Statistical Controversies in Clinical Research: Endpoints Other than Overall Survival Are Vital for Regulatory Approval of Anticancer Agents
Cet article présente des arguments statistiques en faveur de l'usage de critères de jugement autres que la survie globale dans la plupart des essais de phase III de nouveaux traitements chez des patients atteints d'un cancer métastatique
There is an ongoing debate about the relative merits of overall survival (OS) and other metrics that can be used as primary endpoints in cancer clinical trials. Although survival time is arguably the most objective metric for assessing the efficacy of anticancer treatment, OS as a clinical-trial endpoint needs to be conceptually distinguished from increased survival time as a goal desired by patients, clinicians and public-health policy makers. OS presents several drawbacks as a primary endpoint that threaten to hamper further drug development, including the increase in the number of patients and the much longer follow-up required in a clinical trial. In many settings of first-line therapy for metastatic disease, median OS is currently two to four times longer than median progression-free survival. As a result, the analysis of OS appears to be increasingly confounded by the effect of salvage therapies used after disease progression. In this review, we use straightforward statistical reasoning and examples from the oncology literature to argue that OS should no longer be the primary endpoint of most future phase III cancer clinical trials that aim at assessing the efficacy of novel therapies in the setting of metastatic disease.
Annals of Oncology , résumé, 2015