Are experimental treatments for cancer in children superior to established treatments? Observational study of randomised controlled trials by the Children's Oncology Group.
OBJECTIVE
To assess how often new treatments for childhood cancer assessed in phase III randomised trials are superior or inferior to standard treatments and whether the pattern of successes and failures in new treatments is consistent with uncertainty being the ethical basis for enrolling patients in such trials.


METHODS
Observational study.


METHODS
Phase III randomised controlled trials carried out under the aegis of the Children's Oncology Group between 1955 and 1997, regardless of whether they were published.


METHODS
Overall survival, event free survival, and treatment related mortality.


RESULTS
126 trials were included, involving 152 comparisons and 36,567 patients. The odds ratio for overall survival with experimental treatments was 0.96 (99% confidence interval 0.89 to 1.03), indicating that new treatments are as likely to be inferior as they are to be superior to standard treatments. This result was not affected by publication bias, methodological quality, treatment type, disease, or comparator.


CONCLUSIONS
New treatments in childhood cancer tested in randomised controlled trials are, on average, as likely to be inferior as they are to be superior to standard treatments, confirming that the uncertainty principle has been operating.
Kumar
Ambuj
A
Department of Interdisciplinary Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL 33612, USA.
Soares
Heloisa
H
Wells
Robert
R
Clarke
Mike
M
Hozo
Iztok
I
Bleyer
Archie
A
Reaman
Gregory
G
Chalmers
Iain
I
Djulbegovic
Benjamin
B
D002648:Child; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D008495:Medical Oncology / Q000639:trends*; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome