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Borderline Ovarian Mucinous Tumor Phase 3 Time-to-Event Analysis NCT01081262

Carboplatin and Paclitaxel or Oxaliplatin and Capecitabine With or Without Bevacizumab as First-Line Therapy in Treating Patients With Newly Diagnosed Stage II-IV or Recurrent Stage I Epithelial Ovarian or Fallopian Tube Cancer: Complete Statistical Analysis

This randomized phase III trial compares four first-line chemotherapy regimens, with or without bevacizumab, for mucinous epithelial ovarian or fallopian tube cancer. The posted results report overall survival medians by arm, but do not report a sponsor-estimated hazard ratio or a two-arm comparison analysis.

Trial start: 2010-10-12  ·  Enrollment: 50  ·  Sponsor: National Cancer Institute (NCI)
Scope of this record

This page provides an independent statistical analysis and educational interpretation of publicly reported results. ClinicalTrials.gov provides the official trial registry record. Numerical trial results on this page are restricted to the results posted in the ClinicalTrials.gov record; calculations added by Clinical Biostats are labelled as such.

1. Trial at a Glance

This page covers the registry results for Carboplatin and Paclitaxel or Oxaliplatin and Capecitabine With or Without Bevacizumab as First-Line Therapy in Treating Patients With Newly Diagnosed Stage II-IV or Recurrent Stage I Epithelial Ovarian or Fallopian Tube Cancer (NCT01081262), a randomized phase 3 study. The primary outcome is Overall Survival.

50
Enrollment
Phase 3
4
Arms
In the primary outcome
n/a
Effect
No re-analysis shown
n/a
95% CI
See limitations
FeatureRegistry value
ClinicalTrials.gov identifierNCT01081262
PhasePhase 3
ConditionBorderline Ovarian Mucinous Tumor, Ovarian Mucinous Cystadenocarcinoma, Recurrent Fallopian Tube Carcinoma
AllocationRandomized
Design modelParallel
MaskingNone (open label)
Enrollment50
Arms in the primary outcome4
Lead sponsorNational Cancer Institute (NCI)
Results postedYes

2. Clinical Question

Population

The registry describes patients with newly diagnosed stage II-IV or recurrent stage I epithelial ovarian or fallopian tube cancer. The official title specifies mucinous epithelial ovarian or fallopian tube cancer, and the condition list includes mucinous ovarian tumors as well as ovarian and fallopian tube cancer stages. The primary outcome population is all randomized patients.

Intervention

One treatment strategy combines carboplatin and paclitaxel; another combines oxaliplatin and capecitabine. Each strategy is also studied with bevacizumab, creating two additional treatment groups. The treatment arms therefore allow comparisons between chemotherapy combinations and between regimens with and without bevacizumab, although the posted results do not provide formal comparisons for those questions.

Comparator

The four groups are carboplatin and paclitaxel, oxaliplatin and capecitabine, carboplatin and paclitaxel with bevacizumab, and oxaliplatin and capecitabine with bevacizumab. The registry identifies the carboplatin-and-paclitaxel group as the control. Random allocation is reported, and masking is listed as none.

Primary question

The primary endpoint is overall survival, defined as time from study entry to death or last contact. The posted results give a median overall survival for each arm. They do not report a hazard ratio or an inferential comparison between treatment groups, so the medians alone do not establish whether the regimens differ in overall survival.

3. Trial Design

This is a randomized, open-label, parallel-group phase III trial sponsored by the National Cancer Institute. The registry lists an enrollment of 50 and four treatment arms. The posted outcome data include 13 patients in the carboplatin-and-paclitaxel arm, 13 in the oxaliplatin-and-capecitabine arm, 13 in the carboplatin-and-paclitaxel-with-bevacizumab arm, and 11 in the oxaliplatin-and-capecitabine-with-bevacizumab arm. These are arm-specific figures; the registry record does not explain the relationship between the enrollment field and the reported outcome counts.

The treatment descriptions specify chemotherapy combinations, with bevacizumab added in two arms. The two chemotherapy backbones are not identical, so a comparison between those arms would assess different combinations rather than changing only one drug. Comparisons between the two arms using the same chemotherapy backbone would address the addition of bevacizumab, but no formal results for these contrasts are reported.

