Verification of the correlation between progression-free survival and overall survival considering magnitudes of survival post- progression in the treatment of four types of cancer.
BACKGROUND
With development and application of new and effective anti-cancer drugs, the median survival post-progression (SPP) is often prolonged, and the role of the median SPP on surrogacy performance should be considered. To evaluate the impact of the median SPP on the correlation between progression-free survival (PFS) and overall survival (OS), we performed simulations for treatment of four types of cancer, advanced gastric cancer (AGC), metastatic colorectal cancer (MCC), glioblastoma (GBM), and advanced non-small-cell lung cancer (ANSCLC).


METHODS
The effects of the median SPP on the statistical properties of OS and the correlation between PFS and OS were assessed. Further, comparisons were made between the surrogacy performance based on real data from meta-analyses and simulation results with similar scenarios.


RESULTS
The probability of a significant gain in OS and HR for OS was decreased by an increase of the SPP/ OS ratio or by a decrease of observed treatment benefit for PFS. Similarly, for each of the four types of cancer, the correlation between PFS and OS was reduced as the median SPP increased from 2 to 12 months. Except for ANSCLC, for which the median SPP was equal to the true value, the simulated correlation between PFS and OS was consistent with the values derived from meta-analyses for the other three kinds of cancer. Further, for these three types of cancer, when the median SPP was controlled at a designated level (i.e., < 4 months for AGC, < 12 months for MCC, and <6 months for GBM), the correlation between PFS and OS was strong; and the power of OS reached 34.9% at the minimum.


CONCLUSIONS
PFS is an acceptable surrogate endpoint for OS under the condition of controlling SPPs for AGC, MCC, and GBM at their limit levels; a similar conclusion cannot be made for ANSCLC.
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China E-mail : fengchen@njmu.edu.cn.
Li-Ya
LY
Liu
Hao
H
Yu
Jian-Ling
JL
Bai
Ping
P
Zeng
Dan-Dan
DD
Miao
Feng
F
Chen
D015415:Biomarkers; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005909:Glioblastoma / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D015233:Models, Statistical; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate
D015415:Biomarkers