The European Society for Medical Oncology Magnitude of Clinical Benefit Scale in daily practice: a single institution, real-life experience at the Medical University of Vienna

Abstract

BackgroundThe European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS) has been designed to stratify the therapeutic benefit of a certain drug registered for the treatment of cancer. However, though internally validated, this tool has not yet been evaluated for its feasibility in the daily practice of a major center of medical oncology.MethodsThe practicability of the MCBS for advanced oncological diseases at the Clinical Division of Oncology, Medical University of Vienna, which constitutes one of the largest oncological centres in Europe, was analysed in a three-step approach. First, retrospectively collected data were analysed to gain an overview of treatments in regular use. Second, data were scored by using the MCBS. Third, the ensuing results were evaluated within corresponding programme directorships to assess feasibility in a real-life clinical context.ResultsIn the majority of tumour entities, the MCBS results reported earlier are consistent with daily clinical practice. Thus, in metastatic breast cancer or advanced lung cancer, there was a high level of clinical benefit for first-line treatment standards, and these results reflected well real-life experience. However, analyses based on the first version of the MCBS are limited if it comes to salvage treatment in tumour entities in which optimal sequencing of potential treatment options is of major importance, as in metastatic colorectal or renal cell cancer. In contrast to this, it is remarkable that certain novel therapies such as nivolumab assessed for heavily pretreated advanced renal cancer reached the highest level of clinical benefit due to prolongation in survival and a favourable toxicity profile. The MCBS clearly underlines the potential benefit of these compounds.ConclusionsThe MCBS is an excellent tool for daily clinical practice of a tertiary referral centre. It supports treatment decisions based on the clinical benefit to be expected from a novel approach such as immunotherapy in as yet untested indications.

Measuring the Value of New Drugs: Validity and Reliability of 4 Value Assessment Frameworks in the Oncology Setting

“…These findings also provide evidence for the frameworks' face validity, indicating that framework-driven decisions may reflect those made in clinical practice. 28 The complexity of the underlying data used to complete the assessments may have in turn influenced clinical concordance. Specifically, panelists appeared to more easily apply the correct numbers for the prostate cancer drugs than they did for breast and lung cancer drugs.…”

The European Society for Medical Oncology 'Magnitude of Clinical Benefit Scale' field-tested in infrequent tumour entities: an extended analysis of its feasibility at the Medical University of Vienna

“…[8][9][10][11][12][13][14][15] However, a maximum score of 3 is clearly inferior to results achieved for metastatic breast or colorectal Kiesewetter cancer. 5 This fact might possibly be related to the inferior power of trials in infrequent diseases. In addition, we could identify several trials relevant to our practice that added new data to the field but per definition did not meet their statistical endpoint.…”

“…Similar results were also obtained in our analysis for common entities exemplified by PD-1 inhibition in non-small cell lung cancer and renal cell cancer providing a stringent concept for the use of the ESMO-MCBS in the era of immunomodulatory treatment. 5 The limitations of the ESMO-MCBS were clinical settings where a cascade-like treatment algorithm is standard of care. While the ESMO-MCBS in its current version allows assessment of multiple studies in form of meta-analyses, it is not possible to interconnect or combine the results of two or more distinct trials.…”

Applying the ESMO-Magnitude of Clinical Benefit Scale in real life

“…The paper published in the current issue of ESMO Open by Kiesewetter et al 2 describes the first real life assessment of the ESMO-MCBS within a big comprehensive cancer centre. Medical University Vienna is one of the biggest and most important centres in Europe, and physicians in the Clinical Division of Oncology have applied the methodology to their daily clinical practice in treating patients.…”