The carboplatin and paclitaxel regimen is described as intravenous treatment on day 1, repeated every 3 weeks for 6 courses. The oxaliplatin and capecitabine regimen is described as intravenous oxaliplatin on day 1 and oral capecitabine on days 1-14, also repeated every 3 weeks for 6 courses. Bevacizumab is included with each corresponding combination in the other arms. The description for the carboplatin, paclitaxel, and bevacizumab arm also mentions bevacizumab alone after the combination courses, but the available arm description is truncated; the full continuation is not reported in the registry record.

The study start is listed as 2010-10-12, and primary completion as 2015-02-25. The registry status is active, not recruiting. The specific randomization procedure, allocation concealment, site-level details, and protocol deviations are not reported in the registry record.

4. Participant Flow and Accounting

The registry reports how participants moved through each stage of the study. All counts below are exactly as posted; missing counts are not inferred from other stages.

Overall Study

StageArm I (Carboplatin and Paclitaxel)Arm II (Oxaliplatin and Capecitabine)Arm III (Carboplatin, Paclitaxel, Bevacizumab)Arm IV (Oxaliplatin, Capecitabine, Bevacizumab)
STARTED13131311
COMPLETED13131311
NOT COMPLETED0000

Analysis population for the primary outcome, as defined in the registry: All randomized patients

5. Baseline Characteristics

The table reproduces the baseline characteristics posted in the registry, which describe the participants analysed at baseline and help show whether the randomized groups were comparable.

Population: Eligible and Treated Patients

CharacteristicUnitArm I (Carboplatin and Paclitaxel)Arm II (Oxaliplatin and Capecitabine)Arm III (Carboplatin, Paclitaxel, Bevacizumab)Arm IV (Oxaliplatin, Capecitabine, Bevacizumab)Total
Participants analysed1313131150
Age, Customized: 20-29 yearsParticipants21014
Age, Customized: 30-39 yearsParticipants13329
Age, Customized: 40-49 yearsParticipants21137
Age, Customized: 50-59 yearsParticipants375318
Age, Customized: 60-69 yearsParticipants21317
Age, Customized: 70-79 yearsParticipants20114
Age, Customized: 80-89 yearsParticipants10001
Sex: Female, Male: FemaleParticipants1313131150
Sex: Female, Male: MaleParticipants00000

6. Primary Endpoint

The registry lists the primary outcome as Overall Survival, measured over Up to five years.

ElementRegistry entry
Result typeMedian
Measure of spread95% Confidence Interval
Unitmonths
Endpoint classificationTime-to-Event Analysis

Overall survival measures the time from study entry until death, with the date of last contact used when a participant is not known to have died. The registry defines the primary outcome population as all randomized patients and gives a timeframe of up to five years. Overall survival is a time-to-event endpoint: it accounts for both whether an event occurred and how long participants were followed before an event or censoring.

The reported statistic is the median, expressed in months. In general, a median time-to-event estimate is the time by which half of the analyzed population is estimated to have experienced the event, under the analysis used. It is not an average survival time, and it does not describe every participant’s experience. The registry also lists a 95% confidence interval. In general, a confidence interval communicates uncertainty around an estimate; wider intervals indicate less precision than narrower intervals, all else being equal.

Overall survival is used because it captures time to death from any cause and has a direct, clearly defined event. However, an arm-specific median is not by itself a comparison of treatment effects. A comparison typically needs an effect estimate and its uncertainty, such as a hazard ratio with a confidence interval, or another clearly specified contrast. Those comparative estimates are not reported in the registry record.

7. Why No Re-analysis Is Shown

Reported as posted, not recalculated. Values missing or not estimable for a two-arm comparison (median time endpoint). A result is recalculated only when the posted data support a clean two-arm comparison, so no result is shown beyond what the sponsor posted.

8. Statistical Interpretation

Clinical Biostats interpretation

The posted overall survival medians are 37.6 months for carboplatin and paclitaxel, 27.8 months for oxaliplatin and capecitabine, 27.7 months for carboplatin and paclitaxel with bevacizumab, and 55.7 months for oxaliplatin and capecitabine with bevacizumab. These are descriptive estimates for each arm. They do not, on their own, show whether any pair of regimens differs statistically or clinically.

