肿瘤学临床试验中肿瘤进展的盲态独立中央审查评估:一项荟萃分析。

Evaluation of Blinded Independent Central Review of Tumor Progression in Oncology Clinical Trials: A Meta-analysis.

作者信息

Zhang Jenny J, Chen Huanyu, He Kun, Tang Shenghui, Justice Robert, Keegan Patricia, Pazdur Richard, Sridhara Rajeshwari

机构信息

1 Division of Biometrics V, Office of Biostatistics, Office of Translational Sciences, Center of Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.

2 Center for Drug Evaluation and Research, Office of New Drugs, Office of Hematology and Oncology Products, Food and Drug Administration, Silver Spring, MD, USA.

出版信息

Ther Innov Regul Sci. 2013 Mar;47(2):167-174. doi: 10.1177/0092861512459733.

Abstract

Use of blinded independent central review (BICR) has become more common in oncology phase 3 trials as progression-free survival (PFS) has been increasingly used as an endpoint for regulatory approval. Since PFS is primarily a radiographic endpoint, BICR has been implemented to assess and reduce potential bias in the local evaluation (LE) of PFS. Recent publications note an agreement between LE and BICR of the ultimate reported PFS treatment effect, which questions the need for costly and time-consuming complete-case BICR of PFS. A meta-analysis was conducted to systematically evaluate the relationship between BICR- and LE-assessed PFS based on FDA's regulatory experience from 2005 to present. Our results support the claim that a complete review of all radiographs by BICR may not be necessary for oncology trials, and alternative methods should be explored to evaluate bias. One potential alternative is to use BICR as an audit tool to detect evaluation bias in LE assessments.

摘要

随着无进展生存期(PFS)越来越多地被用作肿瘤学3期试验监管批准的终点,采用盲态独立中央审查(BICR)在这类试验中变得更为普遍。由于PFS主要是一个影像学终点,因此实施BICR以评估并减少PFS局部评估(LE)中的潜在偏倚。近期的出版物指出,LE与最终报告的PFS治疗效果的BICR之间存在一致性,这对进行成本高昂且耗时的PFS全病例BICR的必要性提出了质疑。基于美国食品药品监督管理局(FDA)自2005年至今的监管经验,进行了一项荟萃分析,以系统评估BICR评估的PFS与LE评估的PFS之间的关系。我们的结果支持以下观点:对于肿瘤学试验而言,可能无需对所有X光片进行全面审查,应探索替代方法来评估偏倚。一种潜在的替代方法是将BICR用作审计工具,以检测LE评估中的评估偏倚。

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