Benefit and harms of new anti-cancer drugs
Abstract
Phase III randomized controlled trials (RCTs) assess clinically important differences in endpoints that reflect benefit to and harm of patients. Defining benefit of cancer drugs can be difficult. Overall survival and quality of life are the most relevant primary endpoints, but difficulty in measuring these mean that other endpoints are often used, although their surrogacy or clinical relevance has not always been established. In general, advances in drug development have led to numerous new drugs to enter the market. Pivotal RCT of several new drugs have shown that benefit appeared greater for targeted anticancer agents than for chemotherapeutic agents. This effect seems particularly evident with targeted agents evaluated in biomarker-driven studies. Unfortunately, new therapies have also shown an increase in toxicity. Such toxicity is not always evident in the initial reports of RCTs. This may be a result of a statistical inability to detect differences between arms of RCTs, or occasionally due to biased reporting. There are several examples where reports of new toxicities could only be found in drug labels. In some cases, the small improvement in survival has come at a cost of substantial excess toxicity, leading some to consider such therapy as having equipoise.
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No standard instrument exists for grading how much clinical benefit cancer therapies provide.
“To date, there is no standard tool for grading the magnitude of clinical benefit of cancer therapies [25,26]”
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- Authors
- Vera-Badillo, F. E., Al-Mubarak, M., Templeton, A. J., & Amir, E.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Amir, Eitan
- Venue
- Current Oncology Reports
- Published
- 2013-02-23
- Volume
- 15
- Issue
- 3
- Pages
- 270-275
- ISSN
- 1523-3790 (ISSN-L)
- 1534-6269
- OpenAlex
- W1976794477
- Cited by
- 35
- References
- 33
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 5 · 2015: 8 · 2014: 3
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Oncology Reports (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Oncology › Cancer Treatment and Pharmacology
- Keywords
- anticancer agents, targeted therapy, chemotherapy, drug toxicity, surrogate endpoints, overall survival, quality of life, biomarker-driven trials, equipoise, drug labeling, benefit-harm assessment
- MeSH terms
- Antineoplastic Agents, Cost-Benefit Analysis, Drug Eruptions, Drug Labeling, Female, Humans, Male, Neoplasms, United States, United States Food and Drug Administration, Drug Design, Randomized Controlled Trials as Topic, Risk Assessment, Disease-Free Survival, Neurotoxicity Syndromes
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