Abstract
Background: The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) have independently developed their own frameworks to assess the benefits of different cancer treatment options, which have significant implications in health science and policy. We aimed to compare these frameworks in nasopharyngeal carcinoma.Methods: We identified all randomized controlled trials of systemic chemotherapies for nasopharyngeal carcinoma until April 5th, 2020. Trials were eligible if significant differences favoring the experimental group in a prespecified primary or secondary outcome were reported. Two assessors independently scored the trials and the final scores were determined by consensus.Results: Fifteen trials were included in the analysis. Five different toxicity grading criteria were applied to the 15 trials. Ten (66.7%) trials did not report grade 1–2 toxicities and eight (53.3%) did not report late toxicities. The number of acute toxicities reported was strikingly different (17 vs. 8) in two trials using the same regimen. All trials met the ESMO criteria for a high level of benefit. However, significant variations in ASCO scores between trials were observed (mean [standard deviation]: 38.9 [20.0]).Conclusions: The underreporting and inconsistent reporting of toxicities would significantly impair the assessment of value using any framework. Moreover, there is a concern that the ASCO framework generated highly inconsistent scoring for treatments that met the ESMO criteria for a high level of benefit. The anomalies identified in the frameworks function would be helpful in their future improvement.
Highlights
The goal of any cancer therapy is to help patients live longer, or live better, or both
To search PubMed and Web of Science, we adopted a search algorithm used in the latest individual patient data meta-analysis of chemotherapy in Nasopharyngeal carcinoma (NPC) [4]
The language and time were not limited in the search, which was performed on April 5th, 2020
Summary
The goal of any cancer therapy is to help patients live longer, or live better, or both. The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) have proposed and updated frameworks to assess the value of cancer treatment options [1, 2]. Different sequences (induction, concurrent, adjuvant, and their combinations) and regimens of chemotherapy were used in these RCTs and controversy remains over which treatment option is optimal [4]. In recurrent or metastatic NPC, chemotherapy is the mainstay of treatment and various regimens have been used in the clinic. The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) have independently developed their own frameworks to assess the benefits of different cancer treatment options, which have significant implications in health science and policy.
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