Benefits of Using Comparative-Effectiveness Data in Lieu of Clinical Trials to Support Treatment Strategies

A lack of randomized controlled trials (RCTs) shouldn’t rule out the use of effective treatment strategies, such as stereotactic ablative radiotherapy (SABR), for lung cancer, urged a prominent oncologist recently. Instead, comparative-effectiveness research should be viewed as an alternative source of evidence to determine the best treatment strategies for patients with lung cancer.

During his acceptance speech for the Heine H Hansen award at the 2016 European Lung Cancer Conference in Geneva, Switzerland (April 13-16, 2016), Suresh Senan, MD, PhD, University Medical Centre in Amsterdam, The Netherlands, said that the current landscape of health care will increasingly require clinicians to use observational and registry data to make informed decisions, rather than data from RCTs.
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Dr Senan received the reward in recognition of his contributions to the research of nonsurgical treatments for lung cancer. One such strategy is SABR. In 1998, observational data revealed that SABR could be curative in patients with lung cancer whose tumors were smaller than 4 cm in size. When trials were organized to test the use of SABR and other nonsurgical options, many were closed before completion because they were unable to recruit enough patients.

Many trials for radiotherapy of lung cancer encounter this problem, because patients with the disease are hesitant to enter trials where surgery is not included. In addition, current trial formats often segment patients with non-small cell lung cancer into smaller groups based on their presenting tumor subtype, making it difficult to randomize these small subsets into different treatment arms.  

Nevertheless, Dr Senan continued, many guidelines recommend SABR as an option for inoperable patients or for those who refuse surgery. In patients with lung cancer who are over the age of 70 years, SABR has demonstrated benefit over forgoing treatment.