answer a comparative effectiveness question lacking evidence in oncology.

METHODS

We launched an online survey among physicians specialized in oncology. We constructed a vignette-based inquiry where vignettes described study scenarios which could be conducted to answer the predefined question. We designed six vignettes described by study design (RCT or observational study with a trial emulation framework), main study characteristics, probability of the study succeeding and anticipated delay before results availability. Participants randomly assessed five pair-wise comparisons of the vignettes and were asked which study they would preferably plan by using a Likert scale ranging from -5 to 5. The main outcome was the evaluation of clinicians' preferences for each pairwise comparison. Mean and median preference scores were calculated.

RESULTS

Two hundred thirteen participants, specialized in many tumor types, assessed at least one comparison with 82% reporting France as their country of affiliation. The interquartile range was -4 to 4 across pairwise comparisons. The median preference score was in disfavor of the monocentric RCT for the five comparisons where it appeared. The median preference score was strongly in favor of the multicentric national emulated trial when compared to the monocentric emulated trial 4 [IQR 2.5-4]. The mean preference score was the highest for the large European observational study 1.14 (SD 3.33), while the mean preference score was the lowest for the monocentric RCT -1.86 (SD 2.93).

CONCLUSION

No study design was strongly preferred, but the monocentric RCT was the least favored study in pair-wise comparisons. The planification of the new research is a compromise between scientific soundness, feasibility, cost, and time before obtaining results. We need to have the right answers to the right questions at the right time.

Genetic factors associated with reasons for clinical trial stoppage

Many drug discovery projects are started but few progress fully through clinical trials to approval. Previous work has shown that human genetics support for the therapeutic hypothesis increases the chance of trial progression. Here, we applied natural language processing to classify the free-text reasons for 28,561 clinical trials that stopped before their endpoints were met. We then evaluated these classes in light of the underlying evidence for the therapeutic hypothesis and target properties. We found that trials are more likely to stop because of a lack of efficacy in the absence of strong genetic evidence from human populations or genetically modified animal models. Furthermore, certain trials are more likely to stop for safety reasons if the drug target gene is highly constrained in human populations and if the gene is broadly expressed across tissues. These results support the growing use of human genetics to evaluate targets for drug discovery programs.

Press Releases of Drug-Related Randomized Trial Results Prior to Publication in High-Impact Journals: an Observational Study

IMPORTANCE

Results from high-profile randomized controlled trials (RCTs) are routinely reported through press release months prior to peer-reviewed publication. There are potential benefits to press releases (e.g., knowledge dissemination, ensuring regulatory compliance), but also potential drawbacks (e.g., selective reporting, positive "spin").

OBJECTIVE

To characterize the practice of press release predating the publication of a drug-related RCT in a peer-reviewed journal ("preemptive press release"), including factors associated with this practice.

DESIGN, SETTING, AND PARTICIPANTS

We systematically reviewed all RCTs of medications published between 2015 and 2019 in the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and Lancet. Press releases were identified using a systematic search of the grey literature (e.g., press release databases, study sponsor websites). An RCT was considered to have a preemptive press release if the press release was published at least three months (90 days) prior to the date of publication in a peer-reviewed journal.

MAIN OUTCOMES AND MEASURES

Presence of preemptive press release, defined as a press-release at least 90 days prior to the date of publication in a peer-reviewed journal. As secondary measures for dissemination, we also assessed citation count and Altmetric score.

RESULTS

We identified 988 RCTs, of which 172 (17%) had a press release published at least 90 days before the date of peer-reviewed publication. Press releases were published a median of 246 days (interquartile range [IQR] 169-366 days) before publication in a peer-reviewed journal. In the multivariable logistic regression model, the strongest predictor of having a preemptive press release was funding by a pharmaceutical company (odds ratio 13, 95% CI 7, 25). Approximately 85% of RCTs with preemptive press releases had a positive primary outcome and, concordantly, 81% of the corresponding press releases had a positive headline. Multivariable regression models identified studies with a preemptive press release had a similar Altmetric score (median - 15, 95% CI - 33, 12) and higher median citation count (median 22 [95% CI 10 to 33] compared to studies without a preemptive press release.

CONCLUSIONS AND RELEVANCE

Preemptive press releases were common, most often issued for trials funded by a pharmaceutical company, and typically preceded publication in a peer-reviewed journal by approximately eight months.

