Green Angela K, Reeder-Hayes Katherine E, Corty Robert W, Basch Ethan, Milowsky Mathew I, Dusetzina Stacie B, Bennett Antonia V, Wood William A
UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Oncologist. 2015 May;20(5):464-e20. doi: 10.1634/theoncologist.2014-0431. Epub 2015 Apr 15.
In this paper, we provide background and context regarding the potential for a new data-sharing platform, the Project Data Sphere (PDS) initiative, funded by financial and in-kind contributions from the CEO Roundtable on Cancer, to transform cancer research and improve patient outcomes. Given the relatively modest decline in cancer death rates over the past several years, a new research paradigm is needed to accelerate therapeutic approaches for oncologic diseases. Phase III clinical trials generate large volumes of potentially usable information, often on hundreds of patients, including patients treated with standard of care therapies (i.e., controls). Both nationally and internationally, a variety of stakeholders have pursued data-sharing efforts to make individual patient-level clinical trial data available to the scientific research community.
For researchers, shared data have the potential to foster a more collaborative environment, to answer research questions in a shorter time frame than traditional randomized control trials, to reduce duplication of effort, and to improve efficiency. For industry participants, use of trial data to answer additional clinical questions could increase research and development efficiency and guide future projects through validation of surrogate end points, development of prognostic or predictive models, selection of patients for phase II trials, stratification in phase III studies, and identification of patient subgroups for development of novel therapies. Data transparency also helps promote a public image of collaboration and altruism among industry participants. For patient participants, data sharing maximizes their contribution to public health and increases access to information that may be used to develop better treatments. Concerns about data-sharing efforts include protection of patient privacy and confidentiality. To alleviate these concerns, data sets are deidentified to maintain anonymity. To address industry concerns about protection of intellectual property and competitiveness, we illustrate several models for data sharing with varying levels of access to the data and varying relationships between trial sponsors and data access sponsors.
PDS is an independent initiative of the CEO Roundtable on Cancer Life Sciences Consortium, built to voluntarily share, integrate, and analyze comparator arms of historical cancer clinical trial data sets to advance future cancer research. The aim is to provide a neutral, broad-access platform for industry and academia to share raw, deidentified data from late-phase oncology clinical trials using comparator-arm data sets. These data are likely to be hypothesis generating or hypothesis confirming but, notably, do not take the place of performing a well-designed trial to address a specific hypothesis. Prospective providers of data to PDS complete and sign a data sharing agreement that includes a description of the data they propose to upload, and then they follow easy instructions on the website for uploading their deidentified data. The SAS Institute has also collaborated with the initiative to provide intrinsic analytic tools accessible within the website itself. As of October 2014, the PDS website has available data from 14 cancer clinical trials covering 9,000 subjects, with hopes to further expand the database to include more than 25,000 subject accruals within the next year. PDS differentiates itself from other data-sharing initiatives by its degree of openness, requiring submission of only a brief application with background information of the individual requesting access and agreement to terms of use. Data from several different sponsors may be pooled to develop a comprehensive cohort for analysis. In order to protect patient privacy, data providers in the U.S. are responsible for deidentifying data according to standards set forth by the Privacy Rule of the U.S. Health Insurance Portability and Accountability Act of 1996. USING DATA SHARING TO IMPROVE OUTCOMES IN CANCER THE "PROSTATE CANCER CHALLENGE": Control-arm data of several studies among patients with metastatic castration-resistant prostate cancer (mCRPC) are currently available through PDS. These data sets have multiple potential uses. The "Prostate Cancer Challenge" will ask the cancer research community to use clinical trial data deposited in the PDS website to address key research questions regarding mCRPC. General themes that could be explored by the cancer community are described in this article: prognostic models evaluating the influence of pretreatment factors on survival and patient-reported outcomes; comparative effectiveness research evaluating the efficacy of standard of care therapies, as illustrated in our companion article comparing mitoxantrone plus prednisone with prednisone alone; effects of practice variation in dose, frequency, and duration of therapy; level of patient adherence to elements of trial protocols to inform the design of future clinical trials; and age of subjects, regional differences in health care, and other confounding factors that might affect outcomes.
The number of data sets available and the lack of experimental-arm data limit the potential scope of research using the current PDS. The number of trials is expected to grow exponentially over the next year and may include multiple cancer settings, such as breast, colorectal, lung, hematologic malignancy, and bone marrow transplantation. Other potential limitations include the retrospective nature of the data analyses performed using PDS and its generalizability, given that clinical trials are often conducted among younger, healthier, and less racially diverse patient populations. Methodological challenges exist when combining individual patient data from multiple clinical trials; however, advancements in statistical methods for secondary database analysis offer many tools for reanalyzing data arising from disparate trials, such as propensity score matching. Despite these concerns, few if any comparable data sets include this level of detail across multiple clinical trials and populations.
Access to large, late-phase, cancer-trial data sets has the potential to transform cancer research by optimizing research efficiency and accelerating progress toward meaningful improvements in cancer care. This type of platform provides opportunities for unique research projects that can examine relatively neglected areas and that can construct models necessitating large amounts of detailed data. The full potential of PDS will be realized only when multiple tumor types and larger numbers of data sets are available through the website.
