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Yin J, Salem ME, Dixon JG, Jin Z, Cohen R, DeGramont A, Van Cutsem E, Taieb J, Alberts SR, Wolmark N, Schmoll HJ, Saltz LB, George TJ, Goldberg RRM, Kerr R, Lonardi S, Yoshino T, Yothers G, Grothey A, Andre T, Shi Q. Reevaluating Disease-Free Survival as an Endpoint vs Overall Survival in Stage III Adjuvant Colon Cancer Trials. J Natl Cancer Inst 2021; 114:60-67. [PMID: 34505880 PMCID: PMC8755492 DOI: 10.1093/jnci/djab187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Disease-free survival (DFS) with a 3-year median follow-up (3-year DFS) was validated as a surrogate for overall survival (OS) with a 5-year median follow-up (5-year OS) in adjuvant chemotherapy colon cancer (CC) trials. Recent data show further improvements in OS and survival after recurrence in patients who received adjuvant FOLFOX. Hence, reevaluation of the association between DFS and OS and determination of the optimal follow-up duration of OS to aid its utility in future adjuvant trials are needed. METHODS Individual patient data from 9 randomized studies conducted between 1998 and 2009 were included; 3 trials tested biologics. Trial-level surrogacy examining the correlation of treatment effect estimates of 3-year DFS with 5 to 6.5-year OS was evaluated using both linear regression (RWLS2) and Copula bivariate (RCopula2) models and reported with 95% confidence intervals (CIs). For R2, a value closer to 1 indicates a stronger correlation. RESULTS Data from a total of 18 396 patients were analyzed (median age = 59 years; 54.0% male), with 54.1% having low-risk tumors (T1-3 and N1), 31.6% KRAS mutated, 12.3% BRAF mutated, and 12.4% microsatellite instability high or deficient mismatch repair tumors. Trial-level correlation between 3-year DFS and 5-year OS remained strong (RWLS2 = 0.82, 95% CI = 0.67 to 0.98; RCopula2 = 0.92, 95% CI = 0.83 to 1.00) and increased as the median follow-up of OS extended. Analyses limited to trials that tested biologics showed consistent results. CONCLUSIONS Three-year DFS remains a validated surrogate endpoint for 5-year OS in adjuvant CC trials. The correlation was likely strengthened with 6 years of follow-up for OS.
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Affiliation(s)
- Jun Yin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Romain Cohen
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Aimery DeGramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University Georges Pompidou European Hospital, Paris, France
| | | | - Norman Wolmark
- Department of Clinical Trials, Alleghany Health Network, Pittsburgh, PA, USA
| | | | | | - Thomas J George
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Richard R M Goldberg
- West Virginia University Cancer Institute, the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Rachel Kerr
- Adjuvant Colorectal Cancer Group, University of Oxford, Oxford, UK
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IRCCS, Padova PD, Italy
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center, Tokyo, Japan
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thierry Andre
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Correspondence to: Qian Shi, PhD, Department of Quantitative Health Sciences, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA (e-mail: )
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