Rapid, accurate publication and dissemination of clinical trial results: benefits and challenges

Large-scale clinical trials are essential in cardiology and require rapid, accurate publication, and dissemination. Whereas conference presentations, press releases, and social media disseminate information quickly and often receive considerable coverage by mainstream and healthcare media, they lack detail, may emphasize selected data, and can be open to misinterpretation. Preprint servers speed access to research manuscripts while awaiting acceptance for publication by a journal, but these articles are not formally peer-reviewed and sometimes overstate the findings. Publication of trial results in a major journal is very demanding but the use of existing checklists can help accelerate the process. In case of rejection, procedures such as easing formatting requirements and possibly carrying over peer-review to other journals could speed resubmission. Secondary publications can help maximize benefits from clinical trials; publications of secondary endpoints and subgroup analyses further define treatment effects and the patient populations most likely to benefit. These rely on data access, and although data sharing is becoming more common, many challenges remain. Beyond publication in medical journals, there is a need for wider knowledge dissemination to maximize impact on clinical practice. This might be facilitated through plain language summary publications. Social media, websites, mainstream news outlets, and other publications, although not peer-reviewed, are important sources of medical information for both the public and for clinicians. This underscores the importance of ensuring that the information is understandable, accessible, balanced, and trustworthy. This report is based on discussions held on December 2021, at the 18th Global Cardiovascular Clinical Trialists meeting, involving a panel of editors of some of the top medical journals, as well as members of the lay press, industry, and clinical trialists.

Transparency of Results Reporting in Cancer Clinical Trials

This cross-sectional study investigates rates of results reporting among oncology clinical trials across trial registries, medical journals, and medical conferences.

Data Dissemination of the Role of Neoadjuvant Radiation in Retroperitoneal Sarcoma: A CTOS and CSSO Survey

Consensus guidelines call for complete resection of retroperitoneal sarcoma with consideration of neoadjuvant radiation for curative-intent treatment. The 15-month delay from the initial presentation of an abstract to the final publication of the STRASS trial results assessing the impact of neoadjuvant radiation led to a dilemma of how patients should be managed in the interim. This study aims to (1) understand perspectives regarding neoadjuvant radiation for RPS during this period; and (2) assess the process of integrating data into practice. A survey was distributed to international organizations including all specialties treating RPS. Eighty clinicians responded, including surgical (60.5%), radiation (21.0%) and medical oncologists (18.5%). Low kappa correlation coefficients on a series of clinical scenarios querying individual recommendations before and after initial presentation as an abstract indicate considerable change. Over 62% of respondents identified a practice change; however, most also noted discomfort in adopting changes without a manuscript available. Of the 45 respondents indicating discomfort with practice changes without a full manuscript, 28 (62%) indicated that their practice changed in response to the abstract. There was substantial variability in recommendations for neoadjuvant radiation between the presentation of the abstract and the publication of trial results. The difference in the proportion of clinicians describing comfort with changing practice based on the presentation of the abstract versus those that had done so shows that indications for proper integration of data into practice are not clear. Endeavors to resolve this ambiguity and expedite availability of practice-changing data are warranted.

Publication Speed Across Neurosurgery Journals: A Bibliometric Analysis

OBJECTIVE

Many factors influence an author's choice for journal submission, including journal impact factor and publication speed. These and other bibliometric data points have not been assessed in journals dedicated to neurosurgery.

METHODS

Eight leading neurosurgery journals were analyzed to identify original articles and reviews, collected via randomized, stratified sampling per published issue per year from 2016 to 2020. Bibliometric data on publication speed were gathered for each article. Journal impact factor, article processing fees, and open access availability were determined using Clarivate Journal Citation Reports. Correlation analysis and a linear regression model were used to estimate the effect of impact factor and publication year on publication speed.

RESULTS

Across the 8 neurosurgery journals, 1617 published articles were reviewed. The mean (standard deviation) time from submission to acceptance (SA) was 131 (101) days, from acceptance to online publication was 77 (61) days, and from submission to online publication was 207 (123) days. Higher impact factors correlated with longer publication times for all metrics. Later years of publication correlated with longer times from SA and submission to online publication. For each point increase in a journal's impact factor, multivariate regression modeling estimated a 19.2-day increase in time from SA, a 19.7-day increase in time from acceptance to online publication, and a 38.9-day increase in time from submission to online publication (P < 0.001 for all).

CONCLUSIONS

Publication speeds vary widely among neurosurgery journals and appear to be associated with the journal impact factor. Time to publication increased over the study period.