Precision is difficult to assess from the reported intervals because several have only one bound recorded. The registry reports 8.8 months as a lower bound for the carboplatin-and-paclitaxel arm, 9.3 months as a lower bound for the oxaliplatin-and-capecitabine arm, and 9.9 months as a lower bound for the oxaliplatin-and-capecitabine-with-bevacizumab arm; their upper bounds are not reported in the record. For the carboplatin-and-paclitaxel-with-bevacizumab arm, the reported interval is 4.9 to 53.6 months. These interval estimates indicate uncertainty in the arm-specific medians, but the incomplete bounds limit how fully that uncertainty can be read across arms.

The outcome counts for the arms are 13, 13, 13, and 11, respectively. Estimates based on small arm counts can be imprecise, particularly when follow-up and event timing vary. The registry record does not report the number of deaths in each arm, the amount of censoring, or the follow-up distribution. It also does not report a sponsor-estimated hazard ratio, a log-rank test, or another formal between-arm comparison. The analysis count is listed as 0.

Consequently, the numerical ordering of the medians should not be treated as evidence that the arm with the largest median is superior. Medians can be affected by the timing of events and the shape of survival curves, and they do not convey the full curve. A valid comparative interpretation would require the trial’s prespecified analysis, relevant uncertainty estimates, and information about follow-up and analysis populations. Those details are not reported in the registry record. The registry also states no discrepancy between its posted results and the sponsor’s analysis, but that does not substitute for a reported comparative analysis.

The trial includes four regimens and is randomized, which is relevant to its intended comparisons. Nevertheless, randomization alone does not supply a treatment-effect estimate or establish that the groups are comparable in every realized sample. The posted medians are best read as arm-level summaries of overall survival, not as a conclusion about which strategy performs better.

9. Statistical Methods Explained

Overall survival is a time-to-event outcome. The observed time can end in a death event or in censoring, such as when a participant is last known to be alive at the end of available follow-up. In general, censoring means the event time is not fully observed; it does not mean that the event occurred at the censoring date. A time-to-event analysis uses event and follow-up information rather than reducing each participant to a simple yes-or-no outcome at one fixed point.

What does a median survival estimate describe?

In general, the median is the point on an estimated survival distribution at which the estimated probability of remaining alive reaches one half. It summarizes the center of the event-time distribution, rather than the average time lived or the outcome for a particular participant. The posted arm-specific medians are 37.6 months, 27.8 months, 27.7 months, and 55.7 months in the order of the four arms. Those values are descriptive summaries; comparing them directly does not produce a valid test of a treatment effect.

Survival curves contain information about the timing of events throughout follow-up. Two groups can have similar medians but different patterns at other times, or different medians without a clear statistical difference. A median also depends on the availability of sufficient follow-up to estimate the point at which half the population has experienced the event. The registry does not report the survival curves, numbers at risk over time, event counts by arm, or censoring details in the registry record for interpretation.

How should the confidence intervals be read?

In general, a confidence interval is a range of estimates compatible with the data under the statistical method used, and it conveys uncertainty around a point estimate. It is not a range containing a fixed proportion of individual survival times. The registry identifies the dispersion measure as a 95% confidence interval. It records 8.8 months as the lower bound for the median of the carboplatin-and-paclitaxel arm, 9.3 months for oxaliplatin and capecitabine, and 9.9 months for oxaliplatin and capecitabine with bevacizumab. The upper bounds for those three arms are not reported in the registry record. The interval for carboplatin and paclitaxel with bevacizumab is reported as 4.9 to 53.6 months.

Because most upper bounds are absent, the precision of those estimates cannot be assessed fully from the record. The one complete interval is broad, which indicates substantial uncertainty around that arm’s median estimate. A confidence interval for an arm-specific median is also not a confidence interval for the difference between two arms. A comparative interval or test would be needed to assess uncertainty in a treatment contrast.

What comparative method is reported?

For a time-to-event endpoint, a common general approach is to compare event-time patterns using a hazard ratio, often alongside a confidence interval and a test of the null hypothesis of no difference. A hazard ratio summarizes the relative event rate over follow-up under the model and assumptions used; it is not the ratio of the reported medians. This is general statistical context, not a claim that the trial used a particular model. The registry record does not report a sponsor-estimated hazard ratio or any analysis count. Its method description indicates that only sponsor-reported hazard ratios are used, but none are included among the posted outcome details.

