title: Use and misuse of common terminology criteria for adverse events in cancer clinical trials.
abstract: Common Terminology Criteria for Adverse Events, Version 3.0 (CTCAE v3.0) were released in 2003 and have been used widely to report toxicity in publications or presentations describing cancer clinical trials. Here we evaluate whether guidelines for reporting toxicity are followed in publications reporting randomized clinical trials (RCTs) for cancer.
  
  
  
  Phase III RCTs evaluating systemic cancer therapy published between 2011 and 2013, were reviewed to identify eligible studies, which stated explicitly that CTCAE v3.0 was used to report toxicity. Each AE term and its grade were located in CTCAE v3.0 to determine if they fell within the guidelines provided in the explanatory file.
  
  
  
  A total of 166 publications were included in this analysis. Criteria from CTCAE v3.0 were frequently used incorrectly. For example, CATEGORY names such as Metabolic were misreported as AEs in 19 trials, and inappropriate grades for AEs assigned frequently. For example, febrile neutropenia was graded 1 or 2 in 35 of 91 studies (38 %), but the minimum grade for this toxicity is 3. Alopecia was graded 3 or more in 19 of 77 studies (25 %), but the maximum is only grade 2.
  
  
  
  The present study provides evidence of poor reporting of toxicity in clinical trials. The study provides a lower estimate for the misuse of AE terms and grades, and implies that other AE terms and grades that conform to CTCAE v3.0 guidelines may have been assigned incorrectly. Inaccurate reporting of toxicity in clinical trials can lead clinicians to make inappropriate treatment decisions.
authors.affiliation: Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China. wozhangsheng@hotmail.com.|Medical Oncology, Shanghai Cancer Center, Fudan University, 270 Dongan Road, 200032, Shanghai, China. wozhangsheng@hotmail.com.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Liang
authors.affiliation: Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Tannock
mesh_terms: D000970:Antineoplastic Agents / Q000633:toxicity*; D017326:Clinical Trials, Phase III as Topic / Q000592:standards; D017408:Guidelines as Topic; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D009626:Terminology as Topic
chemical_list: D000970:Antineoplastic Agents
keywords: Adverse event; Common terminology criteria; Randomized clinical trial