Study finds shifts in treatment trends prior to publication of study results

The percentage of women receiving adjuvant chemotherapy who received taxanes such as paclitaxel remained at around 10% from 1994 to early 1998, and after early 1998 the rate of increase over time increased more than sevenfold. Rates of taxane use increased primarily in women with node-positive breast cancer in early 1998, and it also increased in women with node-negative breast cancer by the end of 1999, even though such women were not included in the CALGB study. The authors suggest the increased use resulted from publicity at ASCO and consequent media coverage. They caution medical decisions based on premature data from a meeting presentation may pose a risk for patients who could be exposed to drugs that may have toxic effects before the drugs' benefits have been definitively established.

The authors write, "Although in many ways this example represents a best-case scenario, in which the meeting report of a multicenter randomized trial turns out to have stimulated the adoption of a treatment that has eventually become part of evidence-based practice, it also illustrates the enormous power of highly publicized meeting presentations. Investigators should be aware of the potential impact of their presentations and exercise appropriate caution and judgment in their interpretation of research findings."

In an accompanying editorial, Lisa M. Schwartz, M.D., and Steven Woloshin, M.D., of the VA Outcomes Group in White River Junction, Vt., discuss the problems and benefits of adopting a new therapy or research finding based on preliminary evidence presented at a national meeting. They present the story of Iressa (gefitinib), a drug used for treating lung cancer, prescribed based on early studies that didn't have control groups and that used surrogate endpoints, such as decrease in tumor size, rather than clinical endpoints, such as improved survival. In addition to having the occasional toxic side effect of fatal pneumonia, Iressa later did not imp

Contact: Ariel Whitworth
Journal of the National Cancer Institute

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