Prospective Comparisons of Clinical Trial and Real-world Outcomes in Nasopharyngeal Carcinoma

Study Overview
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Brief Summary
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Study results from randomized controlled trials (RCTs) usually have been found not adequately inform practice. A RCT is optimized to determine efficacy, while real-world study is conducted in a routine care setting aimed to determine effectiveness. Thus, it is necessary to evaluate the pragmatism of clinical trials for a better understanding of the external generalizability. Nonetheless, comparative pragmatic features of RCTs and real-world studies still lack well elucidation. By capitalizing on a nasopharyngeal carcinoma (NPC)-specific big-data, real-world database and individual patient data extracted from three landmark RCTs, investigators conducted the direct comparison of NPC cohorts receiving same treatment strategy in clinical trial versus real-world settings, and examined the comparative pragmatic features and their influences on survival outcomes, safety profile, and the probability of returning to society.

Detailed Description
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Study results from randomized controlled trials (RCTs) usually have been found not adequately inform practice. A RCT is optimized to determine efficacy. Such trials were performed with relatively small samples at sites with experienced investigators and highly selected participants, they could be overestimating benefits and underestimating harm. Real-world study is conducted in a routine care setting aimed to determine effectiveness. Thus, it is necessary to evaluate the pragmatism of clinical trials for a better understanding of the external generalizability. Nonetheless, comparative pragmatic features of RCTs and real-world studies still lack well elucidation. Nasopharyngeal carcinoma (NPC) is a malignant head and neck cancer with the highest incidences in endemic regions such as Southern China, where over 60,600 new cases were diagnosed in 2015 representing 40% of all cases worldwide. Studies conducted in China are critical in optimizing clinical decision-making of NPC. In the past two decades, the recommendation level of induction chemotherapy (IC) + concurrent chemoradiotherapy (CCRT) has been improved evidently from Category 3 to 2A, and CCRT alone has long been a stable (Category 2B) and classic treatment option of NPC and therefore becomes the most commonly used control group in comparative studies. By capitalizing on a NPC-specific big-data, real-world database via a cancer registry in Southern China and individual patient data extracted from the three landmark RCTs, investigators conducted the direct comparison on IC+CCRT cohort or CCRT cohort of clinical trial versus real-world settings, and examined the comparative pragmatic features and their influences on survival outcomes, safety profile, and the probability of returning to society, with the aim to provide new insight into the optimization of trial design and the translation of study evidences into tangible benefits.

Official Title
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Prospective Comparisons of Survival Outcomes, Safety Profile, and Probability of Returning to Society Between Three Randomized Controlled Trials and Real-world Evidence in Nasopharyngeal Carcinoma.

Conditions
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Nasopharyngeal Carcinoma

Intervention / Treatment
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* Other: Trial setting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients treated in our center from April 2009 to December 2016; All patients were pathologically diagnosed, non-metastatic nasopharyngeal carcinoma; Only included cases staged as T3-4N1 & T1-4N2-3 according to the 6th or 7th edition American Joint Committee on Cancer / Union for International Cancer Control (AJCC/UICC) system; For trial patients, treatment strategies only limited to concurrent chemoradiotherapy, induction chemotherapy combined with concurrent chemoradiotherapy, or concurrent chemoradiotherapy combined with adjuvant chemotherapy; For patients from real-world database, patients are permitted to receive additional targeted therapy to standard chemoradiotherapy, as far as it met clinical needs and was approved by physicians. The patient's basic information, prognosis related data, and follow-up data are complete. Exclusion Criteria: The clinical stage of T3-4N0 was excluded; Cases from large real-world databases need to exclude patients who participate in clinical trials;

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CCRT-randomized clinical trial<br>Trial patients receiving CCRT | Other: Trial setting<br>* Study results from clinical trials usually have been found not work efficiently in clinical practice. This outcome disparity may be caused by different pragmatic features of medical environment, also known as study setting such as trial setting and real-world setting, in which biases inherent to clinical trial design restrict its applicability even though all confounding factors are avoided.<br>* Other names: Non-pragmatic features;|
| CCRT-real-world database<br>Patients receiving CCRT from real-world database | |
| IC+CCRT-randomized clinical trial<br>Trial patients receiving IC+CCRT | Other: Trial setting<br>* Study results from clinical trials usually have been found not work efficiently in clinical practice. This outcome disparity may be caused by different pragmatic features of medical environment, also known as study setting such as trial setting and real-world setting, in which biases inherent to clinical trial design restrict its applicability even though all confounding factors are avoided.<br>* Other names: Non-pragmatic features;|
| IC+CCRT-real-world database<br>Patients receiving IC+CCRT from real-world database | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival | Overall survival is measured from day of diagnosis until death due to any cause or the latest known date alive. | 5-year | 
| Failure-free survival (FFS) | Failure-free survival is measured from day of diagnosis to locoregional failure, distant failure, or death from any cause, whichever occurred first. | 5-year | 
| Locoregional failure-free survival (LRFFS) | Locoregional failure-free survival is measured from day of diagnosis to first locoregional failure. | 5-year | 
| Distant failure-free survival (DFFS) | Distant failure-free survival is measured from day of diagnosis to distant failure. | 5-year | 
| Probability of studying/work stoppage caused by disease and treatment | Probability of learning (students who are in college/university/school before illness) or work (staff who are working before illness) stoppage due to illness and treatment. | 5-year | 
| Probability of returning to studying/work after suspending | Probability of returning to learning (students who are in college/university/school before illness) or work (staff who are working before illness) after suspending due to illness and treatment. | 5-year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of radioactive brain injury | Incidence of radioactive brain injury according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of hearing loss | Incidence of hearing loss according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of blind | Incidence of blind according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of decreased taste | Incidence of decreased taste according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of second cancer | Incidence of second cancer according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of dysphagia | Incidence of dysphagia according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of malnutrition | Incidence of malnutrition according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 
| Incidence of hypothyroidism | Incidence of hypothyroidism according to the Common Terminology Criteria for Adverse Events (version 4.0). | 5-year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Clinical trial, Real-world study, Nasopharyngeal carcinoma, Pragmatism, Survival, Return to society