Publication Times and Impact Factors (IFs) in Dentistry Journals

INTRODUCTION

 The speed of manuscript publication in reputable journals plays a crucial role in spreading scientific novelties and may influence the number of received citations. In the present study, the authors investigated the publication speed of dentistry journals. This is crucial for both authors, who desire rapid dissemination of their findings, and patients in need, who seek new therapies.

MATERIALS AND METHODS

 This was a cross-sectional bibliometric analysis of published dentistry journals. A list of dentistry journals featured in the 2021 Journal Citation Report was downloaded. A total of five random original articles were extracted from each of these journals. These articles were published between January and December 2020. Median and interquartile range (IQR) times from submission to acceptance, publication in print, online publication, time from acceptance to in print and online publication were calculated. The correlation between publication times and journal impact factor (IF) was examined.

RESULTS

 A total of 89 journals were included. Individual time from submission to acceptance (peer review time) ranged from 6 to 279 days, the combined median peer review time was 115 (80-159) days. The overall median time from acceptance to online or print publication was 17 (12-38) and 153 (92-249) days, respectively. Journals with available data concerning publication times tended to have higher IF than others. Only journals that did not have available time from acceptance to online publication had higher IF. There were negative correlations between times from submission (r = -0.442, p = 0.007), acceptance (r = -0.616, p < 0.001) to in-print publication, and IF. There were no correlations between IF and time from submission to acceptance, acceptance to online publication, and submission to online publication.

CONCLUSIONS

 Publication times availability was revealed to be an indicator of higher impacted journals, which is a potential new exponent of journal quality. Higher IF values were associated with shorter times from submission to acceptance and in-print publication, which is consistent with current editorial policies.

Availability of Results of Trials Studying Pancreatic Adenocarcinoma over the Past 10 Years

BACKGROUND

Pancreatic adenocarcinoma (PDAC) is a lethal cancer with few therapeutic options. Availability of results is a crucial step in interventional research. Our aim was to evaluate results availability for trials in patients with PDAC and explore associated factors.

MATERIALS AND METHODS

We performed a retrospective cohort study and searched the ClinicalTrials.gov registry for trials evaluating PDAC management with a primary completion date between 1 January 2010 and 1 June 2020. Then, we searched for results submitted on ClinicalTrials.gov and/or published. Our primary outcome was the proportion of PDAC trials with available results: submitted on ClinicalTrials.gov (either publicly available or undergoing quality control check) and/or published in a full-text article. The association of predefined trial characteristics with results availability was assessed.

RESULTS

We identified 551 trials of which 386 (70%) had available results. The cumulative percentage of trials with available results was 21% (95% CI, 18-25%) at 12 months after the primary completion date, 44% (95% CI, 30-48%) at 24 months and 57% (95% CI, 53-61%) at 36 months. Applicable clinical trials, required to comply with the 2007 Food and Drug Administration Amendments Act 801 and its final rule on reporting of results on ClinicalTrials.gov, were more likely to have available results over time (HR 2.1 [95% CI 1.72-2.63], P < .001). Industry-funded, small sample size, and terminated trials were less likely to have available results. Other trial characteristics showed no association with results availability.

CONCLUSION

Our results highlight a waste in interventional research studying PDAC.

[Risk of Publication Bias in Therapeutic Interventions for COVID-19Risco de viés de publicação em intervenções terapêuticas para a COVID-19]

En este artículo se describe el sesgo de publicación, sus causas más frecuentes, sus características, las herramientas regulatorias para evitarlo y algunas técnicas estadísticas para analizarlo. Se explican y aplican estas técnicas a tres intervenciones terapéuticas relacionadas con la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés): corticoides, ivermectina y tocilizumab; se detectó riesgo de sesgo de publicación para ivermectina y tocilizumab. Las revisiones sistemáticas y los metaanálisis son diseños de investigación secundaria que constituyen una referencia para guiar la toma de decisiones. Son propensos a distintos tipos de sesgo, que es una desviación sistemática en los resultados. Aun desarrollados con rigor metodológico, su validez puede verse amenazada por el sesgo de publicación. Este se define como el acto de ocultar o retrasar la publicación, retener datos surgidos de los estudios de investigación, o ambos. Hasta la mitad de los ensayos controlados que se realizan permanecen sin publicarse. Durante la pandemia por virus H1N1, el sesgo de publicación de estudios financiados por la industria llevó a recomendar y comprar en gran escala el fármaco oseltamivir que, luego se supo, no tenía efectos beneficiosos relevantes. Dos tercios del financiamiento de los estudios clínicos para COVID-19 provienen de la industria farmacéutica. En el contexto de la pandemia actual por COVID-19, se publican estudios a un ritmo acelerado, por lo que resulta de gran trascendencia conocer e identificar el sesgo de publicación. Para reducir el sesgo de publicación es necesario regular el registro y la publicación de ensayos clínicos, pero esto requiere una coordinación de los países y organismos internacionales. Es importante sospechar e intentar identificar el sesgo de publicación para la toma de decisiones.

