- Email: [email protected]
An open letter to all members of the IASLC
Lung Cancer (2004) 45, 119—120
CORRESPONDANCE
An open letter to all members of the IASLC Over the last 30 years the IASLC has, through this journal, its workshops and its conferences, significantly improved the understanding of lung cancer and its management. However over the next 30 years the profile of lung cancer is likely to change. It will increasingly become a problem for developing countries and a disease of the elderly in developed countries. This means that the focus of clinical research may need to shift. Trials on complex, technically demanding and often toxic treatments, which run the risk of being applicable only to highly selected patients treated in specialist centres in wealthy countries, will need to be balanced by trials of treatments that are more widely applicable across the globe. Following the 9th World Lung Cancer Conference in Tokyo, the idea of a world strategy for clinical trials was proposed [1] and endorsed [2]. This arose from the perception that many of the randomised trials presented at that conference were too small to have sufficient power to reliably demonstrate clinically significant differences in survival, that those already published were often too heterogeneous to permit robust meta-analysis, and that the direction of trials was too focused on the more complex treatments. Although things improved a little at the recent conference in Vancouver (Table 1), these themes were repeated both in presentations [3,4] and in general discussion. In particular, one presentation [3] suggested that in trials where the true survival benefit was 5%, recruiting only 250 patients would be more likely to give a false positive than a true positive result. This together with the tendency to underpower trials because of an over-optimistic estimate of the likely benefit from new therapies, means that the evidence-base for our daily practice may be less secure than we believe. Present and future lung cancer patients and their health professionals throughout the world need relevant questions about treatment answered as
Table 1 Number of subjects recruited to randomised trials that were reported orally at two World Lung Cancer Conferences
Total number of RCTs 1000—1999 subjects 500—999 subjects 250—499 subjects <250 subjects Median number of subjects Range
Tokyo (2000)
Vancouver (2003)
32 1 5 6 20 219
32 2 4 18 8 325
68—1019
40—1867
efficiently and reliably as possible. To do this we believe we all need to collaborate and run much larger trials over much shorter time periods on topics that are widely applicable. We would welcome responses to this idea, and if possible practical suggestions for collaboration and trials. We believe that the IASLC is ideally placed to take the lead in fostering a global strategy for such clinical trials and will be writing to the Board asking them to provide a forum for discussion at the next World Conference (or before), where practical ideas could be shared and a plan developed. This is an opportunity to develop something unique and exciting that we believe will make a real difference to lung cancer care over the next 30 years.
References [1] Stephens R. Time for a global strategy to improve the treatment of lung cancer? Lung Cancer 2001;31(2–3):349. [2] Macbeth F. A global strategy must be a priority for the IASLC. Lung Cancer 2001;34:461. [3] Stephens R. The need for a world strategy for clinical trials. Lung Cancer 2003;1(S3):S96. [4] Crowley J. Lung cancer clinical trials: principles and pitfalls. Lung Cancer 2003;41(S3):S26.
0169-5002/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.lungcan.2004.04.001
120
F. Macbeth et al. Fergus Macbeth∗ Velindre Hospital, Whitchurch Cardiff CF14 2TL, UK Richard Stephens MRC Clinical Trials Unit, 222 Euston Road London NW1 2DA, UK
Raymond P. Abratt Groote Schuur Hospital, 7925 Observatory Road Cape Town, South Africa Roderigo Arriagada Instituto de Radiomedecina, Americo Vespucio Norte 1314, Vitacura 124, Santiago 34, Chile
John Crowley Cancer Research and Biostatistics 1730 Minor Ave Seattle, WA 98101, USA Mary O’Brien The Royal Marsden Hospital, Downs Road Sutton, Surrey SM2 5PT, UK Tom Shakespeare The Cancer Institute, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
David Ball Peter MacCallum Cancer Centre, Locked Bag 1 A’Beckett Street, Melbourne, 8006 Vic., Australia
Elinor Thompson Cochrane Lung Cancer Review Group Hospital de la Santa Creu i Sant Pau St Antoni M Claret 171 08041 Barcelona, Spain
Andrea Bezjak Princess Margaret Hospital, 610 University Avenue, Toronto, Ont., Canada M5G 2M9
Jan van Meerbeeck University Hospital, De Pintelaan 185 B9000 Ghent, Belgium
Lucinda Billingham Cancer Research UK Clinical Trials Unit Institute for Cancer Studies, University of Birmingham, Birmingham B15 2TT, UK
∗ Corresponding
