Incidence of KRAS status in ongoing adjuvant trials in colon cancer

Adaptive designs at European Organisation for Research and Treatment of Cancer (EORTC) with a focus on adaptive sample size re-estimation based on interim-effect size

Given the high failure rates and the increased costs of Phase III trials in oncology and the recent explosion of targeted agents, researchers are looking for better design strategies to try and optimise the use of available patients and financial resources. In this context, adaptive designs are seen as promising tools. We reviewed the different possible adaptations in the design of a clinical trial on the basis of the FDA guidance and summarized these. The pro and cons of adaptive designs are highlighted with a focus on one of the more 'controversial' adaptive designs, the sample size reassessment based on interim-effect size as proposed by Mehta and Pocock. While group sequential designs are preferable to such adaptive designs, both are difficult to implement in the case of rapid accrual and long time to event. Adaptive designs may have some potential in less favourable situations. However, the increase in overall power should be carefully weighted as well as the risk of a large negative trial. Adaptive designs need good, sometimes extensive, logistics. Some adaptive designs (e.g. group sequential designs) proved to be very useful and are already a part of the standard repertoire of trial designs used at European Organisation for Research and Treatment of Cancer (EORTC). Adaptive designs need strong measures to prevent bias that could otherwise become uncontrollable, particularly if interim results are leaked. This includes a prospective planning of adaptations. Finally, these studies currently have the potential to induce a heavy workload and cost linked to their regulatory management.

Recent advances in gastrointestinal oncology--updates and insights from the 2009 annual meeting of the American society of clinical oncology

We have reviewed the pivotal presentations related to gastrointestinal malignancies from 2009 annual meeting of the American Society of Clinical Oncology with the theme of "personalizing cancer care". We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. Adding trastuzumab to chemotherapy improved the survival of patients with advanced gastric cancer overexpressing human epidermal growth factor receptor 2. Gemcitabine plus cisplatin has become a new standard for first-line treatment of advanced biliary cancer. Octreotide LAR significantly lengthened median time to tumor progression compared with placebo in patients with metastatic neuroendocrine tumors of the midgut. Addition of oxaliplatin to fluoropyrimidines for preoperative chemoradiotherapy in patients with stage II or III rectal cancer did not improve local tumor response but increased toxicities. Bevacizumab did not provide additional benefit to chemotherapy in adjuvant chemotherapy for stage II or III colon cancer. In patients with resected stage II colon cancer, recurrence score estimated by multigene RT-PCR assay has been shown to provide additional risk stratification. In stage IV colorectal cancer, data have supported the routine use of prophylactic skin treatment in patients receiving antibody against epidermal growth factor receptor, and the use of upfront chemotherapy as initial management in patients with synchronous metastasis without obstruction or bleeding from the primary site.