Correlation of changes between 2-year disease-free survival and 5-year overall survival in adjuvant breast cancer trials from 1966 to 2006

Ng, Ryan; Pond, Gregory R.; Tang, Patricia A.; MacIntosh, Peter W.; Siu, Lillian L.; Chen, E.X.

doi:10.1093/annonc/mdm486

Cited by 40 publications

(29 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a 2007 meta-analysis of 10 randomized clinical trials of AIS versus tamoxifen, a strong correlation between DFS and OS was found 17, supporting the use of DFS as a surrogate endpoint for OS in breast cancer adjuvant endocrine trials. Further support was demonstrated in a recent analysis of 128 breast cancer adjuvant trials in which the difference in 2-year DFS was found to be a significant predictor of the difference in 5-year OS 18.…”

Section: Trial Endpointsmentioning

confidence: 80%

An Updated Review on the Efficacy of Adjuvant Endocrine Therapies in Hormone Receptor–Positive Early Breast Cancer

Verma

Sehdev

Joy³

et al. 2009

Current Oncology

View full text Add to dashboard Cite

The third-generation aromatase inhibitors (AIS) are largely replacing tamoxifen in the adjuvant treatment of early-stage breast cancer in postmenopausal women with hormone receptor–positive tumours. To date, multiple trials have been conducted comparing tamoxifen treatment with an AI, and all have demonstrated improved disease-free survival with AI treatment. Trials have included direct 5-year comparisons between tamoxifen and an AI, switching to an AI within 5 years after initial tamoxifen treatment, or extending treatment with an AI after 5 years of completed tamoxifen treatment. Some of these trials have been completed; others are ongoing; and head-to-head trial comparisons of individual AIS are also in progress. The present article summarizes the data obtained from various clinical trials of hormonal therapy for early breast cancer. It also reviews recent data so as to shed light on the current status of these therapies. The focus is on the efficacy of treatment with an AI. Toxicity is discussed in the second article in this supplement.

show abstract

Section: Trial Endpointsmentioning

confidence: 80%

An Updated Review on the Efficacy of Adjuvant Endocrine Therapies in Hormone Receptor–Positive Early Breast Cancer

Verma

Sehdev

Joy³

et al. 2009

Current Oncology

View full text Add to dashboard Cite

show abstract

“…Several meta-analyses have been published (Table 1) that show a link between time-toprogression (TTP) or progression-free survival (PFS) with overall survival (OS) in metastatic colorectal or non-small cell lung cancer (Johnson et al, 2006) and colon cancer in the adjuvant setting (Sargent et al, 2005). For breast cancer, a moderately strong correlation between 2-year disease-free survival and 5-year overall survival was observed in the adjuvant setting (Ng et al, 2008). A meta-analysis of metastatic breast cancer studies found a positive relationship between objective response and overall survival on an individual patient basis, but the relationship was less clear when treatment regimens were compared (Bruzzi et al, 2005).…”

mentioning

confidence: 99%

Relationship between effects on time-to-disease progression and overall survival in studies of metastatic breast cancer

Sherrill

Amonkar

et al. 2008

Br J Cancer

View full text Add to dashboard Cite

The relationship between overall survival (OS) and disease progression end points has been demonstrated in colorectal, colon, and non-small cell lung cancers. We assessed the association between OS and time-to-progression (TTP) or progression-free survival (PFS) in metastatic breast cancer (MBC) studies. A literature search retrieved all randomised controlled trials since 1994 in patients with MBC in which OS and either TTP or PFS were reported. Summary data on trial and patient characteristics were abstracted. Study effect sizes were derived as the ratio of median progression (or survival) times, which approximates the hazard ratio. Effects were centred at zero for regression analyses weighted by sample size. Numerous treatments were represented in 67 studies (17 081 patients). Modeling showed a positive association between outcomes for progression and survival (R 2 ¼ 0.30) with a slope of 0.32 (Po0.001) and a non-significant intercept. Thus, a treatment effect on TTP/PFS translated into a concordant effect on OS, but with attenuated effect size. Similar results were found in models of subsets and sensitivity analyses. These results demonstrate that treatment effects on progression end points in MBC trials are expected to result in treatment differences on OS that are smaller yet consistently in the same direction. British Journal of Cancer (2008) Most studies of anticancer agents are designed and powered to show differences between groups on disease progression end points such as response rates, time-to-progression, time-torecurrence or disease-free survival. Although increased survival time is clearly an implicit goal, it is difficult to establish in randomised studies when standard clinical practise is to change treatments at the onset of new progressive events. Especially in the metastatic setting, where expected survival time may be very short, the use of drug combinations or sequential use of multiple drug classes is commonplace. Increasingly, patients in clinical trials are offered alternate treatment upon progression. Consequently, few studies actually demonstrate an unequivocal survival benefit using intent-to-treat analysis approaches.In several tumour types, efforts have been made to justify the use of alternate, more easily established end points by showing how well they are correlated with survival. Several meta-analyses have been published (Table 1) that show a link between time-toprogression (TTP) or progression-free survival (PFS) with overall survival (OS) in metastatic colorectal or non-small cell lung cancer (Johnson et al, 2006) and colon cancer in the adjuvant setting (Sargent et al, 2005). For breast cancer, a moderately strong correlation between 2-year disease-free survival and 5-year overall survival was observed in the adjuvant setting (Ng et al, 2008). A meta-analysis of metastatic breast cancer studies found a positive relationship between objective response and overall survival on an individual patient basis, but the relationship was less clear when treatment regimens were compared...

