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Mukherjee A, Coad DS, Jana S. Covariate-adjusted response-adaptive designs for censored survival responses. J Stat Plan Inference 2023. [DOI: 10.1016/j.jspi.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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The Evolution of Master Protocol Clinical Trial Designs: A Systematic Literature Review. Clin Ther 2020; 42:1330-1360. [DOI: 10.1016/j.clinthera.2020.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
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Aragon-Ching JB, Dreicer R. Treatment in hormone-sensitive metastatic prostate cancer: factors to consider when personalizing therapy. Expert Rev Anticancer Ther 2020; 20:483-490. [PMID: 32406281 DOI: 10.1080/14737140.2020.1770087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The addition of the androgen-signaling inhibitors (ASI) apalutamide, enzalutamide and abiraterone acetate or docetaxel to standard androgen deprivation therapy (ADT) has been demonstrated to improve overall survival in men with hormone-sensitive metastatic prostate cancer (HSMPC). AREAS COVERED The majority of men presenting with metastatic prostate cancer will now benefit from the addition of either a novel ASI or docetaxel to standard ADT. In the absence of comparative studies of these agents, clinicians are left with assessing the individual studies and attempting to individualize therapy. EXPERT OPINION ADT with either docetaxel or androgen-signaling inhibitors (ASI) have changed the treatment landscape of HSMPC with clinically meaningful improvement in overall survival compared to ADT alone. Among the factors to consider in the selection of the optimal agent include the volume of disease, performance status and comorbidities, toxicity profile cost and drug availability, and further resistance or sequencing options.
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Affiliation(s)
| | - Robert Dreicer
- Medical Oncology, University of Virginia Cancer Center , Charlottesville, VA, USA
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Dimairo M, Pallmann P, Wason J, Todd S, Jaki T, Julious SA, Mander AP, Weir CJ, Koenig F, Walton MK, Nicholl JP, Coates E, Biggs K, Hamasaki T, Proschan MA, Scott JA, Ando Y, Hind D, Altman DG. The adaptive designs CONSORT extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design. Trials 2020; 21:528. [PMID: 32546273 PMCID: PMC7298968 DOI: 10.1186/s13063-020-04334-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adaptive designs (ADs) allow pre-planned changes to an ongoing trial without compromising the validity of conclusions and it is essential to distinguish pre-planned from unplanned changes that may also occur. The reporting of ADs in randomised trials is inconsistent and needs improving. Incompletely reported AD randomised trials are difficult to reproduce and are hard to interpret and synthesise. This consequently hampers their ability to inform practice as well as future research and contributes to research waste. Better transparency and adequate reporting will enable the potential benefits of ADs to be realised.This extension to the Consolidated Standards Of Reporting Trials (CONSORT) 2010 statement was developed to enhance the reporting of randomised AD clinical trials. We developed an Adaptive designs CONSORT Extension (ACE) guideline through a two-stage Delphi process with input from multidisciplinary key stakeholders in clinical trials research in the public and private sectors from 21 countries, followed by a consensus meeting. Members of the CONSORT Group were involved during the development process.The paper presents the ACE checklists for AD randomised trial reports and abstracts, as well as an explanation with examples to aid the application of the guideline. The ACE checklist comprises seven new items, nine modified items, six unchanged items for which additional explanatory text clarifies further considerations for ADs, and 20 unchanged items not requiring further explanatory text. The ACE abstract checklist has one new item, one modified item, one unchanged item with additional explanatory text for ADs, and 15 unchanged items not requiring further explanatory text.The intention is to enhance transparency and improve reporting of AD randomised trials to improve the interpretability of their results and reproducibility of their methods, results and inference. We also hope indirectly to facilitate the much-needed knowledge transfer of innovative trial designs to maximise their potential benefits. In order to encourage its wide dissemination this article is freely accessible on the BMJ and Trials journal websites."To maximise the benefit to society, you need to not just do research but do it well" Douglas G Altman.