A hazard ratio can be difficult to summarize when the relative event rate changes over time. In general, the proportional-hazards assumption means that the relative hazard is treated as constant over follow-up. If that assumption is not appropriate, a single hazard ratio may not represent the treatment contrast well. The registry record does not report whether proportional hazards were assessed or whether another survival comparison was planned or performed. No conclusion about the analysis model can therefore be drawn.

Why do the posted arm counts matter?

The posted outcome counts are 13, 13, 13, and 11 across the four arms. With relatively few participants in each arm, estimates may be unstable and confidence intervals may be wide. The number of participants alone does not reveal how many experienced death, how long they were followed, or how much censoring occurred. Those details are not reported in the registry record. The registry enrollment is 50, but the record does not explain the difference between that enrollment figure and the outcome counts shown by arm.

The sample-size assumptions describe a planning illustration based on an observed effect, a two-sided significance level of 0.05, equal allocation, and a normal approximation. Such an illustration is not the trial’s original sample-size justification and is not observed power. The registry record does not report a protocol-based sample-size rationale, and no numeric planning estimates are included in the registry entries. Planning calculations cannot replace a reported trial analysis or explain why this study enrolled the number of participants it did.

10. Multiplicity, Missing Data and Analysis Populations

The trial has four treatment arms and several listed secondary outcomes, including progression-free survival, objective tumor response, patient-reported neurotoxicity, patient-reported quality of life, and adverse effects. With multiple outcomes and possible pairwise comparisons, the chance of a false-positive finding can rise if many statistical tests are conducted without an appropriate strategy. In general, multiplicity methods may control error across a set of planned tests or define a hierarchy of primary and secondary questions. The strategy used for this trial is not reported in the registry record.

The record identifies overall survival as the primary outcome and gives a timeframe of up to five years. It does not report a statistical analysis plan, planned contrasts, a testing hierarchy, an adjustment for multiple comparisons, or interim analyses. The analysis count is listed as 0. Therefore, the posted medians should not be interpreted as results from a documented set of adjusted or unadjusted pairwise tests.

For missing data and follow-up, time-to-event analyses generally distinguish an observed event from censoring at the last known contact. That distinction is important because participants may have different lengths of follow-up. The registry defines overall survival using death or date of last contact, but does not report how many participants were censored, how missing contact information was handled, or the completeness of follow-up by arm. The record also does not describe imputation or sensitivity analyses.

The primary population is described as all randomized patients. The registry does not specify additional analysis populations, such as a per-protocol population, nor does it describe how participants who did not follow assigned treatment were handled. No assumptions about these choices can be made from the posted record.

11. Safety Results

The registry reports serious adverse events as affected participants divided by participants at risk.

ArmParticipants with serious adverse eventsParticipants at riskPercentage
Arm I (Carboplatin and Paclitaxel)31323.1%
Arm II (Oxaliplatin and Capecitabine)41330.8%
Arm III (Carboplatin, Paclitaxel, Bevacizumab)21315.4%
Arm IV (Oxaliplatin, Capecitabine, Bevacizumab)31127.3%
Participants with at least one serious adverse event
Serious adverse events by armArm I (Carboplatin and Paclit…23.1%Arm II (Oxaliplatin and Capec…30.8%Arm III (Carboplatin, Paclita…15.4%Arm IV (Oxaliplatin, Capecita…27.3%% of participants with at least one serious adverse event

Other (non-serious) adverse events

Participants with at least one non-serious event at or above the registry's 0% reporting threshold.

