This figure represents the proportion of patients who received best standard of care amoung those receiving a systemic treatment upon recurrence in the control arm of FDA registration trials with post-recurrence data (from 2018 to 2024, last updated June 2024).

The dotted red line represents a prespecified rule: at least 90% of patients receiving systemic therapy at recurrence should receive optimal therapy. The blue bars represent trials where the maximum estimate was above 90%, other trials are in light-brown.

Additional black lines:
In some trials, like melanoma trials, because post-recurrence data were provided in aggregate and because the best treatment upon recurrence is not unique, we estimated the maximum and minimum access to optimal therapies. In those the minimum estimate is represented by a black line within the bar.
Here is a detailed explanation: ”Post-recurrence data may be reported in aggregate with same patients possibly receiving different lines of therapies. It may therefore be challenging to assess how many patients got access to optimal care, particularly when the preferred systemic therapy is not unique. In those cases, we estimated two scenarios. For instance, in an adjuvant melanoma trial, optimal therapies upon progression are BRAF and MEK inhibitors or anti-PD1 containing regimens. In a first scenario, we selected the highest number of patients receiving one of the two standard-of-care strategies, and made the “worst case scenario” assumption, assuming the same patients also received the other standard-of-care therapy as another line of therapy, and the remaining patients had no access to either option. Conversely, we estimated a “best case scenario”, adding up the numbers of patients receiving different therapies, which often resulted in more than 100% of patients.“

Best standard of care for patients in the control arm receiving a systemic therapy at recurrence:
COMBI-AD: Checkpoint inhibitor(s) or BRAF plus MEK inhibitors.
EORTC 1325-MG/KEYNOTE-054: Checkpoint inhibitor(s) or BRAF plus MEK inhibitors.
ADAURA: Osimertinib.
CheckMate 577: Checkpoint inhibitor containing regimen.
Impower010: Checkpoint inhibitor containing regimen.
KEYNOTE-564: Checkpoint inhibitor containing regimen. 
KEYNOTE-716: Checkpoint inhibitor(s) or BRAF plus MEK inhibitors.
CheckMate-816: Checkpoint inhibitor containing regimen.
CheckMate-76K: Checkpoint inhibitor(s) or BRAF plus MEK inhibitors.
KEYNOTE-671: Checkpoint inhibitor containing regimen
ALINA: alectinib or lorlatinib.

The data are also available in a table here.

This Shiny App was created by Timothée Olivier