1
|
Horita N. Tumor Response, Disease Control, and Progression-Free Survival as Surrogate Endpoints in Trials Evaluating Immune Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: Study- and Patient-Level Analyses. Cancers (Basel) 2022; 15:cancers15010185. [PMID: 36612179 PMCID: PMC9818635 DOI: 10.3390/cancers15010185] [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: 10/24/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/30/2022] Open
Abstract
Background: To assess the usefulness of tumor response and progression-free survival (PFS) as surrogates for overall survival (OS) in non-small cell lung cancer (NSCLC) trials with immune checkpoint inhibitors (ICI), which have not been confirmed. Methods: Patient- and trial-level analyses were performed. The Response Evaluation Criteria in Solid Tumors was preferred for image assessment. For trial-level analysis, surrogacy was assessed using the weighted rank correlation coefficient (r) following "reciprocal duplication." This method duplicates all plots as if the experimental and the reference arms were switched. Monte Carlo simulations were performed for evaluating this method. Results: A total of 3312 cases were included in the patient-level analysis. Patients without response (first line (1L): hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.71-2.23; second or later line (2L-): HR 4.22, 95% CI 3.22-5.53), without disease control (1L: HR 4.34, 95% CI 3.82-4.94; 2L-: HR 3.36, 95% CI 2.96-3.81), or with progression during the first year (1L: HR 3.42, 95% CI 2.60-4.50; 2L-: HR 3.33, 95% CI 2.64-4.20), had a higher risk of death. Systematic searches identified 38 RCTs including 17,515 patients for the study-level analysis. Odds ratio in the objective response rate (N = 38 × 2, r = -0.87) and HR in PFS (N = 38 × 2, r = 0.85) showed an excellent association with HR in overall survival, while this effect was not observed in the disease control rate (N = 26 × 2, r = -0.03). Conclusions: Objective response rate and PFS are reasonable surrogates for OS in NSCLC trials with ICI.
Collapse
Affiliation(s)
- Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama 232-0024, Japan
| |
Collapse
|
2
|
Kent DM, van Klaveren D, Paulus JK, D'Agostino R, Goodman S, Hayward R, Ioannidis JPA, Patrick-Lake B, Morton S, Pencina M, Raman G, Ross JS, Selker HP, Varadhan R, Vickers A, Wong JB, Steyerberg EW. The Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement: Explanation and Elaboration. Ann Intern Med 2020; 172:W1-W25. [PMID: 31711094 PMCID: PMC7750907 DOI: 10.7326/m18-3668] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The PATH (Predictive Approaches to Treatment effect Heterogeneity) Statement was developed to promote the conduct of, and provide guidance for, predictive analyses of heterogeneity of treatment effects (HTE) in clinical trials. The goal of predictive HTE analysis is to provide patient-centered estimates of outcome risk with versus without the intervention, taking into account all relevant patient attributes simultaneously, to support more personalized clinical decision making than can be made on the basis of only an overall average treatment effect. The authors distinguished 2 categories of predictive HTE approaches (a "risk-modeling" and an "effect-modeling" approach) and developed 4 sets of guidance statements: criteria to determine when risk-modeling approaches are likely to identify clinically meaningful HTE, methodological aspects of risk-modeling methods, considerations for translation to clinical practice, and considerations and caveats in the use of effect-modeling approaches. They discuss limitations of these methods and enumerate research priorities for advancing methods designed to generate more personalized evidence. This explanation and elaboration document describes the intent and rationale of each recommendation and discusses related analytic considerations, caveats, and reservations.
