OnCo
ideasIdea

Validate real-world progression endpoints so pragmatic trials can use them

Pragmatic trials want to use the progression dates recorded in ordinary clinic notes instead of expensive protocol scans. Checking how well those routine records match formal trial measurements would show when that shortcut is safe.

Paired studies in which patients enrolled in conventional trials also have their routine clinical progression (rwPFS from clinician notes and imaging reports, abstracted or NLP-derived) captured, quantifying agreement in progression dates and hazard ratios by tumour type. Regulators publish acceptable-use conditions for rwPFS and time-to-next-treatment as endpoints in pragmatic and registry-based trials.

Hypothesis
In common solid tumours, rwPFS will yield hazard ratios within a pre-specified tolerance of RECIST-based PFS, enabling pragmatic trials to drop protocol imaging schedules in those settings.
Rationale
Retrospective comparisons of rwPFS and trial PFS show reasonable agreement in some cancers; prospective paired validation would allow protocol-free endpoints and make registry-embedded and pragmatic trials far cheaper.
What would test it
Embed routine-record endpoint capture in three ongoing phase 3 trials and report concordance of progression dates and hazard ratios.
Maturity
early clinical
Who has to act
data
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks

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