Informative censoring — a neglected cause of bias in oncology trials

Informative censoring — a neglected cause of bias in oncology trials

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Informative censoring occurs when progression-free survival is the primary end point of a randomized clinical trial and unequal patient dropout is observed between treatment arms owing to poorer tolerance of experimental treatment. Herein we discuss how informative censoring in the experimental arm before criteria for disease progression are met causes bias towards a positive result. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Access Nature and 54 other Nature Portfolio journals Get Nature+, our best-value online-access subscription $32.99 / 30 days cancel any time Learn more Subscribe to this journal Receive 12 print issues and online access $209.00 per year only $17.42 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support REFERENCES * Ranganathan, P. & Pramesh, C. S. Censoring in survival analysis: potential for bias. _Perspect. Clin. Res._ 3, 40 (2012). Article  Google Scholar  * Stone, A. M. et al. Research outcomes and recommendations for the assessment of progression in cancer clinical trials from a PhRMA working group. _Eur. J. Cancer_ 47, 1763–1771 (2011). Article  CAS  Google Scholar  * Fleming, T. R., Rothmann, M. D. & Lu, H. L. Issues in using progression-free survival when evaluating oncology products. _J. Clin. Oncol._ 27, 2874–2880 (2009). Article  Google Scholar  * Shih, W. Problems in dealing with missing data and informative censoring in clinical trials. _Curr. Control Trials Cardiovasc. Med._ 3, 4 (2002). Article  Google Scholar  * Baselga, J. et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. _N. Engl. J. Med._ 366, 520–529 (2012). Article  CAS  Google Scholar  * Piccart, M. et al. Everolimus plus exemestane for hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: overall survival results from BOLERO-2. _Ann. Oncol._ 25, 2357–2362 (2014). Article  CAS  Google Scholar  * Templeton, A. J. et al. Influence of censoring on conclusions of trials for women with metastatic breast cancer. _Eur. J. Cancer_ 51, 721–724 (2015). Article  Google Scholar  * Sun, J. _The Statistical Analysis of Interval-Censored Failure Time Data: Statistics for Biology and Health_. (Springer, 2006). * Sparano, J. A. et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. _N. Engl. J. Med._ 379, 111–121 (2018). Article  CAS  Google Scholar  * Ethier, J.L. et al. Influence of competing risks of death on the interpretation of adjuvant endocrine therapy trials for breast cancer. _Cancer Res_. 79, Abstract P4-14-03 (2019). Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Oncology, St. Claraspital Basel, University of Basel, Basel, Switzerland Arnoud J. Templeton * Faculty of Medicine, University of Basel, Basel, Switzerland Arnoud J. Templeton * Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada Eitan Amir & Ian F. Tannock Authors * Arnoud J. Templeton View author publications You can also search for this author inPubMed Google Scholar * Eitan Amir View author publications You can also search for this author inPubMed Google Scholar * Ian F. Tannock View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Ian F. Tannock. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. SUPPLEMENTARY INFORMATION SUPPLEMENTARY TABLE 1 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Templeton, A.J., Amir, E. & Tannock, I.F. Informative censoring — a neglected cause of bias in oncology trials. _Nat Rev Clin Oncol_ 17, 327–328 (2020). https://doi.org/10.1038/s41571-020-0368-0 Download citation * Published: 09 April 2020 * Issue Date: June 2020 * DOI: https://doi.org/10.1038/s41571-020-0368-0 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

Informative censoring occurs when progression-free survival is the primary end point of a randomized clinical trial and unequal patient dropout is observed between treatment arms owing to


poorer tolerance of experimental treatment. Herein we discuss how informative censoring in the experimental arm before criteria for disease progression are met causes bias towards a positive


result. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Access Nature


and 54 other Nature Portfolio journals Get Nature+, our best-value online-access subscription $32.99 / 30 days cancel any time Learn more Subscribe to this journal Receive 12 print issues


and online access $209.00 per year only $17.42 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local


taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support REFERENCES * Ranganathan,


P. & Pramesh, C. S. Censoring in survival analysis: potential for bias. _Perspect. Clin. Res._ 3, 40 (2012). Article  Google Scholar  * Stone, A. M. et al. Research outcomes and


recommendations for the assessment of progression in cancer clinical trials from a PhRMA working group. _Eur. J. Cancer_ 47, 1763–1771 (2011). Article  CAS  Google Scholar  * Fleming, T. R.,


Rothmann, M. D. & Lu, H. L. Issues in using progression-free survival when evaluating oncology products. _J. Clin. Oncol._ 27, 2874–2880 (2009). Article  Google Scholar  * Shih, W.


Problems in dealing with missing data and informative censoring in clinical trials. _Curr. Control Trials Cardiovasc. Med._ 3, 4 (2002). Article  Google Scholar  * Baselga, J. et al.


Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. _N. Engl. J. Med._ 366, 520–529 (2012). Article  CAS  Google Scholar  * Piccart, M. et al. Everolimus plus


exemestane for hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: overall survival results from BOLERO-2. _Ann. Oncol._ 25, 2357–2362


(2014). Article  CAS  Google Scholar  * Templeton, A. J. et al. Influence of censoring on conclusions of trials for women with metastatic breast cancer. _Eur. J. Cancer_ 51, 721–724 (2015).


Article  Google Scholar  * Sun, J. _The Statistical Analysis of Interval-Censored Failure Time Data: Statistics for Biology and Health_. (Springer, 2006). * Sparano, J. A. et al. Adjuvant


chemotherapy guided by a 21-gene expression assay in breast cancer. _N. Engl. J. Med._ 379, 111–121 (2018). Article  CAS  Google Scholar  * Ethier, J.L. et al. Influence of competing risks


of death on the interpretation of adjuvant endocrine therapy trials for breast cancer. _Cancer Res_. 79, Abstract P4-14-03 (2019). Download references AUTHOR INFORMATION AUTHORS AND


AFFILIATIONS * Department of Oncology, St. Claraspital Basel, University of Basel, Basel, Switzerland Arnoud J. Templeton * Faculty of Medicine, University of Basel, Basel, Switzerland


Arnoud J. Templeton * Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada Eitan Amir & Ian F. Tannock Authors


* Arnoud J. Templeton View author publications You can also search for this author inPubMed Google Scholar * Eitan Amir View author publications You can also search for this author inPubMed 


Google Scholar * Ian F. Tannock View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Ian F. Tannock. ETHICS


DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. SUPPLEMENTARY INFORMATION SUPPLEMENTARY TABLE 1 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS


ARTICLE CITE THIS ARTICLE Templeton, A.J., Amir, E. & Tannock, I.F. Informative censoring — a neglected cause of bias in oncology trials. _Nat Rev Clin Oncol_ 17, 327–328 (2020).


https://doi.org/10.1038/s41571-020-0368-0 Download citation * Published: 09 April 2020 * Issue Date: June 2020 * DOI: https://doi.org/10.1038/s41571-020-0368-0 SHARE THIS ARTICLE Anyone you


share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the


Springer Nature SharedIt content-sharing initiative