Characteristics and interpretation of subgroup analyses based on tumour characteristics in randomised trials testing target-specific anticancer drugs: design of a systematic survey
Open Access
- 30 May 2020
- Vol. 10 (5), e034565
- https://doi.org/10.1136/bmjopen-2019-034565
Abstract
Background Target-specific anticancer drugs are under rapid development. Little is known, however, about the risk of administering target-specific drugs to patients who have tumours with molecular alterations or other characteristics that can make the drug ineffective or even harmful. An increasing number of randomised clinical trials (RCTs) investigating target-specific anticancer drugs include subgroup analyses based on tumour characteristics. Such subgroup analyses have the potential to be more credible and influential than subgroup analyses based on traditional factors such as sex or tumour stage. In addition, they may more frequently lead to qualitative subgroup effects, that is, show benefit in one but harm in another subgroup of patients (eg, if the tumour characteristic makes the drug ineffective or even enhance tumour growth). If so, subgroup analyses based on tumour characteristics would be highly relevant for patient safety. The aim of this study is to systematically assess the frequency and characteristics of subgroup analyses based on tumour characteristics, the frequency of qualitative subgroup effects, their credibility, and the interpretations that investigators and guidelines developers report. Methods and analysis We will perform a systematic survey of 433 RCTs testing the effect of target-specific anticancer drugs. Teams of methodologically trained investigators and oncologists will identify eligible studies, extract relevant data and assess the credibility of putative subgroup effects using a recently developed formal instrument. We will systematically assess how trial investigators interpret apparent subgroup effects based on tumour characteristics and the extent to which they influence subsequent practice guidelines. Our results will provide empirical data characterising an increasingly used type of subgroup analysis in cancer trials and its potential impact on precision medicine to predict benefit or harm. Ethics and dissemination Formal ethical approval is not required for this study. We will disseminate the findings in a peer-reviewed and open-access journal publication.Funding Information
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (180830)
This publication has 30 references indexed in Scilit:
- Panitumumab–FOLFOX4 Treatment and RAS Mutations in Colorectal CancerThe New England Journal of Medicine, 2013
- Assessing Heterogeneity of Treatment Effects: Are Authors Misinterpreting Their Results?Health Services Research, 2010
- Empirical comparison of subgroup effects in conventional and individual patient data meta-analysesInternational Journal of Technology Assessment in Health Care, 2008
- Statistics in Medicine — Reporting of Subgroup Analyses in Clinical TrialsThe New England Journal of Medicine, 2007
- Claims of Sex DifferencesJAMA, 2007
- Subgroup analyses in therapeutic cardiovascular clinical trials: Are most of them misleading?American Heart Journal, 2006
- Subgroup analysis in randomised controlled trials: importance, indications, and interpretationThe Lancet, 2005
- Subgroup analyses in randomized trials: risks of subgroup-specific analyses;: power and sample size for the interaction testJournal of Clinical Epidemiology, 2004
- Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practiceand problemsStatistics in Medicine, 2002
- Subgroup analysis and other (mis)uses of baseline data in clinical trialsThe Lancet, 2000