Evidence map›Paper›PMID 34478046›Full record

ArticleTargeted oncology2021

Exploring the Impact of Treatment Switching on Overall Survival from the PROfound Study in Homologous Recombination Repair (HRR)-Mutated Metastatic Castration-Resistant Prostate Cancer (mCRPC).

Rachel Evans, Neil Hawkins, Pascale Dequen-O'Byrne, Charles McCrea, Dominic Muston, Christopher Gresty, Sameer R Ghate, Lin Fan, Robert Hettle, Keith R Abrams and 3 more

Abstract read
In one paragraph

Article in Targeted oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Trial
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  6. Personalized 3-Gene Panel for Prostate Cancer Target Therapy.Current issues in molecular biology · 2022
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Rachel EvansVisible Analytics, 3 Kings Meadow, Oxford, OX2 0DP, UK. rachel.evans@visibleanalytics.co.uk.ORCID http://orcid.org/0000-0002-4430-0262
Neil HawkinsVisible Analytics, 3 Kings Meadow, Oxford, OX2 0DP, UK.
Pascale Dequen-O'ByrneVisible Analytics, 3 Kings Meadow, Oxford, OX2 0DP, UK.
Charles McCreaAstraZeneca, Cambridge, UK.
Dominic MustonCenter for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
Christopher GrestyAstraZeneca, Cambridge, UK.
Sameer R GhateCenter for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
Lin FanCenter for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
Robert HettleAstraZeneca, Cambridge, UK.
Keith R AbramsVisible Analytics, 3 Kings Meadow, Oxford, OX2 0DP, UK.
Johann de BonoInstitute of Cancer Research and Royal Marsden Hospital, London, UK.
Maha HussainThe Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Neeraj AgarwalHuntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn oncology trials, treatment switching from the comparator to the experimental regimen is often allowed but may lead to underestimating overall survival (OS) of an experimental therapy.

objectiveThis study evaluates the impact of treatment switching from control to olaparib on OS using the final survival data from the PROfound study and compares validated adjustment methods to estimate the magnitude of OS benefit with olaparib. PATIENTS AND

methodsThe primary population from PROfound (Cohort A) was included, alongside two populations approved for treatment with olaparib by the European Medicines Agency and US Food and Drug Administration: BRCAm and Cohort A+B (excluding the PPP2R2A gene). Five methods were explored to adjust for switching: excluding or censoring patients in the control arm who receive subsequent olaparib, Rank Preserving Structural Failure Time Model (RPSFTM), Inverse Probability of Censoring Weights, and Two-Stage Estimation.

resultsThe RPSFTM was considered the most appropriate approach for PROfound as the results were robust to sensitivity analysis testing of the common treatment effect assumption. For Cohort A, the final OS hazard ratio reduced from 0.69 (95% CI 0.5-0.97) to between 0.42 (0.18-0.90) and 0.52 (0.31-1.00) for olaparib versus control, depending on the RPSFTM selected. Median OS reduced from 14.7 months to between 11.73 and 12.63 months for control.

conclusionsThe magnitude of the statistically significant (P < 0.05) survival benefit of olaparib versus control observed in Cohort A of PROfound is likely to be underestimated if adjustment for treatment switching from control to olaparib is not conducted. The RPSFTM was considered the most plausible method, although further development and validation of robust methods to estimate the magnitude of impact of treatment switching is needed.

Indexed as

Prostatic Neoplasms, Castration-ResistantCohort StudiesHumansMaleProportional Hazards ModelsRecombinational DNA RepairTreatment SwitchingUnited States

Identifiers

PMID34478046
PMCPMC8484203

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.