Collapse
|
3
|
Song SY, Seo H, Kim G, Kim AR, Kim EY. Trends in endpoint selection in clinical trials of advanced breast cancer. J Cancer Res Clin Oncol 2016; 142:2403-13. [DOI: 10.1007/s00432-016-2221-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/20/2016] [Indexed: 01/05/2023]
|
4
|
Nakashima K, Horita N, Nagai K, Manabe S, Murakami S, Ota E, Kaneko T. Progression-Free Survival, Response Rate, and Disease Control Rate as Predictors of Overall Survival in Phase III Randomized Controlled Trials Evaluating the First-Line Chemotherapy for Advanced, Locally Advanced, and Recurrent Non-Small Cell Lung Carcinoma. J Thorac Oncol 2016; 11:1574-85. [PMID: 27178983 DOI: 10.1016/j.jtho.2016.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Recent improvements in chemotherapy agents have prolonged postprogression survival of non-small cell lung cancer. Thus, primary outcomes other than overall survival (OS) have been frequently used for recent phase III trials to obtain quick results. However, no systematic review had assessed whether progression-free survival (PFS), response rate (RR), and disease control rate (DCR) can serve as surrogates for OS at the trial level in the phase III first-line chemotherapy setting. METHODS We included phase III randomized clinical trials (RCTs) comparing two arms that were reported as a full article regardless of their primary end point. We included only RCTs that evaluated chemonaive patients with advanced, locally advanced, or metastatic non-small cell lung cancer and were published after January 1, 2005. We systematically searched four public electronic databases. Two investigators independently screened and scrutinized candidate articles. How surrogate outcomes represented hazard ratios (HRs) for OS was examined. RESULTS Among 1907 articles, we ultimately found 44 eligible articles covering 22,709 subjects. HR for PFS, median PFS in the experimental arm minus median PFS in the control arm in months, OR for RR (ORrr), and OR for DCR were evaluated in 34, 35, 44, and 35 RCTs, respectively. HR for OS (HRos), median PFS in the experimental arm minus median PFS in the control arm, ORrr, and OR for DCR had weighted Spearman's rank correlation coefficients with an HRos of 0.496, 0.477, 0.570, and 0.470, respectively; the standardized weighted regression coefficients were 0.439, -0.376, -0.605, and -0.381, respectively; and the adjusted weighted coefficients of determination were 0.224, 0.161, 0.350, and 0.176, respectively. CONCLUSIONS ORrr, followed by HRpfs, had the strongest association with HRos at the trial level. However, these measures were not strong enough to replace OS.
Collapse
Affiliation(s)
- Kentaro Nakashima
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kenjiro Nagai
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Saki Manabe
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Shuji Murakami
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
5
|
Weingärtner V, Dargatz N, Weber C, Mueller D, Stock S, Voltz R, Gaertner J. Patient reported outcomes in randomized controlled cancer trials in advanced disease: a structured literature review. Expert Rev Clin Pharmacol 2016; 9:821-9. [PMID: 26959869 DOI: 10.1586/17512433.2016.1164595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In advanced cancer quality of life (QoL) is the most important goal of care. It is measured by patient-reported-outcomes (PRO). This structured review evaluated how randomized controlled trials (RCTs) on anti-cancer therapy in advanced cancer reported PRO. METHODS Search was performed in MEDLINE via PubMed for RCTs with median patient survival of ≤2 years. Reporting was rated with the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. RESULTS Of 370 retrieved publications, 117 were eligible, but only 30/117 (26%) reported PRO. QoL was most frequently measured (29/30). On average, 4.4 (SD 2.5) of the 14 CONSORT items were met. CONCLUSION PRO are insufficiently reported in advanced cancer trials. Yet, this is paramount to enable an informed and patient-oriented decision making process.
Collapse
Affiliation(s)
- V Weingärtner
- a Department of Palliative Medicine, Clinical Trials Unit and Center for Integrated Oncology (CIO) Cologne/Bonn , University Hospital of Cologne , Cologne , Germany
| | - N Dargatz
- a Department of Palliative Medicine, Clinical Trials Unit and Center for Integrated Oncology (CIO) Cologne/Bonn , University Hospital of Cologne , Cologne , Germany
| | - C Weber
- b Institute of Health Economics and Clinical Epidemiology (IGKE) , University Hospital of Cologne , Cologne , Germany
| | - D Mueller
- b Institute of Health Economics and Clinical Epidemiology (IGKE) , University Hospital of Cologne , Cologne , Germany
| | - S Stock
- b Institute of Health Economics and Clinical Epidemiology (IGKE) , University Hospital of Cologne , Cologne , Germany
| | - R Voltz
- a Department of Palliative Medicine, Clinical Trials Unit and Center for Integrated Oncology (CIO) Cologne/Bonn , University Hospital of Cologne , Cologne , Germany
| | - J Gaertner
