How valid are claims for synergy in published clinical studies?
BACKGROUND
Clinical trials evaluating drug combinations are often stimulated by claims of synergistic interactions in preclinical models. Overuse or misuse of the term synergy could lead to poorly designed clinical studies.


METHODS
We searched PubMed using the terms 'synergy' or 'synergistic' and 'cancer' to select articles published between 2006 and 2010. Eligible studies were those that referred to synergy in preclinical studies to justify a drug combination evaluated in a clinical trial.


RESULTS
Eighty-six clinical articles met eligibility criteria and 132 preclinical articles were cited in them. Most of the clinical studies were phase I (43%) or phase II trials (56%). Appropriate methods to evaluate synergy in preclinical studies included isobologram analysis in 18 studies (13.6%) and median effect in 10 studies (7.6%). Only 26 studies using animal models (39%) attempted to evaluate therapeutic index. There was no association between the result of the clinical trial and the use of an appropriate method to evaluate synergy (P=0.25, chi-squared test).


CONCLUSIONS
Synergy is cited frequently in phase I and phase II studies to justify the evaluation of a specific drug combination. Inappropriate methods for evaluation of synergy and poor assessment of therapeutic index have been used in most preclinical articles.
Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada; Medical Oncology Service and AECC Unit, Albacete University Hospital, Albacete, Spain. Electronic address: Ian.tannock@uhn.on.ca.
A
A
Ocana
Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.
E
E
Amir
Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.
C
C
Yeung
Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada; Sector of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
B
B
Seruga
Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.
I F
IF
Tannock
D000970:Antineoplastic Agents / Q000494:pharmacology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology*; D017321:Clinical Trials, Phase I as Topic / Q000379:methods* / Q000592:standards*; D017322:Clinical Trials, Phase II as Topic / Q000379:methods* / Q000592:standards*; D004357:Drug Synergism; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents