Ann Oncol 2017;28:157–162. Three kinds of between-group contrast metrics (i.e., the difference in RMST, the ratio of RMST and the ratio of the restricted mean time lost (RMTL)) are computed. J Clin Oncol 2017;35:2764–2771. Do contemporary randomized controlled trials meet ESMO thresholds for meaningful clinical benefit? J Clin Oncol 2016;34:786–793. By default, this assumes that the longest survival time is equal to the longest survival time in the data. Examining trends in cost and clinical benefit of novel anticancer drugs over time. Tibau A, Molto C, Ocana A, . General contact details of provider: . If the inline PDF is not rendering correctly, you can download the PDF file here. Howard J. All material on this site has been provided by the respective publishers and authors. Cicènas S, Geater SL, Petrov P, . JAMA Netw Open 2019;2:e196803. We conducted this meta-analysis by identifying a list of immunotherapy and nonimmunotherapy oncology drugs approved by the FDA from January 2011 through November 2017 through a search of the Hematology/Oncology (Cancer) Approvals & Safety Notifications page on the FDA website (2016–2017 notifications) and archives (2011–2015 notifications).23 Notifications regarding marketing approvals, drug packaging changes, optical imaging agents, tests, treatments for adverse effects, biosimilars, nononcologic conditions, and announcements were excluded from our search. Van Cutsem E, Tabernero J, Lakomy R, . Conversely, the adjusted absolute survival benefit for PFS was 1.28 months less for immunotherapy than for nonimmunotherapy (1.99 vs 3.27 months, respectively; P=.02) (supplemental eTable 4). US Food & Drug Administration. Ann Oncol 2017;28:2340–2366. Cheng S, McDonald EJ, Cheung MC, . The routine reporting and use of RMST may assist patients, physicians, and payers in making more informed and responsible decisions regarding the healthcare of patients with cancer. Hope and hype around cancer immunotherapy. We present strmst2, a new command to implement k-sample comparisons using the restricted mean survival time (RMST) as the summary measure of the survival-time distribution.Unlike model-based summary measures such as the hazard ratio, the validity of which relies on the adequacy of the proportional-hazards assumption, the measures based on the RMST (that is, the difference in RMST, … Conventional measures of survival benefit have clinical limitations that were previously overlooked in immunotherapy trials.7, An interpretable and robust measure of clinical efficacy in survival analyses is critical to capture the full context of the benefits of oncology drugs and to make more informed decisions about the cost versus benefit of treatment options. Performs two-sample comparisons using the restricted mean survival time (RMST) as a summary measure of the survival time distribution. Fehrenbacher L, Spira A, Ballinger M, . First, if the KM curves extracted from published trials were of low quality, the accuracy of the RMST estimation may be affected. Measures of survival benefit in cancer drug development and their limitations. If discrepancies greater than the margin of error were found, the 2 reviewers repeated the extraction and calculation process to determine the reason for the discrepancy. Comparison of long-term survival benefits in trials of immune checkpoint inhibitor vs non-immune checkpoint inhibitor anticancer agents using ASCO Value Framework and ESMO Magnitude of Clinical Benefit Scale. Unlike median survival time, it is estimable even under heavy censoring. N Engl J Med 2015;372:142–152. Mailankody S, Prasad V. Five years of cancer drug approvals: innovation, efficacy, and costs. Of the 94 included trials, proportional hazards assumption was found to be violated in 45 trials; 9 (69%) of the immunotherapy trials and 36 (44%) of the nonimmunotherapy trials were found to have nonproportional hazards. Accessed March 12, 2018. Theoretical aspects of RMST (or Kaplan–Meier integrals) are well studied [5–7] and currently RMST is experiencing a renaissance [8–10] being hailed as a model-free, easy to interpret statistic with implications in causal inference [11]. Restricted mean survival time (RMST) can provide additional insight to the survival distribution and is not subject to underestimation by definition. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. Meta-analysis results of RMST difference (absolute survival benefit). September 26, 2016. JAMA Oncol 2015;1:539–540. Ann Oncol 2018;29:1320–1324. Meta-regression was conducted using Comprehensive Meta-Analysis software (version 31; Biostat, Inc.) to assess and adjust for the confounding effects of covariates. Meta-regression was conducted to adjust for potential confounders. Meta-analysis results of RMST ratio (relative survival benefit). If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation. Fundamental aspects of this approach are captured here; detailed overviews of the RMST methodology are provided by Uno and colleagues.16., 17. This allows to link your profile to this item. Clinical benefit, price and approval characteristics of FDA-approved new drugs for treating advanced solid cancer, 2000-2015. Immunotherapy trials sometimes exhibit nonproportional hazards, often because of late postprogression benefit (ie, after median survival times) or nonuniform divergence of the survival curves with potential plateau of the immunotherapy arm, with some trials even exhibiting crossing of survival curves.9–13 Median survival time also does not account for the “tail of the curve,” where the benefit of immunotherapy is more pronounced. See general information about how to correct material in RePEc. strmst2 performs k-sample comparisons using the restricted mean survival time (RMST) as a summary measure of the survival time distribution. ODS Graphics must be enabled for graphs to be produced. Control Clin Trials 1986;7:177–188. This suggests the need for future research of immunotherapy biomarkers and clinicopathologic predictors to allow better selection of patients for immunotherapy. Available at: It has been shown that HR is a relative measure of the rate of death and tends to overestimate the relative survival benefit.4,8,21 Comparability of treatment effects of immunotherapy drugs between RMST ratios and HR estimates has also been shown to be in general agreement.21 It has been suggested that it may be useful to report RMST in immunotherapy trials, in which the benefit typically is at the tail of the curve.3,21,22. The covariate of time horizon of the trial was also significant for OS RMST ratio, PFS RMST difference, and PFS RMST ratio (see supplemental eTables 4–6). Forbes. July 30, 2016. Stewart AK, Rajkumar SV, Dimopoulos MA, . Contrary to popular belief that immunotherapy provides much more benefit than nonimmunotherapy, our findings suggest that observed survival benefits of immunotherapy were not dramatically superior to those of nonimmunotherapy. Davies M. New modalities of cancer treatment for NSCLC: focus on immunotherapy. Schnipper LE, Davidson NE, Wollins DS, . Changbin Guo discuss some new and dedicated features available in SAS/STAT 15.1 that let you analyze the restricted mean survival time (RMST). The restricted mean survival time (RMST) is an alternative treatment outcome measure that can be estimated as the area under the survival curve up to a prespecified time horizon and hence can account for all survival information before that time horizon.