在本文中,我们介绍了一个新的数据共享平台——项目数据领域(PDS)计划的背景和相关情况。该计划由癌症首席执行官圆桌会议提供资金和实物捐助,旨在变革癌症研究并改善患者治疗效果。鉴于过去几年癌症死亡率下降幅度相对较小,需要一种新的研究范式来加速肿瘤疾病的治疗方法。III期临床试验会产生大量潜在可用信息,通常涉及数百名患者,包括接受标准治疗(即对照组)的患者。在国内和国际上,各类利益相关者都在努力进行数据共享,以使科研界能够获取个体患者层面的临床试验数据。
对于研究人员而言,共享数据有可能营造更具协作性的环境,比传统随机对照试验更快地回答研究问题,减少重复劳动并提高效率。对于行业参与者来说,利用试验数据回答更多临床问题可提高研发效率,并通过验证替代终点、开发预后或预测模型、为II期试验选择患者、在III期研究中进行分层以及识别新型疗法的患者亚组来指导未来项目。数据透明度还有助于提升行业参与者之间合作与利他的公众形象。对于患者参与者而言,数据共享能最大限度地发挥他们对公共卫生的贡献,并增加获取可用于研发更好治疗方法的信息的机会。对数据共享的担忧包括患者隐私和保密性的保护。为缓解这些担忧,数据集会进行去标识化处理以保持匿名性。为解决行业对知识产权保护和竞争力的担忧,我们阐述了几种数据共享模式,这些模式在数据访问级别以及试验申办者与数据访问申办者之间的关系方面各不相同。
PDS是癌症首席执行官圆桌会议生命科学联盟的一项独立计划,旨在自愿共享、整合和分析历史癌症临床试验数据集的对照臂,以推动未来癌症研究。其目标是为行业和学术界提供一个中立的、广泛访问的平台,用于使用对照臂数据集共享晚期肿瘤临床试验的原始、去标识化数据。这些数据可能会产生假设或证实假设,但值得注意的是,它们并不能替代为解决特定假设而进行的精心设计的试验。向PDS提供数据的潜在提供者需填写并签署数据共享协议,其中包括对他们提议上传的数据的描述,然后按照网站上的简单说明上传其去标识化数据。SAS研究所也与该计划合作,在网站本身提供内置分析工具。截至2014年10月,PDS网站已有来自14项癌症临床试验的数据,涵盖9000名受试者,并希望在明年进一步扩大数据库,使其纳入超过25000名受试者的数据。PDS与其他数据共享计划的不同之处在于其开放程度,只需提交一份包含访问者背景信息的简短申请并同意使用条款即可。来自多个不同申办者的数据可以汇总起来形成一个综合队列进行分析。为保护患者隐私,美国的数据提供者负责根据1996年《美国健康保险流通与责任法案》隐私规则规定的标准对数据进行去标识化处理。利用数据共享改善癌症治疗效果——“前列腺癌挑战”:目前通过PDS可获取多项转移性去势抵抗性前列腺癌(mCRPC)患者研究的对照臂数据。这些数据集有多种潜在用途。“前列腺癌挑战”将要求癌症研究界利用存储在PDS网站上的临床试验数据来解决有关mCRPC的关键研究问题。本文描述了癌症界可能探索的一般主题:评估预处理因素对生存和患者报告结局影响的预后模型;评估标准治疗疗效的比较效果研究,如我们的配套文章中比较米托蒽醌加泼尼松与单独使用泼尼松的疗效;治疗剂量、频率和持续时间的实践差异影响;患者对试验方案要素的依从程度,以为未来临床试验设计提供参考;以及受试者年龄、医疗保健的地区差异和其他可能影响结局的混杂因素。
现有数据集的数量以及缺乏试验臂数据限制了使用当前PDS进行研究的潜在范围。预计明年试验数量将呈指数增长,可能涵盖多种癌症类型,如乳腺癌、结直肠癌、肺癌、血液系统恶性肿瘤和骨髓移植。其他潜在局限性包括使用PDS进行数据分析的回顾性性质及其可推广性,因为临床试验通常在年龄较小、健康状况较好且种族多样性较低的患者群体中进行。在合并来自多个临床试验的个体患者数据时存在方法学挑战;然而,二次数据库分析的统计方法进展提供了许多工具,可用于重新分析来自不同试验的数据,如倾向得分匹配。尽管存在这些担忧,但几乎没有其他可比数据集能在多个临床试验和人群中包含如此详细的数据。
获取大型、晚期癌症试验数据集有可能通过优化研究效率并加速在癌症治疗方面取得有意义进展的进程来变革癌症研究。这种类型的平台为独特的研究项目提供了机会,这些项目可以研究相对被忽视的领域,并构建需要大量详细数据才能建立的模型。只有当网站上有多种肿瘤类型和更多数据集时,PDS的全部潜力才能实现。