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Affiliation(s)
- Munyaradzi Dimairo
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
| | | | - James Wason
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, Reading, UK
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Steven A Julious
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Adrian P Mander
- Centre for Trials Research, Cardiff University, Cardiff, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Franz Koenig
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Marc K Walton
- Janssen Pharmaceuticals, Titusville, New Jersey, USA
| | - Jon P Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Elizabeth Coates
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Katie Biggs
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | | | - Michael A Proschan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - John A Scott
- Division of Biostatistics in the Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, USA
| | - Yuki Ando
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
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5
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Dimairo M, Pallmann P, Wason J, Todd S, Jaki T, Julious SA, Mander AP, Weir CJ, Koenig F, Walton MK, Nicholl JP, Coates E, Biggs K, Hamasaki T, Proschan MA, Scott JA, Ando Y, Hind D, Altman DG. The Adaptive designs CONSORT Extension (ACE) statement: a checklist with explanation and elaboration guideline for reporting randomised trials that use an adaptive design. BMJ 2020; 369:m115. [PMID: 32554564 PMCID: PMC7298567 DOI: 10.1136/bmj.m115] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Abstract
Adaptive designs (ADs) allow pre-planned changes to an ongoing trial without compromising the validity of conclusions and it is essential to distinguish pre-planned from unplanned changes that may also occur. The reporting of ADs in randomised trials is inconsistent and needs improving. Incompletely reported AD randomised trials are difficult to reproduce and are hard to interpret and synthesise. This consequently hampers their ability to inform practice as well as future research and contributes to research waste. Better transparency and adequate reporting will enable the potential benefits of ADs to be realised.This extension to the Consolidated Standards Of Reporting Trials (CONSORT) 2010 statement was developed to enhance the reporting of randomised AD clinical trials. We developed an Adaptive designs CONSORT Extension (ACE) guideline through a two-stage Delphi process with input from multidisciplinary key stakeholders in clinical trials research in the public and private sectors from 21 countries, followed by a consensus meeting. Members of the CONSORT Group were involved during the development process.The paper presents the ACE checklists for AD randomised trial reports and abstracts, as well as an explanation with examples to aid the application of the guideline. The ACE checklist comprises seven new items, nine modified items, six unchanged items for which additional explanatory text clarifies further considerations for ADs, and 20 unchanged items not requiring further explanatory text. The ACE abstract checklist has one new item, one modified item, one unchanged item with additional explanatory text for ADs, and 15 unchanged items not requiring further explanatory text.The intention is to enhance transparency and improve reporting of AD randomised trials to improve the interpretability of their results and reproducibility of their methods, results and inference. We also hope indirectly to facilitate the much-needed knowledge transfer of innovative trial designs to maximise their potential benefits.
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Affiliation(s)
- Munyaradzi Dimairo
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | | | - James Wason
- MRC Biostatistics Unit, University of Cambridge, UK
- Institute of Health and Society, Newcastle University, UK
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, UK
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, UK
| | - Steven A Julious
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Adrian P Mander
- Centre for Trials Research, Cardiff University, UK
- MRC Biostatistics Unit, University of Cambridge, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, UK
| | - Franz Koenig
- Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria
| | | | - Jon P Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Elizabeth Coates
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Katie Biggs
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | | | - Michael A Proschan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA
| | - John A Scott
- Division of Biostatistics in the Center for Biologics Evaluation and Research, Food and Drug Administration, USA
| | - Yuki Ando
- Pharmaceuticals and Medical Devices Agency, Japan
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
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Oudard S, Latorzeff I, Caty A, Miglianico L, Sevin E, Hardy-Bessard AC, Delva R, Rolland F, Mouret L, Priou F, Beuzeboc P, Gravis G, Linassier C, Gomez P, Voog E, Muracciole X, Abraham C, Banu E, Ferrero JM, Ravaud A, Krakowski I, Lagrange JL, Deplanque G, Zylberait D, Bozec L, Houede N, Culine S, Elaidi R. Effect of Adding Docetaxel to Androgen-Deprivation Therapy in Patients With High-Risk Prostate Cancer With Rising Prostate-Specific Antigen Levels After Primary Local Therapy: A Randomized Clinical Trial. JAMA Oncol 2020; 5:623-632. [PMID: 30703190 DOI: 10.1001/jamaoncol.2018.6607] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Androgen-deprivation therapy (ADT) plus docetaxel is the standard of care in hormone-naive metastatic prostate cancer but is of uncertain benefit in a nonmetastatic, high-risk prostate cancer setting. Objective To assess the benefit of ADT plus docetaxel in patients presenting with rising prostate-specific antigen (PSA) levels after primary local therapy and high-risk factors but no evidence of metastatic disease. Design, Setting, and Participants This open-label, phase 3, randomized superiority trial comparing ADT plus docetaxel vs ADT alone enrolled patients from 28 centers in France between June 4, 2003, and September 25, 2007; final follow-up was conducted April 12, 2017, and analysis was performed May 2 to July 31, 2017. Patients had undergone primary local therapy for prostate cancer, were experiencing rising PSA levels, and were considered to be at high risk of metastatic disease. Stratification was by prior local therapy and PSA-level doubling time (≤6 vs >6 months), and intention-to-treat analysis was used. Interventions Patients were randomly assigned to receive ADT (1 year) plus docetaxel, 70 mg/m2 (every 3 weeks [6 cycles]), or ADT alone (1 year). Main Outcomes and Measures The primary outcome was PSA progression-free survival (PSA-PFS). Secondary end points were PSA response, radiologic PFS, overall survival, safety, and quality of life. Results Overall, 254 patients were randomized (1:1) to the trial; median age, 64 years in the ADT plus docetaxel arm, 66 years in the ADT alone arm. At a median follow-up of 30.0 months, the median PSA-PFS was 20.3 (95% CI, 19.0-21.6) months in the ADT plus docetaxel arm vs 19.3 (95% CI, 18.2-20.8) months in the ADT alone arm (hazard ratio [HR], 0.85; 95% CI, 0.62-1.16; P = .31). At a median follow-up of 10.5 years, there was no significant between-arm difference in radiologic PFS (HR, 1.03; 95% CI, 0.74-1.43; P = .88). Overall survival data were not mature. The most common grade 3 or 4 hematologic toxic effects in the ADT plus docetaxel arm were neutropenia (60 of 125 patients [48.0%]), febrile neutropenia (10 [8.0%]), and thrombocytopenia (4 [3.0%]). There was no significant between-arm difference in overall quality of life. Conclusions and Relevance Compared with ADT alone, combined ADT plus docetaxel therapy with curative intent did not significantly improve PSA-PFS in patients with high-risk prostate cancer and rising PSA levels and no evidence of metastatic disease. Trial Registration French Health Products Safety Agency identifier: 030591; ClinicalTrials.gov identifier: NCT00764166.
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Affiliation(s)
- Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Igor Latorzeff
- Department of Oncology Radiotherapy, Clinique Pasteur, Toulouse, France
| | - Armelle Caty
- Department of Medical Oncology, Centre Galilée, Hôpital Privé la Louvière, Lille, France
| | - Laurent Miglianico
- Department of Oncology Radiotherapy, Centre Hospitalier Privé St Grégoire, Rennes, France
| | - Emmanuel Sevin
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Remy Delva
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers, France
| | - Frédéric Rolland
