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Article

Impact of Value Frameworks on the Magnitude of Clinical Benefit: Evaluating a Decade of Randomized Trials for Systemic Therapy in Solid Malignancies

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Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Faculty of Science, University of Calgary, Calgary, AB T2N 1N4, Canada
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Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 0G4, Canada
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Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(6), 4894-4928; https://doi.org/10.3390/curroncol28060412
Received: 21 October 2021 / Revised: 17 November 2021 / Accepted: 19 November 2021 / Published: 21 November 2021
In the era of rapid development of new, expensive cancer therapies, value frameworks have been developed to quantify clinical benefit (CB). We assessed the evolution of CB since the 2015 introduction of The American Society of Clinical Oncology and The European Society of Medical Oncology value frameworks. Randomized clinical trials (RCTs) assessing systemic therapies for solid malignancies from 2010 to 2020 were evaluated and CB (Δ) in 2010–2014 (pre-value frameworks (PRE)) were compared to 2015–2020 (POST) for overall survival (OS), progression-free survival (PFS), response rate (RR), and quality of life (QoL). In the 485 studies analyzed (12% PRE and 88% POST), the most common primary endpoint was PFS (49%), followed by OS (20%), RR (12%), and QoL (6%), with a significant increase in OS and decrease in RR as primary endpoints in the POST era (p = 0.011). Multivariable analyses revealed significant improvement in ΔOS POST (OR 2.86, 95% CI 0.46 to 5.26, p = 0.02) while controlling for other variables. After the development of value frameworks, median ΔOS improved minimally. The impact of value frameworks has yet to be fully realized in RCTs. Efforts to include endpoints shown to impact value, such as QoL, into clinical trials are warranted. View Full-Text
Keywords: clinical benefit; clinical trials; value frameworks clinical benefit; clinical trials; value frameworks
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MDPI and ACS Style

Cusano, E.; Wong, C.; Taguedong, E.; Vaska, M.; Abedin, T.; Nixon, N.; Karim, S.; Tang, P.; Heng, D.Y.C.; Ezeife, D. Impact of Value Frameworks on the Magnitude of Clinical Benefit: Evaluating a Decade of Randomized Trials for Systemic Therapy in Solid Malignancies. Curr. Oncol. 2021, 28, 4894-4928. https://doi.org/10.3390/curroncol28060412

AMA Style

Cusano E, Wong C, Taguedong E, Vaska M, Abedin T, Nixon N, Karim S, Tang P, Heng DYC, Ezeife D. Impact of Value Frameworks on the Magnitude of Clinical Benefit: Evaluating a Decade of Randomized Trials for Systemic Therapy in Solid Malignancies. Current Oncology. 2021; 28(6):4894-4928. https://doi.org/10.3390/curroncol28060412

Chicago/Turabian Style

Cusano, Ellen, Chelsea Wong, Eddy Taguedong, Marcus Vaska, Tasnima Abedin, Nancy Nixon, Safiya Karim, Patricia Tang, Daniel Y.C. Heng, and Doreen Ezeife. 2021. "Impact of Value Frameworks on the Magnitude of Clinical Benefit: Evaluating a Decade of Randomized Trials for Systemic Therapy in Solid Malignancies" Current Oncology 28, no. 6: 4894-4928. https://doi.org/10.3390/curroncol28060412

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