author E-mail address: [email protected] (F. Macbeth)
CORRESPONDANCE
An open letter to all members of the IASLC Over the last 30 years the IASLC has, through this journal, its workshops and its conferences, significantly improved the understanding of lung cancer and its management. However over the next 30 years the profile of lung cancer is likely to change. It will increasingly become a problem for developing countries and a disease of the elderly in developed countries. This means that the focus of clinical research may need to shift. Trials on complex, technically demanding and often toxic treatments, which run the risk of being applicable only to highly selected patients treated in specialist centres in wealthy countries, will need to be balanced by trials of treatments that are more widely applicable across the globe. Following the 9th World Lung Cancer Conference in Tokyo, the idea of a world strategy for clinical trials was proposed [1] and endorsed [2]. This arose from the perception that many of the randomised trials presented at that conference were too small to have sufficient power to reliably demonstrate clinically significant differences in survival, that those already published were often too heterogeneous to permit robust meta-analysis, and that the direction of trials was too focused on the more complex treatments. Although things improved a little at the recent conference in Vancouver (Table 1), these themes were repeated both in presentations [3,4] and in general discussion. In particular, one presentation [3] suggested that in trials where the true survival benefit was 5%, recruiting only 250 patients would be more likely to give a false positive than a true positive result. This together with the tendency to underpower trials because of an over-optimistic estimate of the likely benefit from new therapies, means that the evidence-base for our daily practice may be less secure than we believe. Present and future lung cancer patients and their health professionals throughout the world need relevant questions about treatment answered as
Table 1 Number of subjects recruited to randomised trials that were reported orally at two World Lung Cancer Conferences
Total number of RCTs 1000—1999 subjects 500—999 subjects 250—499 subjects <250 subjects Median number of subjects Range
Tokyo (2000)
Vancouver (2003)
32 1 5 6 20 219
32 2 4 18 8 325
68—1019
40—1867
efficiently and reliably as possible. To do this we believe we all need to collaborate and run much larger trials over much shorter time periods on topics that are widely applicable. We would welcome responses to this idea, and if possible practical suggestions for collaboration and trials. We believe that the IASLC is ideally placed to take the lead in fostering a global strategy for such clinical trials and will be writing to the Board asking them to provide a forum for discussion at the next World Conference (or before), where practical ideas could be shared and a plan developed. This is an opportunity to develop something unique and exciting that we believe will make a real difference to lung cancer care over the next 30 years.
References [1] Stephens R. Time for a global strategy to improve the treatment of lung cancer? Lung Cancer 2001;31(2–3):349. [2] Macbeth F. A global strategy must be a priority for the IASLC. Lung Cancer 2001;34:461. [3] Stephens R. The need for a world strategy for clinical trials. Lung Cancer 2003;1(S3):S96. [4] Crowley J. Lung cancer clinical trials: principles and pitfalls. Lung Cancer 2003;41(S3):S26.
0169-5002/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.lungcan.2004.04.001
120
F. Macbeth et al. Fergus Macbeth∗ Velindre Hospital, Whitchurch Cardiff CF14 2TL, UK Richard Stephens MRC Clinical Trials Unit, 222 Euston Road London NW1 2DA, UK
Raymond P. Abratt Groote Schuur Hospital, 7925 Observatory Road Cape Town, South Africa Roderigo Arriagada Instituto de Radiomedecina, Americo Vespucio Norte 1314, Vitacura 124, Santiago 34, Chile
John Crowley Cancer Research and Biostatistics 1730 Minor Ave Seattle, WA 98101, USA Mary O’Brien The Royal Marsden Hospital, Downs Road Sutton, Surrey SM2 5PT, UK Tom Shakespeare The Cancer Institute, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
David Ball Peter MacCallum Cancer Centre, Locked Bag 1 A’Beckett Street, Melbourne, 8006 Vic., Australia
Elinor Thompson Cochrane Lung Cancer Review Group Hospital de la Santa Creu i Sant Pau St Antoni M Claret 171 08041 Barcelona, Spain
Andrea Bezjak Princess Margaret Hospital, 610 University Avenue, Toronto, Ont., Canada M5G 2M9
Jan van Meerbeeck University Hospital, De Pintelaan 185 B9000 Ghent, Belgium
Lucinda Billingham Cancer Research UK Clinical Trials Unit Institute for Cancer Studies, University of Birmingham, Birmingham B15 2TT, UK
∗ Corresponding
author E-mail address: [email protected] (F. Macbeth)