Paper of the Month - January, 2012

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Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials.

Early Breast Cancer Trialists’ Collaborative Group.
The quinquennial turning of the handle by the Early Breast Cancer Trials Collaborative Group (EBCTCG) on individual patient data, in this instance to evaluate the effects of adjuvant chemotherapy, must get considerably more difficult as the years go by. This latest analysis includes >100 000 patients involved in studies of adjuvant chemotherapy for early stage breast cancer. As ever, the analysis has produced a lot of food for thought and will doubtless generate considerable discussion within the breast oncology community. This particular iteration of the overview is, I believe, particularly informative since the clinical heterogeneity of some of the trials involved (not necessarily supported in a statistical sense) has been recognized and, largely through efforts by Angelo di Leo and Jonas Bergh, different classifications of chemotherapy comparisons are now included, which go a considerable way towards underscoring our interpretations of individual clinical trial data. Conversely, however, in reading the article, it is clear that there is something of a tension between the hardcore statistical approach and the hopes of clinicians to define subgroups more or less likely to benefit from adjuvant chemotherapy. In this respect, in the preamble to the data, the authors comment that X2 values are not generally high enough for subgroup analyses to be “wholly reliable”, a warning shot across the bows of those of us who are tempted to torture the data to excess.


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