ArmParticipants affected of at risk
Arm I (Carboplatin and Paclitaxel)13 of 13
Arm II (Oxaliplatin and Capecitabine)13 of 13
Arm III (Carboplatin, Paclitaxel, Bevacizumab)13 of 13
Arm IV (Oxaliplatin, Capecitabine, Bevacizumab)11 of 11

Most frequent serious adverse event terms

Event termOrgan systemArm I (Carboplatin and Paclitaxel)Arm II (Oxaliplatin and Capecitabine)Arm III (Carboplatin, Paclitaxel, Bevacizumab)Arm IV (Oxaliplatin, Capecitabine, Bevacizumab)
Allergic reactionImmune system disorders1 of 131 of 131 of 130 of 11
AnemiaBlood and lymphatic system disorders1 of 130 of 130 of 131 of 11
Low NeutrophilsInvestigations1 of 130 of 131 of 130 of 11
Nausea/VomitingGastrointestinal disorders0 of 130 of 130 of 132 of 11
PneumothoraxRespiratory, thoracic and mediastinal disorders0 of 131 of 130 of 131 of 11
BleedingGeneral disorders0 of 130 of 130 of 131 of 11
ConstipationGastrointestinal disorders0 of 130 of 130 of 131 of 11
DiarrheaGastrointestinal disorders0 of 130 of 130 of 131 of 11
DyspneaRespiratory, thoracic and mediastinal disorders0 of 131 of 130 of 130 of 11
FatigueGeneral disorders0 of 130 of 131 of 130 of 11

Most frequent non-serious adverse event terms

Event termOrgan systemArm I (Carboplatin and Paclitaxel)Arm II (Oxaliplatin and Capecitabine)Arm III (Carboplatin, Paclitaxel, Bevacizumab)Arm IV (Oxaliplatin, Capecitabine, Bevacizumab)
Peripheral/sensory NeuropathyNervous system disorders11 of 1311 of 138 of 1310 of 11
NauseaGastrointestinal disorders8 of 138 of 139 of 139 of 11
PainGeneral disorders9 of 136 of 137 of 137 of 11
Other GI ProblemsGastrointestinal disorders8 of 136 of 137 of 137 of 11
Low NeutrophilsInvestigations7 of 135 of 134 of 137 of 11
Low plateletsInvestigations8 of 133 of 135 of 137 of 11
OtherGeneral disorders4 of 134 of 137 of 137 of 11
Low White Blood CellsInvestigations5 of 135 of 134 of 136 of 11
Oral problemsGastrointestinal disorders3 of 132 of 134 of 139 of 11
Weight LossInvestigations2 of 133 of 134 of 135 of 11

Serious events with the highest arm-level rate: nausea/vomiting (18.2%), anemia (9.1%), bleeding (9.1%), constipation (9.1%), diarrhea (9.1%).

Do not overextend the safety comparison. Serious-adverse-event counts are safety observations, not efficacy outcomes, and should not be combined with the primary result into a single benefit-risk number.

The serious adverse-effect figures are counts of participants with at least one serious adverse effect, alongside the number at risk in each arm. The registry reports 3 of 13 in the carboplatin-and-paclitaxel arm, 4 of 13 in the oxaliplatin-and-capecitabine arm, 2 of 13 in the carboplatin-and-paclitaxel-with-bevacizumab arm, and 3 of 11 in the oxaliplatin-and-capecitabine-with-bevacizumab arm. These are participant counts, not counts of all events; one participant may have experienced more than one event.

The listed serious-event terms include nausea/vomiting at 18.2%, and anemia, bleeding, constipation, diarrhea, and GI perforation at 9.1% each. The registry does not give enough detail to determine event counts by arm or whether participants experienced multiple listed terms. Death counts are not reported in the registry record.

These figures describe events recorded in the trial, but the small arm counts and lack of a formal comparative safety analysis limit conclusions about differences between regimens. The record also reports that all participants at risk in each arm had other adverse effects; that broad category should not be confused with serious adverse effects. The posted figures do not establish causality for an individual event or quantify comparative risk.

12. What the Result Does, and Does Not, Mean

The registry results describe four arm-specific estimates of median overall survival and report counts of participants with serious adverse effects. The medians range from 27.7 months to 55.7 months across the arms. They are useful as descriptive summaries of the posted outcome data, but the record does not include a hazard ratio, a confidence interval for a between-arm contrast, or a formal test comparing regimens.

Accordingly, the medians do not establish that one chemotherapy backbone is better than the other, or that adding bevacizumab changes overall survival. Differences between arm medians are not themselves a treatment-effect estimate, and no new contrasts should be inferred from them. The available intervals are incomplete for three arms, while the interval for one arm is reported as 4.9 to 53.6 months. That limits the ability to judge the precision of the arm estimates from the registry record.

