The use of expert surrogates to evaluate clinical trials in non-small cell lung cancer

Mackillop, William J.; Ward, G K; O’Sullivan, Brian

doi:10.1038/bjc.1986.224

Cited by 81 publications

(23 citation statements)

References 9 publications

(6 reference statements)

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“…An indirect attempt to approach this problem has been made by MacKillop et al (1986), who asked 118 experts in the management of lung cancer to take part in a surrogate study. They were given three scenarios which included randomised trials with chemotherapy.…”

Section: Patient Characteristicsmentioning

confidence: 99%

A randomised trial of cisplatin and vindesine versus supportive care only in advanced non-small cell lung cancer

Woods

Williams²,

Levi³

et al. 1990

Br J Cancer

150

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Summary The value of chemotherapy in advanced non-small cell lung cancer (NSCLC) remains contentious. Because of this two separate but very similar trials were set up in Australia and Southampton (UK). Two hundred and one patients with stage IIIb or IV NSCLC were randomly assigned to cisplatin 120 mg m 2 on days 1 and 29 and vindesine 3 mg m-2 weekly x 6 or to no chemotherapy. Both groups were eligible to receive radiotherapy or other palliative treatment as required. Of 188 evaluable patients, 97 received chemotherapy and 91 were in the control arm. Response was assessed between days 42 and 49. Responders continued chemotherapy at the same doses though cisplatin being given 6 weekly x 4 and the vindesine 2 weekly x 12. The overall response rate to chemotherapy was 28%; there were no significant differences according to major prognostic criteria. Although the overall survival of the chemotherapy group (median 27 weeks) was longer than that of the no chemotherapy group (median 17 weeks) this was not statistically significant (log rank P = 0.33). For patients without dissemination (IlIb), median survival was 45 weeks in the chemotherapy arm and 26 weeks in the non-chemotherapy (log rank P = 0.075). Toxicity was universal and frequently severe: of 17 patients discontinuing chemotherapy after one cycle, 13 did so because of unacceptable toxicity. This chemotherapy cannot be recommended as routine treatment. Further phase III studies of chemotherapy in advanced NSCLC should continue to use a no chemotherapy control and should also attempt to measure quality of life, an issue not addressed effectively in this or other recent trials.

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Section: Patient Characteristicsmentioning

confidence: 99%

A randomised trial of cisplatin and vindesine versus supportive care only in advanced non-small cell lung cancer

Woods

Williams²,

Levi³

et al. 1990

Br J Cancer

150

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show abstract

“…Physicians may provide advice to patients which is at odds with the decisions they make for themselves [5]. Therefore, the physician surrogate method uses a physician's personal preferences rather than expressed recommendations to assess treatment acceptability [6]. This method has been previously evaluated in expert physicians treating genitourinary (GU) cancers [7] but, to our knowledge, this is the first application of this technique to PSA screening.…”

Section: Introductionmentioning

confidence: 99%

Personal prostate-specific antigen screening and treatment choices for localized prostate cancer among expert physicians

Wallis

Cheung

Klotz

et al. 2017

CUAJ

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Introduction: We aimed to determine the personal practices of urologists, radiation oncologists, and medical oncologists regarding prostate cancer screening and treatment using the physician surrogate method, which seeks to identify acceptable healthcare interventions by ascertaining interventions physicians select for themselves.Methods: A hierarchical, contingent survey was developed through a consensus involving urologists, medical oncologists, and radiation oncologists. It was piloted at the University of Toronto and then circulated to urologists, radiation oncologists, and medical oncologists through professional medical societies in the U.S., Canada, Central and South America, Australia, and New Zealand. The primary outcome was physicians’ personal choices regarding prostatespecific antigen (PSA) screening and the secondary outcome was treatment selection among those diagnosed with prostate cancer.Results: A total of 869 respondents provided consent and completed the survey. Of these, there were 719 urologists, 89 radiation oncologists, nine medical oncologists, and 53 undisclosed specialists. Most (784 of 869 respondents; 90%) endorsed past or future screening for themselves (among male physicians) or for relatives (among female physicians). Among urologists and radiation oncologists making prostate cancer treatment decisions, there was a significant correlation between physician specialty and the treatment selected (Phi coefficient=0.61; p=0.001).Conclusions: Physicians who routinely treat prostate cancer are likely to undertake prostate cancer screening themselves or recommend it for immediate family members. Treatment choice is influenced by the well-recognized specialty bias.

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“…Unfortunately, none of the current studies has presented data on 'quality of life' so that the advantages of chemotherapy remain tenuous, being based solely on a small improvement (weeks) in survival and no chance of cure. The data from the surrogate study of MacKillop et al (1986) suggests that most lung cancer experts do not feel that the small potential survival gain is worth the toxicity, since they would have refused consent to their own inclusion in chemotherapy trials in 69-91% of cases.…”

mentioning

confidence: 99%

Chemotherapy of non-small cell lung cancer

Williams

1989

Br J Cancer

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The use of expert surrogates to evaluate clinical trials in non-small cell lung cancer

Cited by 81 publications

References 9 publications

A randomised trial of cisplatin and vindesine versus supportive care only in advanced non-small cell lung cancer

A randomised trial of cisplatin and vindesine versus supportive care only in advanced non-small cell lung cancer

Personal prostate-specific antigen screening and treatment choices for localized prostate cancer among expert physicians

Chemotherapy of non-small cell lung cancer

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