- a Department of Palliative Medicine, Clinical Trials Unit and Center for Integrated Oncology (CIO) Cologne/Bonn , University Hospital of Cologne , Cologne , Germany.,c Department of Palliative Care , University Hospital Freiburg , Freiburg , Germany.,d Competence Center Palliative Care Baden-Württemberg , University Medical Center Freiburg , Freiburg , Baden-Württemberg , Germany
| |
Collapse
|
6
|
Gaertner J, Weingärtner V, Lange S, Hausner E, Gerhardus A, Simon ST, Voltz R, Becker G, Schmacke N. The Role of End-of-Life Issues in the Design and Reporting of Cancer Clinical Trials: A Structured Literature Review. PLoS One 2015; 10:e0136640. [PMID: 26327232 PMCID: PMC4556677 DOI: 10.1371/journal.pone.0136640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 08/06/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) are important sources of information on the benefits and harms patients may expect from treatment options. The aim of this structured literature review by the German Institute for Quality and Efficiency in Health Care was to explore whether and how the end-of-life (EoL) situation of patients with advanced cancer is considered in RCTs investigating anti-cancer treatments. METHODS Our journal pool comprised 19 medical journals, namely five preselected key general medical journals as well as 14 specialist journals (mainly cancer) identified via a scoping search. We systematically searched these journals in MEDLINE to identify RCTs investigating anti-cancer treatments for the following four cancer types: glioblastoma, lung cancer (stage IIIb-IV), malignant melanoma (stage IV), and pancreatic cancer (search via OVID; November 2012). We selected a representative sample of 100 publications, that is, the 25 most recent publications for each cancer type. EoL was defined as a life expectancy of ≤ two years. We assessed the information provided on (1) the descriptions of the terminal stage of the disease, (2) the therapeutic goal (i.e. the intended therapeutic benefit of the intervention studied), (3) the study endpoints assessed, (4) the authors' concluding appraisal of the intervention's effects, and (5) the terminology referring to the patients' EoL situation. RESULTS Median survival was ≤ one year for each of the four cancer types. Descriptions of the terminal stage of the disease were ambiguous or lacking in 29/100 publications. One or more therapeutic goals were mentioned in 51/100 publications; these goals were patient-relevant in 38 publications (survival alone: 30/38; health-related quality of life (HRQoL) or HRQoL and survival: 6/38; symptom control or symptom control and survival: 2/38). Primary endpoints included survival (50%), surrogates (44%), and safety (3%). Patient-reported outcomes (PROs) were assessed in 36/100 RCTs. The implications of treatment-related harms for the patients were discussed in 22/100 appraisals. Terminology referring to the patients' EoL situation (e.g. "terminal") was scarce, whereas terms suggesting control of the disease (e.g. "cancer control") were common. CONCLUSIONS The EoL situation of patients with advanced cancer should be more carefully considered in clinical trials. Although the investigation and robust reporting of PROs is a prerequisite for informed decision-making in healthcare, they are rarely defined as endpoints and HRQoL is rarely mentioned as a therapeutic goal. Suggestions for improving standards for study design and reporting are presented.
Collapse
Affiliation(s)
- Jan Gaertner
- Department of Palliative Care, University Medical Center Freiburg, Freiburg, Germany
- Palliative Care Center of Excellence for Baden-Württemberg, Baden-Württemberg, Germany
| | - Vera Weingärtner
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Stefan Lange
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Elke Hausner
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Ansgar Gerhardus
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Steffen T. Simon
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Cologne/Bonn, Cologne/Bonn, Germany
- Clinical Trials Unit (BMBF 01KN1106), University Hospital of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Cologne/Bonn, Cologne/Bonn, Germany
- Clinical Trials Unit (BMBF 01KN1106), University Hospital of Cologne, Cologne, Germany
| | - Gerhild Becker
- Department of Palliative Care, University Medical Center Freiburg, Freiburg, Germany
- Palliative Care Center of Excellence for Baden-Württemberg, Baden-Württemberg, Germany
| | - Norbert Schmacke
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| |
Collapse
|
7
|
Baldo P, Fornasier G, Francescon S, Ferrarin E, Truccolo I, De Paoli P. Toxicities and Adverse Drug Reactions Experienced During Anticancer Treatment: It Is Desirable to Consider the Problem Within the International System of Pharmacovigilance. J Clin Oncol 2015. [PMID: 26195718 DOI: 10.1200/jco.2015.61.7613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paolo Baldo
- CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | | | - Sara Francescon
- CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | | | - Ivana Truccolo
- CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Paolo De Paoli
- CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| |
Collapse
|