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In the absence of randomized trials, the benefit and best way of patient selection remain unclear.
However, due to the lack of randomized trials, the benefit of concurrent chemoradiation over radiation in cervical cancer patients with intermediate-risk factors remains unclear.
A different approach for addressing this problem has been to explore in prospective trials the benefit of non-cisplatin-based treatments.
Although the clinical benefit of adjuvant chemotherapy in patients with non-small cell lung cancer (NSCLC) who have undergone complete surgical resection has been observed in stage II IIIA in some prospective clinical trials, the benefit has not been seen in stage I NSCLC [ 50– 50].
Based on data from randomised clinical trials, the benefit of compounds that inhibit angiogenesis has already been demonstrated in several types of cancer, including metastatic colon carcinoma (Kabbinavar et al, 2003), renal cell carcinoma (Motzer et al, 2007), and non-small lung cell carcinoma (Sandler et al, 2006).
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Despite the enrolment of more than 3000 women in randomised trials, the benefits and risks of neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer remain uncertain.
In all these trials the benefits of renin-angiotensin-aldosterone system blockade on chronic kidney disease appeared to be beyond those attributable solely to changes in blood pressure.
The difficulty is that, as for participants in most clinical trials, the benefits of nested recruitment studies accrue to the wider scientific community in the future, whereas the costs fall more immediately on the research team.
In clinical trials, the benefits of a new treatment strategy should be weighed carefully against the adverse effects of that treatment, in terms of overall and progression-free survivals, as well as in terms of HRQoL.
For the moment, observers are willing to give the trial the benefit of the doubt.
However, it should be noted that in the ISEL trial, the benefit was of borderline significance (treatment by biomarker interaction test P=0.049; Hirsch et al, 2006).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com