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, St Herblain, France
| | - Loic Mouret
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Franck Priou
- Department of Medical Oncology, Centre Hospitalier de Vendée, La Roche sur Yon, France
| | | | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Claude Linassier
- Department of Medical Oncology, Centre Hospitalier Bretonneau, Tours, France
| | - Philippe Gomez
- Department of Oncology Radiotherapy, Centre Joliot Curie, Rouen, France
| | - Eric Voog
- Department of Medical Oncology, Clinique Victor Hugo, Institut Inter-régional de Cancérologie, Le Mans, France
| | - Xavier Muracciole
- Department of Oncology Radiotherapy, Hôpital de la Timone, Marseille, France
| | - Christine Abraham
- Department of Medical Oncology, Centre Hospitalier Versailles André Mignot, Le Chesnay, France
| | - Eugeniu Banu
- Department of Medical Oncology, Cancer Institute Ion Chiricuta, Cluj-Napoca, Romania
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital St Andre, Bordeaux, France
| | - Ivan Krakowski
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | | | - Gaël Deplanque
- Department of Medical Oncology, Fondation Hopital St Joseph, Paris, France
| | - David Zylberait
- Department of Medical Oncology, Centre Hospitalier de Compiegne, Compiegne, France
| | - Laurence Bozec
- Department of Medical Oncology, Hôpital Foch, Suresnes, France
| | - Nadine Houede
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital St Louis, Paris, France
| | - Reza Elaidi
- Association pour la Recherche sur les Thérapeutiques Innovantes en Cancérologie, Paris, France
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Park JJH, Siden E, Zoratti MJ, Dron L, Harari O, Singer J, Lester RT, Thorlund K, Mills EJ. Systematic review of basket trials, umbrella trials, and platform trials: a landscape analysis of master protocols. Trials 2019; 20:572. [PMID: 31533793 PMCID: PMC6751792 DOI: 10.1186/s13063-019-3664-1] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Master protocols, classified as basket trials, umbrella trials, and platform trials, are novel designs that investigate multiple hypotheses through concurrent sub-studies (e.g., multiple treatments or populations or that allow adding/removing arms during the trial), offering enhanced efficiency and a more ethical approach to trial evaluation. Despite the many advantages of these designs, they are infrequently used. METHODS We conducted a landscape analysis of master protocols using a systematic literature search to determine what trials have been conducted and proposed for an overall goal of improving the literacy in this emerging concept. On July 8, 2019, English-language studies were identified from MEDLINE, EMBASE, and CENTRAL databases and hand searches of published reviews and registries. RESULTS We identified 83 master protocols (49 basket, 18 umbrella, and 16 platform trials). The number of master protocols has increased rapidly over the last five years. Most have been conducted in the US (n = 44/83) and investigated experimental drugs (n = 82/83) in the field of oncology (n = 76/83). The majority of basket trials were exploratory (i.e., phase I/II; n = 47/49) and not randomized (n = 44/49), and more than half (n = 28/48) investigated only a single intervention. The median sample size of basket trials was 205 participants (interquartile range, Q3-Q1 [IQR]: 500-90 = 410), and the median study duration was 22.3 (IQR: 74.1-42.9 = 31.1) months. Similar to basket trials, most umbrella trials were exploratory (n = 16/18), but the use of randomization was more common (n = 8/18). The median sample size of umbrella trials was 346 participants (IQR: 565-252 = 313), and the median study duration was 60.9 (IQR: 81.3-46.9 = 34.4) months. The median number of interventions investigated in umbrella trials was 5 (IQR: 6-4 = 2). The majority of platform trials were randomized (n = 15/16), and phase III investigation (n = 7/15; one did not report information on phase) was more common in platform trials with four of them using seamless II/III design. The median sample size was 892 (IQR: 1835-255 = 1580), and the median study duration was 58.9 (IQR: 101.3-36.9 = 64.4) months. CONCLUSIONS We anticipate that the number of master protocols will continue to increase at a rapid pace over the upcoming decades. More efforts to improve awareness and training are needed to apply these innovative trial design methods to fields outside of oncology.
