title: Improved endpoints for cancer immunotherapy trials.
abstract: Unlike chemotherapy, which acts directly on the tumor, cancer immunotherapies exert their effects on the immune system and demonstrate new kinetics that involve building a cellular immune response, followed by changes in tumor burden or patient survival. Thus, adequate design and evaluation of some immunotherapy clinical trials require a new development paradigm that includes reconsideration of established endpoints. Between 2004 and 2009, several initiatives facilitated by the Cancer Immunotherapy Consortium of the Cancer Research Institute and partner organizations systematically evaluated an immunotherapy-focused clinical development paradigm and created the principles for redefining trial endpoints. On this basis, a body of clinical and laboratory data was generated that supports three novel endpoint recommendations. First, cellular immune response assays generate highly variable results. Assay harmonization in multicenter trials may minimize variability and help to establish cellular immune response as a reproducible biomarker, thus allowing investigation of its relationship with clinical outcomes. Second, immunotherapy may induce novel patterns of antitumor response not captured by Response Evaluation Criteria in Solid Tumors or World Health Organization criteria. New immune-related response criteria were defined to more comprehensively capture all response patterns. Third, delayed separation of Kaplan-Meier curves in randomized immunotherapy trials can affect results. Altered statistical models describing hazard ratios as a function of time and recognizing differences before and after separation of curves may allow improved planning of phase III trials. These recommendations may improve our tools for cancer immunotherapy trials and may offer a more realistic and useful model for clinical investigation.
authors.affiliation: Cancer Immunotherapy Consortium of the Cancer Research Institute, New York, NY, USA. axel.hoos@bms.com
authors.forename: Axel
authors.initials: A
authors.lastname: Hoos
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Sylvia
authors.initials: S
authors.lastname: Janetzki
authors.forename: F Stephen
authors.initials: FS
authors.lastname: Hodi
authors.forename: Ramy
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Aparna
authors.initials: A
authors.lastname: Anderson
authors.forename: Rachel
authors.initials: R
authors.lastname: Humphrey
authors.forename: Brent
authors.initials: B
authors.lastname: Blumenstein
authors.forename: Lloyd
authors.initials: L
authors.lastname: Old
authors.forename: Jedd
authors.initials: J
authors.lastname: Wolchok
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D019496:Cancer Vaccines / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000592:standards* / Q000639:trends; D006801:Humans; D007111:Immunity, Cellular; D007167:Immunotherapy / Q000379:methods* / Q000592:standards / Q000639:trends; D053208:Kaplan-Meier Estimate; D015233:Models, Statistical; D015337:Multicenter Studies as Topic / Q000592:standards; D009369:Neoplasms / Q000276:immunology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D019496:Cancer Vaccines
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