Vol 15, No 3 (2019)
Review paper
Published online: 2019-06-26

open access

Page views 1295
Article views/downloads 750
Get Citation

Connect on Social Media

Connect on Social Media

Critical appraisal of clinical trials in oncology — part II

Piotr Potemski1, Joanna Połowinczak-Przybyłek1, Rafał Wójcik2, Marcin Kaczor3
Oncol Clin Pract 2019;15(3):158-166.

Abstract

The article is the second part of papers presenting informations useful for an independent analysis of the value of published results of clinical trials in oncology. Based on selected examples of clinical trials, a few attempts of critical appraisal of clinical trial assumptions, construction, and interpretation of their results are given. Several non-inferiority trials are discussed. The paper provides examples of publications in which post hoc analyses, grouping of variables, and multiple comparisons were made. Examples of research with a controversial selection of patients and a comparator, as well as studies whose clinical significance of the obtained results is questionable are presented. The aim of our work is to draw the reader’s attention to selected essential elements of clinical trials and the way of presenting their results in order to facilitate practitioners in the independent evaluation of available publications and rational use of clinical trial results in everyday practice in the future. 

Article available in PDF format

View PDF Download PDF file

References

  1. Price TJ, Peeters M, Kim TW, et al. Panitumumab versus cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer (ASPECCT): a randomised, multicentre, open-label, non-inferiority phase 3 study. Lancet Oncol. 2014; 15(6): 569–579.
  2. Karapetis CS, Khambata-Ford S, Jonker DJ, et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med. 2008; 359(17): 1757–1765.
  3. Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage III colon cancer. N Engl J Med. 2018; 378(13): 1177–1188.
  4. André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004; 350(23): 2343–2351.
  5. Price T, Kim TW, Li J, et al. Final results and outcomes by prior bevacizumab exposure, skin toxicity, and hypomagnesaemia from ASPECCT: randomized phase 3 non-inferiority study of panitumumab versus cetuximab in chemorefractory wild-type KRAS exon 2 metastatic colorectal cancer. Eur J Cancer. 2016; 68: 51–59.
  6. Austin PC, Mamdani MM, Juurlink DN, et al. Testing multiple statistical hypotheses resulted in spurious associations: a study of astrological signs and health. J Clin Epidemiol. 2006; 59(9): 964–969.
  7. Szydlo RM, Gabriel I, Olavarria E, et al. Sign of the Zodiac as a predictor of survival for recipients of an allogeneic stem cell transplant for chronic myeloid leukaemia (CML): an artificial association. Transplant Proc. 2010; 42(8): 3312–3315.
  8. Ryan CJ, Smith MR, de Bono JS, et al. COU-AA-302 Investigators. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med. 2013; 368(2): 138–148.
  9. Rathkopf DE, Smith MR, de Bono JS, et al. Updated interim efficacy analysis and long-term safety of abiraterone acetate in metastatic castration-resistant prostate cancer patients without prior chemotherapy (COU-AA-302). Eur Urol. 2014; 66(5): 815–825.
  10. Ryan C, Smith M, Fizazi K, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2015; 16(2): 152–160.
  11. Méjean A, Ravaud A, Thezenas S, et al. Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2018; 379(5): 417–427.
  12. Hudes G, Carducci M, Tomczak P, et al. Global ARCC Trial. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007; 356(22): 2271–2281.
  13. Motzer RJ, Tannir NM, McDermott DF, et al. CheckMate 214 Investigators. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med. 2018; 378(14): 1277–1290.
  14. https://clinicaltrials.gov/ct2/show/NCT02282020.
  15. Kim TW, Elme A, Kusic Z, et al. A phase 3 trial evaluating panitumumab plus best supportive care vs best supportive care in chemorefractory wild-type KRAS or RAS metastatic colorectal cancer. Br J Cancer. 2016; 115(10): 1206–1214.
  16. Van Cutsem E, Peeters M, Siena S, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007; 25(13): 1658–1664.
  17. Moore MJ, Goldstein D, Hamm J, et al. National Cancer Institute of Canada Clinical Trials Group. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007; 25(15): 1960–1966.
  18. Van Cutsem E, Tabernero J, Lakomy R, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol. 2012; 30(28): 3499–3506.
  19. Joulain F, Proskorovsky I, Allegra C, et al. Mean overall survival gain with aflibercept plus FOLFIRI vs placebo plus FOLFIRI in patients with previously treated metastatic colorectal cancer. Br J Cancer. 2013; 109(7): 1735–1743.
  20. Chau I, Joulain F, Iqbal SU, et al. A VELOUR post hoc subset analysis: prognostic groups and treatment outcomes in patients with metastatic colorectal cancer treated with aflibercept and FOLFIRI. BMC Cancer. 2014; 14: 605.
  21. Saltz LB, Clarke S, Díaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008; 26(12): 2013–2019.
  22. Cherny NI, Sullivan R, Dafni U, et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Ann Oncol. 2015; 26(8): 1547–1573.
  23. Del Paggio JC, Azariah B, Sullivan R, et al. Do Contemporary Randomized Controlled Trials Meet ESMO Thresholds for Meaningful Clinical Benefit? Ann Oncol. 2017; 28(1): 157–162.