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Affiliation(s)
- Jay J. H Park
- Experimental Medicine, Department of Medicine, 10th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- MTEK Sciences, 802-777 West Broadway, Vancouver, BC V5Z 1J5 Canada
| | - Ellie Siden
- MTEK Sciences, 802-777 West Broadway, Vancouver, BC V5Z 1J5 Canada
| | - Michael J. Zoratti
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Louis Dron
- MTEK Sciences, 802-777 West Broadway, Vancouver, BC V5Z 1J5 Canada
| | - Ofir Harari
- MTEK Sciences, 802-777 West Broadway, Vancouver, BC V5Z 1J5 Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3 Canada
- Data and Methodology Program, CIHR Canadian HIV Trials Network, 588 – 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Richard T. Lester
- Experimental Medicine, Department of Medicine, 10th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Kristian Thorlund
- MTEK Sciences, 802-777 West Broadway, Vancouver, BC V5Z 1J5 Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
- Knowledge Integration, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109 USA
| | - Edward J. Mills
- MTEK Sciences, 802-777 West Broadway, Vancouver, BC V5Z 1J5 Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
- Knowledge Integration, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109 USA
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Siden EG, Park JJH, Zoratti MJ, Dron L, Harari O, Thorlund K, Mills EJ. Reporting of master protocols towards a standardized approach: A systematic review. Contemp Clin Trials Commun 2019; 15:100406. [PMID: 31334382 PMCID: PMC6616543 DOI: 10.1016/j.conctc.2019.100406] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In September 2018 the FDA provided a draft guidance on master protocols reflecting an increased interest in these designs by industry. Master protocols refer to a single overarching protocol developed to evaluate multiple hypotheses and may be further categorized as basket, umbrella, and platform trials. However, inconsistencies in reporting persist in the literature. We conducted a systematic review to describe master protocol reporting with the goal of facilitating the further development and spread of these innovative trial designs. METHODS We searched MEDLINE, EMBASE, and CENTRAL from inception to April 25, 2019 for English articles on master protocols. This was supplemented by hand searches of trial registries and of the bibliographies of published reviews. We used the FDA's definitions of master protocols as references and compared them to self-reported master protocols. RESULTS We identified 278 master protocol publications, consisting of 228 protocols and 50 reviews. Sixty-six records provided unique definitions of master protocol types. We observed considerable heterogeneity in definitions of master protocols, and over half (54%) used oncology-specific language. The majority of self-classified master protocols (57%) were consistent with the FDA's definitions of master protocols. CONCLUSION The terms 'master protocol', 'basket trial', 'umbrella trial', and 'platform trial' are inconsistently described. Careful treatment of these terms and adherence to the definitions set forth by the FDA will facilitate better understanding of these trial designs and allow them to be used broadly and to their full potential in clinical research. We encourage trial methodologists to use these trial designations when applicable.
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Affiliation(s)
- Ellie G. Siden
- MTEK Sciences, 777 West Broadway, Suite 802, Vancouver, BC, V5Z 1J5, Canada
| | - Jay JH. Park
- MTEK Sciences, 777 West Broadway, Suite 802, Vancouver, BC, V5Z 1J5, Canada
- Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Michael J. Zoratti
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St, 2C Area, Hamilton, ON, L8S 4K1, Canada
| | - Louis Dron
- MTEK Sciences, 777 West Broadway, Suite 802, Vancouver, BC, V5Z 1J5, Canada
| | - Ofir Harari
- MTEK Sciences, 777 West Broadway, Suite 802, Vancouver, BC, V5Z 1J5, Canada
| | - Kristian Thorlund
- MTEK Sciences, 777 West Broadway, Suite 802, Vancouver, BC, V5Z 1J5, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St, 2C Area, Hamilton, ON, L8S 4K1, Canada
| | - Edward J. Mills
- MTEK Sciences, 777 West Broadway, Suite 802, Vancouver, BC, V5Z 1J5, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main St, 2C Area, Hamilton, ON, L8S 4K1, Canada
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9
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Parry MA, Srivastava S, Ali A, Cannistraci A, Antonello J, Barros-Silva JD, Ubertini V, Ramani V, Lau M, Shanks J, Nonaka D, Oliveira P, Hambrock T, Leong HS, Dhomen N, Miller C, Brady G, Dive C, Clarke NW, Marais R, Baena E. Genomic Evaluation of Multiparametric Magnetic Resonance Imaging-visible and -nonvisible Lesions in Clinically Localised Prostate Cancer. Eur Urol Oncol 2019; 2:1-11. [PMID: 30929837 PMCID: PMC6472613 DOI: 10.1016/j.euo.2018.