NCI-Funded Trials Have Extended Lives of US Patients With Cancer

Pam Harrison

June 06, 2017

CHICAGO — An estimated 3.34 million life-years has been added to patients affected by cancer in the United States, at a modest investment of $125 per life-year gained, from clinical trials of therapy conducted by the National Cancer Institute (NCI)–sponsored network cooperative research group, Southwest Oncology Group (SWOG).

"The NCI's investment in SWOG and our network has resulted in a significant benefit to the American public," Joseph Unger, PhD, Fred Hutchinson Cancer Research Center, Seattle, Washington, said in a statement.

A lot of people with cancer have lived longer because of the therapies tested. Dr Joseph Unger

 

"A lot of people with cancer have lived longer because of the therapies tested in our publicly-funded trials," he added.

"At the same time, the cost of this research is relatively low so with high impact and low cost, it's a great value for taxpayers," Dr Unger suggested.

The analysis was presented here on June 5 at the American Society of Clinical Oncology (ASCO) 2017 Annual Meeting and published simultaneously online in JAMA Oncology.

Broad Range of Cancers

The study included 193 randomized phase 3 trials conducted by SWOG between 1956 and 2016, which were analyzed for evidence that a new therapy for a broad range of cancers led to a statistically significant improvement in overall survival (OS) compared with existing therapies. 

Of these, 23 trials, or 11.9% of all SWOG-conducted trials, indicated that the new experimental therapy led to a significant improvement in OS for patients involved in the trials. Some 12,361 patients participated in these 23 trials, which were conducted between 1965 and 2012.

"Recently completed trials typically generated fewer life-years than older trials," the authors write.

"[But] given the duration of the time under examination, estimates of cumulative life-years gained were only modestly attenuated if new treatment uptake was assumed to occur after (rather than at) the trial publication date," they add.

Projected life-years gained also increased over time, the study authors point out. For example, by the year 2020, life-years gained as a result of the 23 positive SWOG trials were projected to be 4.32 million; through to 2025, life-years gained were projected to be 5.38 million.

By 2030, projected life-years gained by the same 23 positive SWOG trials were estimated to be 6.29 million.

"We estimated the US dollar return on investment for funding agencies through support of a cooperative cancer clinical trials group," Dr Unger and coauthors continue.

Having cost the federal government $418 million over SWOG's 60-year history, "the US dollar return on investment for funding agencies is the ratio of the total expenditures to life-years gained, or $125 per life-year gained through 2015," they observe.

Projected over time, the cost per life-year gain is expected to drop over time: $113 for 2020, $106 for 2025, and $104 for 2030.

As the study authors point out, SWOG treatment trials have benefitted patients in other ways rather than simply prolonging survival. For instance, the trials might have shown that a new therapy reduced toxicity or morbidity compared with an existing treatment.

Prevention trials in turn might have identified ways to prevent cancer or shown that previous strategies used to prevent cancer might in fact be harmful.

On the other hand, findings from the current analysis are based on several important assumptions, notably that physicians immediately adopted changes in oncology practice as soon as SWOG published their findings.

Asked to comment on this particular assumption, Dr Unger told Medscape Medical News that the authors did in fact recognize that assuming a new treatment would be instantly diffused into the oncology community might seem unrealistic.

"However, to address this, we estimated life-years gained under the assumption that diffusion occurred at 1, 2, and 3 years after trial publication," he explained.

"And while the total life-years gained was smaller, it was only modestly so," he added: at 3.19 million years if the new treatment were adopted a year later, 3.04 million if adopted 2 years later, and 2.9 million if adopted 3 years later.

Dr Unger also pointed out that diffusion of new treatments can occur before publication of definitive trial results if information about the treatment has already begun to filter into the treatment community based on early-phase trial results.

"A limitation of this study is that it only considers life-years gained from trials showing benefit on overall survival," Dr Unger said.

"But other trials showed benefits in more proximal survival endpoints, like progression-free survival, so these studies may also have changed standard of care, leading to survival gains in the general cancer population," he added.

The authors have disclosed no relevant financial relationships.

American Society of Clinical Oncology (ASCO) 2017 Annual Meeting. Abstract 6513. Presented June 5, 2017.

JAMA Oncol. Published online June 5, 2017. Abstract

Follow Medscape Oncology on Twitter: @MedscapeOnc

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