Reducing publication delay to improve the efficiency and impact of conservation science

Evidence-based decision-making is most effective with comprehensive access to scientific studies. If studies face significant publication delays or barriers, the useful information they contain may not reach decision-makers in a timely manner. This represents a potential problem for mission-oriented disciplines where access to the latest data is required to ensure effective actions are undertaken. We sought to analyse the severity of publication delay in conservation science—a field that requires urgent action to prevent the loss of biodiversity. We used the Conservation Evidence database to assess the length of publication delay (time from finishing data collection to publication) in the literature that tests the effectiveness of conservation interventions. From 7,447 peer-reviewed and non-peer-reviewed studies of conservation interventions published over eleven decades, we find that the raw mean publication delay was 3.2 years (±2SD = 0.1) and varied by conservation subject. A significantly shorter delay was observed for studies focused on Bee Conservation, Sustainable Aquaculture, Management of Captive Animals, Amphibian Conservation, and Control of Freshwater Invasive Species (Estimated Marginal Mean range from 1.4–1.9 years). Publication delay was significantly shorter for the non-peer-reviewed literature (Estimated Marginal Mean delay of 1.9 years ± 0.2) compared to the peer-reviewed literature (i.e., scientific journals; Estimated Marginal Mean delay of 3.0 years ± 0.1). We found publication delay has significantly increased over time (an increase of ~1.2 years from 1912 (1.4 years ± 0.2) to 2020 (2.6 years ± 0.1)), but this change was much weaker and non-significant post-2000s; we found no evidence for any decline. There was also no evidence that studies on more threatened species were subject to a shorter delay—indeed, the contrary was true for mammals, and to a lesser extent for birds. We suggest a range of possible ways in which scientists, funders, publishers, and practitioners can work together to reduce delays at each stage of the publication process.

Publication Times in Ophthalmology Journals: The Story of Accepted Manuscripts

Introduction: The process of scientific publishing changed greatly in the past decades. The authors aimed to get insight into the time required for articles to be accepted and released online in high-impacted ophthalmology journals.

Methods: Comprehensive review of all original articles published by eight ophthalmology journals during a one-year period was performed for 2020 and 2005. Time taken from submission to acceptance and the first online release of the article was abstracted and analyzed.

Results: A total of 3110 articles were reviewed. In 2020, the overall median time from submission to acceptance (AT) was 119 days (IQR 83-168) and 30 days (10-71) from acceptance to the first online release of the article (OP). AT increased by 7.3% from 2005 to 2020, whereas OP reduced by 73%. Publications, which the corresponding author was affiliated with US-located institution had shorter both AT and OP in 2005 and 2020. The author’s specialty in ophthalmology had an inconclusive impact on AT and OP. Papers with multiple affiliated institutions had shorter AT and OP in both 2005 and 2020; however, these differences were not statistically significant.

Conclusion: This study demonstrated that increasing pressure on authors, editors, and reviewers to publish articles and journals with high impact factor (IF) significantly influenced publication times in ophthalmology journals. Inflation of research papers was associated with rising AT time. A significant decrease in OP time was potentially explained by the editor’s demand to achieve decent journal IF. This article brings to light relative publication times in the ophthalmology scientific journals.

Factors Affecting the Time to Publication in Ophthalmology Journals: A Comprehensive Bibliometric Analysis

Purpose: There are currently no available aids for authors when selecting ophthalmology journals to submit their manuscripts. We aim to provide comprehensive data on the duration from submission to various stages of the publication process and assess factors influencing time to publication in ophthalmology journals.Methods: A list of ophthalmology journals was obtained from the 2019 Web of Science Journal Citation Report. Journal characteristics, such as five-year impact factor, number of authors per article, journal type, and number of multi-institutional articles, were collected. The dates of submission, acceptance, electronic and print publication for all articles published in an ophthalmology journal in 2019 were determined.Results: In total, 56 journals and 8835 research articles were included. Of these articles, 3591 (40.6%) were open access and 4837 (54.7%) were multi-institutional. In 2019, most publications came from the United States of America (n = 1973), China (n = 1069) and Germany (n = 602). Significant associations were found between various predictors and a reduced mean number of days from submission to electronic publication: increased journal five-year impact factor (p = .026), more authors (p = .028), publishing in a hybrid journal (both open-access and subscription articles) versus an open-access journal (p = .021), and a reduced proportion of multi-institutional articles in a journal (p = .030).Conclusions: There is a wide variation in the time to acceptance and publication in ophthalmology journals. Authors can expect a shorter time to publication when publishing in high-impact journals.