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The prostate cancer (PCa) diagnostic pathway is undergoing a radical change with the introduction of multiparametric magnetic resonance imaging (mpMRI), genomic testing, and different prostate biopsy techniques. It has been proposed that these tests should be used in a sequential manner to optimise risk stratification. OBJECTIVE To characterise the genomic, epigenomic, and transcriptomic features of mpMRI-visible and -nonvisible PCa in clinically localised disease. DESIGN, SETTING, AND PARTICIPANTS Multicore analysis of fresh prostate tissue sampled immediately after radical prostatectomy was performed for intermediate- to high-risk PCa. INTERVENTION Low-pass whole-genome, exome, methylation, and transcriptome profiling of patient tissue cores taken from microscopically benign and cancerous areas in the same prostate. Circulating free and germline DNA was assessed from the blood of five patients. OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS Correlations between preoperative mpMRI and genomic characteristics of tumour and benign prostate samples were assessed. Gene profiles for individual tumour cores were correlated with existing genomic classifiers currently used for prognostication. RESULTS AND LIMITATIONS A total of 43 prostate cores (22 tumour and 21 benign) were profiled from six whole prostate glands. Of the 22 tumour cores, 16 were tumours visible and six were tumours nonvisible on mpMRI. Intratumour genomic, epigenomic, and transcriptomic heterogeneity was found within mpMRI-visible lesions. This could potentially lead to misclassification of patients using signatures based on copy number or RNA expression. Moreover, three of the six cores obtained from mpMRI-nonvisible tumours harboured one or more genetic alterations commonly observed in metastatic castration-resistant PCa. No circulating free DNA alterations were found. Limitations include the small cohort size and lack of follow-up. CONCLUSIONS Our study supports the continued use of systematic prostate sampling in addition to mpMRI, as avoidance of systematic biopsies in patients with negative mpMRI may mean that clinically significant tumours harbouring genetic alterations commonly seen in metastatic PCa are missed. Furthermore, there is inconsistency in individual genomics when genomic classifiers are applied. PATIENT SUMMARY Our study shows that tumour heterogeneity within prostate tumours visible on multiparametric magnetic resonance imaging (mpMRI) can lead to misclassification of patients if only one core is used for genomic analysis. In addition, some cancers that were missed by mpMRI had genomic aberrations that are commonly seen in advanced metastatic prostate cancer. Avoiding biopsies in mpMRI-negative cases may mean that such potentially lethal cancers are missed.
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Affiliation(s)
- Marina A Parry
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Shambhavi Srivastava
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Computational Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Adnan Ali
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Genitourinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Cancer Research Centre, Manchester, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Alessio Cannistraci
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Jenny Antonello
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - João Diogo Barros-Silva
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Valentina Ubertini
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Vijay Ramani
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Maurice Lau
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - Jonathan Shanks
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Daisuke Nonaka
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Pedro Oliveira
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Thomas Hambrock
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Hui Sun Leong
- Computational Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Nathalie Dhomen
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Crispin Miller
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Computational Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; RNA Biology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Ged Brady
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Caroline Dive
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK
| | - Noel W Clarke
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Genitourinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Cancer Research Centre, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, Salford NHS Foundation Trust, Salford, UK.
| | - Richard Marais
- Molecular Oncology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK.
| | - Esther Baena
- Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK; Prostate Oncobiology, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, UK.
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Fonteyne V, Ost P. Current Insights in the Management of High-risk Prostate Cancer: Still More Questions than Answers. Eur Urol 2019; 75:61-62. [DOI: 10.1016/j.eururo.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
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Langley RE. The direction of travel to better outcomes for patients with oesophago-gastric cancer. J Thorac Dis 2018; 10:1236-1238. [PMID: 29708129 DOI: 10.21037/jtd.2018.03.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ajithkumar TV, Gilbert DC. Modern Challenges of Cancer Clinical Trials. Clin Oncol (R Coll Radiol) 2017; 29:767-769. [PMID: 29066171 DOI: 10.1016/j.clon.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | - D C Gilbert
- Sussex Cancer Centre and Brighton and Sussex Medical School, Brighton, UK
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