Surrogate endpoints for overall survival in metastatic melanoma: a meta-analysis of randomised controlled trials

Flaherty KT, Hennig M, Lee SJ, Ascierto PA, Dummer R, Eggermont AMM, Hauschild A, Kefford R, Kirkwood JM, Long GV, Lorigan P, Mackensen A, Mcarthur G, O'Day S, Patel PM, Robert C, Schadendorf D (2014)

Publication Type: Journal article

Publication year: 2014

Journal

Lancet Oncology Elsevier: Lancet

Book Volume: 15

Pages Range: 297-304

Journal Issue: 3

DOI: 10.1016/S1470-2045(14)70007-5

Abstract

Recent phase 3 trials have shown an overall survival benefit in metastatic melanoma. We aimed to assess whether progression-free survival (PFS) could be regarded as a reliable surrogate for overall survival through a meta-analysis of randomised trials.We systematically reviewed randomised trials comparing treatment regimens in metastatic melanoma that included dacarbazine as the control arm, and which reported both PFS and overall survival with a standard hazard ratio (HR). We correlated HRs for overall survival and PFS, weighted by sample size or by precision of the HR estimate, assuming fixed and random effects. We did sensitivity analyses according to presence of crossover, trial size, and dacarbazine dose.After screening 1649 reports and meeting abstracts published before Sept 8, 2013, we identified 12 eligible randomised trials that enrolled 4416 patients with metastatic melanoma. Irrespective of weighting strategy, we noted a strong correlation between the treatment effects for PFS and overall survival, which seemed independent of treatment type. Pearson correlation coefficients were 0·71 (95% CI 0·29-0·90) with a random-effects assumption, 0·85 (0·59-0·95) with a fixed-effects assumption, and 0·89 (0·68-0·97) with sample-size weighting. For nine trials without crossover, the correlation coefficient was 0·96 (0·81-0·99), which decreased to 0·93 (0·74-0·98) when two additional trials with less than 50% crossover were included. Inclusion of mature follow-up data after at least 50% crossover (in vemurafenib and dabrafenib phase 3 trials) weakened the PFS to overall survival correlation (0·55, 0·03-0·84). Inclusion of trials with no or little crossover with the random-effects assumption yielded a conservative statement of the PFS to overall survival correlation of 0·85 (0·51-0·96).PFS can be regarded as a robust surrogate for overall survival in dacarbazine-controlled randomised trials of metastatic melanoma; we postulate that this association will hold as treatment standards evolve and are adopted as the control arm in future trials.None.

Authors with CRIS profile

Andreas Mackensen Lehrstuhl für Innere Medizin V

Involved external institutions

Massachusetts General Hospital US United States (USA) (US) GlaxoSmithKline plc. (GSK) GB United Kingdom (GB) Dana–Farber Cancer Institute US United States (USA) (US) Universitätsspital Zürich (USZ) CH Switzerland (CH) University of Paris 11 - Paris-Sud / Université Paris XI Paris-Sud FR France (FR) Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) University of Sydney (USYD) AU Australia (AU) University of Pittsburgh US United States (USA) (US) Melanoma Institute Australia AU Australia (AU) University of Manchester GB United Kingdom (GB) Peter MacCallum Cancer Centre AU Australia (AU) Beverly Hills Cancer Center US United States (USA) (US) University of Nottingham GB United Kingdom (GB) Universitätsklinikum Essen DE Germany (DE) Fondazione IRCCS: Istituto Nazionale dei Tumori IT Italy (IT)

How to cite

APA:

Flaherty, K.T., Hennig, M., Lee, S.J., Ascierto, P.A., Dummer, R., Eggermont, A.M.M.,... Schadendorf, D. (2014). Surrogate endpoints for overall survival in metastatic melanoma: a meta-analysis of randomised controlled trials. Lancet Oncology, 15(3), 297-304. https://dx.doi.org/10.1016/S1470-2045(14)70007-5

MLA:

Flaherty, Keith T., et al. "Surrogate endpoints for overall survival in metastatic melanoma: a meta-analysis of randomised controlled trials." Lancet Oncology 15.3 (2014): 297-304.

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