Preprint Servers in Kidney Disease Research: A Rapid Review

Preprint servers, such as arXiv and bioRxiv, have disrupted the scientific communication landscape by providing rapid access to research before peer review. medRxiv was launched as a free online repository for preprints in the medical, clinical, and related health sciences in 2019. In this review, we present the uptake of preprint server use in nephrology and discuss specific considerations regarding preprint server use in medicine. Distribution of kidney-related research on preprint servers is rising at an exponential rate. Survey of nephrology journals identified that 15 of 17 (88%) are publishing original research accepted submissions that have been uploaded to preprint servers. After reviewing 52 clinically impactful trials in nephrology discussed in the online Nephrology Journal Club (NephJC), an average lag of 300 days was found between study completion and publication, indicating an opportunity for faster research dissemination. Rapid review of papers discussing benefits and risks of preprint server use from the researcher, publisher, or end user perspective identified 53 papers that met criteria. Potential benefits of biomedical preprint servers included rapid dissemination, improved transparency of the peer review process, greater visibility and recognition, and collaboration. However, these benefits come at the risk of rapid spread of results not yet subjected to the rigors of peer review. Preprint servers shift the burden of critical appraisal to the reader. Media may be especially at risk due to their focus on "late-breaking" information. Preprint servers have played an even larger role when late-breaking research results are of special interest, such as during the global coronavirus disease 2019 pandemic. Coronavirus disease 2019 has brought both the benefits and risks of preprint servers to the forefront. Given the prominent online presence of the nephrology community, it is poised to lead the medicine community in appropriate use of preprint servers.

When will I get my paper back? A replication study of publication timelines for health professions education research

INTRODUCTION

Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists' careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown.

METHODS

This study replicates Himmelstein's work with a sample of 14 HPE journals published between 2008-2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded.

RESULTS

Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72).

DISCUSSION

This study presents publication metadata for journals that openly provide it-a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.

Variation in Toxicity Reporting Methods for Early Phase Lung Cancer Treatment Trials at Oncology Conferences

INTRODUCTION

Phase I and II trials provide the initial human safety and tolerability data for new drugs. Nevertheless, the methods for presenting toxicity data are not standardized. Clinicians often first encounter these data at professional conferences. We sought to characterize how the burden of adverse events (AEs) is reported at the largest professional conference in clinical oncology.

METHODS

We collected toxicity data from all lung cancer-associated phase I and II trial presentations and posters at the American Society for Clinical Oncology annual meetings from 2017 to 2019. We captured the various AE features, including the minimum incidence used for reporting; whether AEs found were treatment emergent or treatment related, grouped by organ system or separated by individual descriptors; whether combined or separated across dose levels when a dose-escalation component was included; and whether dose-limiting toxicities, serious AE, dose-reduction rules, and denominators for laboratory tests were described.

RESULTS

A total of 209 trials were analyzed. There was wide variability in toxicity reporting practices. Six different thresholds for reporting AEs of any grade were used. Treatment-related AEs were reported twice as frequently as treatment-emergent AEs. Toxicities were as likely to be reported across dose levels as by dose level. Terms such as dose-limiting toxicity and serious AE were rarely defined. Dose-reduction rules and denominators for laboratory tests were never defined.

CONCLUSIONS

Standardization of methods for reporting toxicities could improve the quality and ease of comparability of data on adverse effects in early phase therapeutic trials. A minimal AE data disclosure template is proposed.

Optimizing Postoperative Opioid Prescribing Through Quality-Based Reimbursement

This quality improvement study examines the use of a novel reimbursement incentive for surgeons to counsel patients on an opioid-sparing pathway for postoperative pain management.

Publish or Perish v2

Communication of clinical trial outcomes is important, but the results of many clinical trials are never published. If we do not publish the results of clinical trials, the lessons learned from those trials will perish. The Oncologist offers a powerful solution through the Clinical Trial Results publishing platform, which uses an established template for authors to easily build a manuscript by simply providing the essential trial data. Through it, every patient's legacy of clinical trial enrollment can matter.

