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Agarwal N, Bellmunt J, Maughan BL, Boucher KM, Choueiri TK, Qu AQ, Vogelzang NJ, Fougeray R, Niegisch G, Albers P, Wong YN, Ko YJ, Sridhar SS, Tantravahi SK, Galsky MD, Petrylak DP, Vaishampayan UN, Mehta AN, Beer TM, Sternberg CN, Rosenberg JE, Sonpavde G
Six-Month Progression-Free Survival as the Primary Endpoint to Evaluate the Activity of New Agents as Second-line Therapy for Advanced Urothelial Carcinoma
Clinical Genitourinary Cancer (2014) 12:130-137.
Abstract
This study examined the association of progression-free survival at 6 months with overall survival in the context of second-line therapy of advanced urothelial carcinoma in pooled patient-level data from 10 phase II trials and then externally validated in a large phase III trial. Progression-free survival at 6 months was significantly correlated with overall survival and is an innovative primary endpoint to evaluate new agents in this setting. Objective: Second-line systemic therapy for advanced urothelial carcinoma (UC) has substantial unmet needs, and current agents show dismal activity. Second-line trials of metastatic UC have used response rate (RR) and median progression-free survival (PFS) as primary endpoints, which may not reflect durable benefits. A more robust endpoint to identify signals of durable benefits when investigating new agents in second-line trials may expedite drug development. PFS at 6 months (PFS6) is a candidate endpoint, which may correlate with overall survival (OS) at 12 months (OS12) and may be applicable across cytostatic and cytotoxic agents. Methods: Ten second-line phase II trials with individual patient outcomes data evaluating chemotherapy or biologics were combined for discovery, followed by external validation in a phase III trial. The relationship between PFS6/RR and OS12 was assessed at the trial level using Pearson correlation and weighted linear regression, and at the individual level using Pearson chi-square test with Yates continuity correction. Results: In the discovery dataset, a significant correlation was observed between PFS6 and OS12 at the trial (R-2 = 0.55, Pearson correlation = 0.66) and individual levels (82%, K = 0.45). Response correlated with OS12 at the individual level less robustly (78%,. = 0.36), and the trial level association was not statistically significant (R-2 = 0.16, Pearson correlation = 0.37). The correlation of PFS6 (81%,K = 0.44) appeared stronger than the correlation of response (76%, K = 0.17) with OS12 in the external validation dataset. Conclusions: PFS6 is strongly associated with OS12 and appears more optimal than RR to identify active second-line agents for advanced UC. (C) 2014 Elsevier Inc. All rights reserved.
Note
Publication Date: 2014-04-01.
PMCID: Pmc4142680
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