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Article Dans Une Revue Journal of Clinical Epidemiology Année : 2024

Restricted Net Treatment Benefit in oncology

Max Piffoux
Brice Ozenne
  • Fonction : Auteur
Mickaël de Backer
  • Fonction : Auteur
Marc Buyse
  • Fonction : Auteur
Jean-Christophe Chiem
Julien Péron

Résumé

Objectives: The restricted Net Treatment Benefit (rNTB) is a clinically meaningful and tractable estimand of the overall treatment ef- fect assessed in randomized trials when at least one survival endpoint with time restriction is used. Its interpretation does not rely on para- metric assumptions such as proportional hazards, can be estimated without bias even in the presence of independent right-censoring, and can include a prespecified threshold of minimal clinically relevant difference. To demonstrate that the rNTB, corresponding to the NTB during a predefined time interval, is a meaningful and adaptable measure of treatment effect in clinical trials. Methods: In this simulation study, we tested the impact on the rNTB value, estimation, and power of several factors including the pres- ence of a delayed treatment effect, minimal clinically relevant difference threshold value, restriction time value, and the inclusion of both efficacy and toxicity in the rNTB definition. The impact of right censoring on rNTB was assessed in terms of bias. rNTB-derived statistical tests and log rank (LR) tests were compared in terms of power. Results: RNTB estimates are unbiased even in case of right-censoring. rNTB may be used to estimate the benefit/risk ratio of a new treatment, for example, taking into account both survival and toxicity and include several prioritized outcomes. The estimated rNTB is much easier to interpret in this context compared to NTB in the presence of censoring since the latter is intrinsically dependent on the follow-up duration. Including toxicity increases the test power when the experimental treatment is less toxic. rNTB-derived test power in- creases when the experimental treatment is associated with longer survival and lower toxicity and might increase in the presence of a cure rate or a delayed treatment effect. Case applications on the PRODIGE, Checkmate-066, and Checkmate-067 trials are provided. Conclusions: RNTB is an interesting alternative to describe and test the treatment’s effect in a clear and understandable way in case of restriction, particularly in scenarios with nonproportional hazards or when trying to balance benefit and safety. It can be tuned to take into consideration short- or long-term survival differences and one or more prioritized outcomes.
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hal-04591070 , version 1 (28-05-2024)

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Max Piffoux, Brice Ozenne, Mickaël de Backer, Marc Buyse, Jean-Christophe Chiem, et al.. Restricted Net Treatment Benefit in oncology. Journal of Clinical Epidemiology, 2024, 170, pp.111340. ⟨10.1016/j.jclinepi.2024.111340⟩. ⟨hal-04591070⟩
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