Estimation of Study Time Reduction Using Surrogate End Points Rather Than Overall Survival in Oncology Clinical Trials

IMPORTANCE

Surrogate end points in oncology trade the advantage of reducing the time needed to conduct clinical trials for the disadvantage of greater uncertainty regarding the treatment effect on patient-centered end points, such as overall survival (OS) and quality of life.

OBJECTIVE

To quantify the amount of time saved through the acceptance of surrogate end points, including response rate (RR) and progression-free survival (PFS).

DESIGN, SETTING, AND PARTICIPANTS

This retrospective study of US Food and Drug Administration (FDA) oncology approvals and their drug registration trials based on actual publication analyzed the original and updated clinical trials data that led to FDA-approved drug indications in oncology from 2006 to 2017 by using existing publications, conference abstracts, and package inserts from the FDA. Data related to cancer type, line of therapy (first-line, second-line, and third- or later-line treatment of advanced or metastatic disease), FDA approval type, end point basis for approval (RR, PFS, or OS/quality of life), sample size, accrual rate, and drug RR were extracted by March 23, 2018. All data were analyzed by July 13, 2018.

MAIN OUTCOMES AND MEASURES

The main outcome was the study duration needed to complete the primary end point analysis used for each drug indication approval. This was estimated from reported enrollment dates, analysis cutoff dates, time to response, median duration of response, median PFS, and median OS.

RESULTS

In total, 188 distinct indications among 107 cancer drugs were identified. The RR was more often used for FDA approval in subsequent lines of therapy (17 of 71 drug indications [24%] in first-line therapy vs 34 of 77 drug indications [44%] in second-line therapy vs 19 of 24 drug indications [79%] in third- or later-line therapy, P < .001). Study duration for PFS (median, 31 [range, 10-104] months) was similar to that for OS (median, 33 [range, 12-117] months; P = .31), whereas study duration for RR (median, 25 [range, 11-54] months) was shorter than that for OS (P = .001). In multivariate analysis, compared with using OS, use of PFS as the end point was associated with study durations that were shorter by a mean of 11 months (95% CI, 5-17 months), and the use of RR as the end point was associated with study durations that were shorter by a mean of 19 months (95% CI, 13-25 months).

CONCLUSIONS AND RELEVANCE

From the findings of this study, an estimated 11 months appeared to be needed (ie, approximately 12% longer in the drug development cycle) to assess the OS benefit of a cancer drug. This study's findings suggest that this must be weighed against the downside of increased uncertainty of clinical benefit arising from using surrogate end points.

Evaluating the Landscape of Clinical Research in Neurosurgery

BACKGROUND

Many clinical trials and observational research never reach publication in peer-reviewed journals. Unpublished research results, including neutral study findings, hinder generation of new research questions, utilize healthcare resources without benefit, and may place patients at risk without benefit.

OBJECTIVE

To examine the publication of neurosurgery trials listed in ClinicalTrials.gov.

METHODS

Clinical neurosurgery research was identified by searching the registry and categorized by study type. Associated publications were identified on Pubmed.gov.

RESULTS

Among the 709 studies identified, spine (292, 41.2%) studies were most common, followed by tumor and cranial (each 114, 16.1%). Funding was predominantly private (482, 68.0%), followed by industry (135, 19.0%) and National Institutes of Health (9, 1.3%). A lower proportion of published studies (vs unpublished) received private funding in functional (33.3 vs 65.3%) and tumor (80.0 vs 68.7%). Only 104/464 (22.4%) studies had an associated publication. The mean time from listed study completion to first publication was 31.0 ± 27.5 mo. Most published studies had significant study differences between treatment arms (n = 72, 69.2%); studies with neutral findings were less likely to be published (n = 13, 12.5%). Surgical discipline (P = .1), funding source (P = .8), patient age (P = .4), planned enrollment (P = .1), phase of trial (P = .3), and study type (P = .2) did not affect publication rates. However, the interaction between study category and funding source significantly affected publication rate (P = .04, generalized linear model, R2 = 0.05). Publication timing (1-way analysis of variance, P = .5) and frequency (chi-square, P = .2) did not differ among disciplines.

CONCLUSION

Clinical trials and observational research in neurosurgery are often not published promptly, especially if results were nonsignificant or the trial had private funding.