title: Creating clinical trial designs that incorporate clinical outcome assessments.
abstract: Clinical outcome assessments (COAs) are increasingly being used in determining the efficacy of new treatment regimens. This was typified in the recent use of a symptom-based instrument combined with an organ-based measure of response for the approval of ruxolitinib in myelofibrosis. There are challenges in incorporating these COAs into clinical trials, including designating the level of priority, incorporating these measures into a combined or composite endpoint, and dealing with issues related to compliance and interpretation of results accounting for missing data. This article describes the results of a recent panel discussion that attempted to address these issues and provide guidance to the incorporation of COAs into clinical trials, including novel statistical designs, so that the testing of new treatments in patients with cancers of the central nervous system can incorporate these important clinical endpoints.
authors.affiliation: Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.).
authors.forename: Mark R
authors.initials: MR
authors.lastname: Gilbert
authors.affiliation: Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.).
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rubinstein
authors.affiliation: Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.).
authors.forename: Glenn
authors.initials: G
authors.lastname: Lesser
mesh_terms: D002490:Central Nervous System / Q000503:physiopathology; D002986:Clinical Trials as Topic; D023381:Endpoint Determination / Q000379:methods; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome
keywords: clinical trials; statistical design; study endpoints