The trial’s randomized design is relevant to treatment comparisons, but interpretation also depends on the analysis method, completeness and duration of follow-up, event counts, and the handling of participants after randomization. These details are not reported in the registry record. The outcomes should therefore be understood as posted descriptive results rather than a complete account of comparative efficacy.

The safety counts likewise do not demonstrate that one regimen is safer or less safe. The numbers at risk are small, event details by arm are limited, and no comparative safety estimate is reported. The result cannot determine what treatment an individual should receive. It records what was reported for this trial and identifies important gaps in the comparative statistical evidence available in the registry.

13. Why This Trial Matters Statistically

This trial raises a statistically important design question: how to compare two chemotherapy backbones while also studying the addition of bevacizumab. The four-arm structure contains both backbone comparisons and same-backbone comparisons with and without bevacizumab. Those questions are not interchangeable. A contrast between arms with different chemotherapy combinations concerns the full regimens, whereas a contrast within a backbone concerns the addition of bevacizumab.

Random allocation is valuable because, in general, it can reduce systematic differences between treatment groups at baseline. But a randomized design still needs clearly reported contrasts, effect estimates, uncertainty, and analysis populations for readers to interpret treatment comparisons. Here, the record provides arm-level medians but no comparative hazard ratio or test. The numerical ordering of the medians therefore cannot answer the central comparative questions by itself.

The trial also illustrates why precision matters. Each arm’s posted outcome count is modest, and several reported confidence intervals lack an upper bound. Without event counts, follow-up summaries, or full intervals, readers cannot fully evaluate how stable the estimates are. The registry record’s enrollment field and arm-level outcome counts also differ, with no explanation in the record.

For clinical research, transparent reporting of the planned statistical methods, multiplicity strategy, censoring, missing data, and population definitions helps distinguish descriptive summaries from confirmatory evidence. Those details are not reported in the registry record. The trial remains informative as a record of the treatment strategies studied and the outcomes posted, while its available comparative statistical reporting is limited.

14. Limitations

The primary limitation for interpretation is the absence of a reported between-arm analysis for overall survival. The registry gives medians but no sponsor-reported hazard ratio, comparative confidence interval, or test result. The analysis count is listed as 0, and the analysis method is not described in sufficient detail to assess how the medians were estimated.

Confidence interval reporting is incomplete: upper bounds are absent for three arms. The record also does not report deaths by arm, numbers at risk over follow-up, censoring patterns, or follow-up summaries. Although the outcome timeframe is up to five years, the duration and completeness of actual follow-up are not reported in the registry record.

The arm outcome counts are 13, 13, 13, and 11, while enrollment is listed as 50. The record does not explain this difference. It does not report whether any participants were excluded from the primary analysis, how deviations from assigned treatment were handled, or what analysis populations were used beyond the statement that the primary population is all randomized patients.

The official title identifies mucinous epithelial ovarian or fallopian tube cancer, while the brief summary describes newly diagnosed stage II-IV or recurrent stage I epithelial ovarian or fallopian tube cancer. The conditions list includes a range of stages and diagnoses. Detailed eligibility criteria and the characteristics of the enrolled participants are not reported in the registry record. The full description of one treatment arm is truncated, and details of the multiplicity plan, missing-data approach, sample-size justification, and interim analyses are not reported.

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18. Record Summary

NCT01081262 is a randomized, open-label, parallel-group phase III trial sponsored by the National Cancer Institute. It compares carboplatin and paclitaxel or oxaliplatin and capecitabine, each with or without bevacizumab, as first-line therapy for mucinous epithelial ovarian or fallopian tube cancer. The primary outcome is overall survival, defined from study entry to death or last contact, with a timeframe of up to five years.

The posted median overall survival values are 37.6 months, 27.8 months, 27.7 months, and 55.7 months across the four arms. The registry record does not report a sponsor-estimated hazard ratio or a formal comparison between arms. Several confidence interval bounds, follow-up details, event counts, and analysis methods are also not reported. Serious adverse-effect counts are posted by arm, but comparative safety conclusions are not established by those counts alone.

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