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Article Dans Une Revue JNCI: Journal of the National Cancer Institute Année : 2019

Assessing Long-Term Survival Benefits of Immune Checkpoint Inhibitors Using the Net Survival Benefit

Julien Péron
  • Fonction : Auteur
Alexandre Lambert
  • Fonction : Auteur
Stephane Munier
  • Fonction : Auteur
Brice Ozenne
  • Fonction : Auteur
Joris Giai
Stéphane Dalle
Abigirl Machingura
  • Fonction : Auteur
Marc Buyse
  • Fonction : Auteur

Résumé

Abstract Background The treatment effect in survival analysis is commonly quantified as the hazard ratio, and tested statistically using the standard log-rank test. Modern anticancer immunotherapies are successful in a proportion of patients who remain alive even after a long-term follow-up. This new phenomenon induces a nonproportionality of the underlying hazards of death. Methods The properties of the net survival benefit were illustrated using the dataset from a trial evaluating ipilimumab in metastatic melanoma. The net survival benefit was then investigated through simulated datasets under typical scenarios of proportional hazards, delayed treatment effect, and cure rate. The net survival benefit test was computed according to the value of the minimal survival difference considered clinically relevant. As comparators, the standard and the weighted log-rank tests were also performed. Results In the illustrative dataset, the net survival benefit favored ipilimumab [Δ(0) = 15.8%, 95% confidence interval = 4.6% to 27.3%, P = .006]. This favorable effect was maintained when the analysis was focused on long-term survival differences (eg, >12 months, Δ(12) = 12.5% (95% confidence interval = 4.4% to 20.6%, P = .002). Under the scenarios of a delayed treatment effect and cure rate, the power of the net survival benefit test compared favorably to the standard log-rank test power and was comparable to the power of the weighted log-rank test for large values of the threshold of clinical relevance. Conclusion The net long-term survival benefit is a measure of treatment effect that is meaningful whether or not hazards are proportional. The associated statistical test is more powerful than the standard log-rank test when a delayed treatment effect is anticipated.

Dates et versions

hal-03836883 , version 1 (02-11-2022)

Identifiants

Citer

Julien Péron, Alexandre Lambert, Stephane Munier, Brice Ozenne, Joris Giai, et al.. Assessing Long-Term Survival Benefits of Immune Checkpoint Inhibitors Using the Net Survival Benefit. JNCI: Journal of the National Cancer Institute, 2019, 111 (11), pp.1186-1191. ⟨10.1093/jnci/djz030⟩. ⟨hal-03836883⟩

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