show abstract

“…Follow-up in our study was not long enough to assess patient prognosis (two years). Indeed, Ng et al reported that, despite the existence of a correlation between 2-year PFS and 5-year overall survival, the correlation was not strong enough to be used as a predictor [22]. …”

Section: Discussionmentioning

confidence: 99%

Organizing medical oncology care at a regional level and its subsequent impact on the quality of early breast cancer management: a before-after study

Voidey

Pivot

Woronoff³

et al. 2014

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundOne of the main measures of the French national cancer plan is to encourage physicians to work collectively, and to minimize territorial inequities in access to care by rethinking the geographical distribution of oncologists. For this reason, cancer care services are currently being reorganized at national level. A new infrastructure for multidisciplinary cancer care delivery has been put in place in our region. Patients can receive multidisciplinary health care services nearer their homes, thanks to a mobile team of oncologists. The objective of our study was to assess, using a quality approach, the impact on medical management and on the costs of treating early breast cancer, of the new regional structure for cancer care delivery.MethodsBefore-and-after study performed from 2007 to 2010, including patients treated for early breast cancer in three hospitals in the region of Franche-Comté in Eastern France. The main outcome measures were quality criteria, namely delayed treatment (>12 weeks), dose-intensity and assessment of adjuvant chemotherapy. Other outcomes were 24-month progression-free survival (PFS) and economic evaluation.ResultsThis study included 667 patients. The rate of chemotherapy tended to decrease, but not significantly (49.3% before versus 42.2% after, p=0.07), while the use of taxanes increased by 38% across all centres (59.6% before versus 98.0% after, p < 0.0001). There was a non-significant reduction in the time between surgery and adjuvant chemotherapy (6.0 ± 3.0 weeks before versus 5.6 ± 3.6 weeks after, p=0.11). Dose-dense chemotherapy improved slightly, albeit non significantly (86.3% versus 91.1% p=0.22) and time to treatment tended to decrease. The new regional infrastructure did not change 24-month PFS, which remained at about 96%. The average cost of treatment was estimated at €7000, with no difference between the two periods.ConclusionsDespite a shortage of oncologists, the new organization put in place in our region for the provision of care for early breast cancer makes it possible to maintain local community-based treatment, without negative economic consequences. This new structure for cancer care delivery offers cancer services of similar quality with no modification of 24-month PFS in early breast cancer.

show abstract

Correlation of changes between 2-year disease-free survival and 5-year overall survival in adjuvant breast cancer trials from 1966 to 2006

Abstract: There is a statistically significant correlation, of moderate strength, between difference in 2-year DFS between treatment comparisons and difference in 5-year OS but the correlation is not strong enough to be used as a predictor.

Cited by 40 publications

References 19 publications

An Updated Review on the Efficacy of Adjuvant Endocrine Therapies in Hormone Receptor–Positive Early Breast Cancer

An Updated Review on the Efficacy of Adjuvant Endocrine Therapies in Hormone Receptor–Positive Early Breast Cancer

Relationship between effects on time-to-disease progression and overall survival in studies of metastatic breast cancer

Organizing medical oncology care at a regional level and its subsequent impact on the quality of early breast cancer management: a before-after study

Contact Info

Product

Resources

About