Constructive vs. destructive radonc clinical trials

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

ProtonElectronNeutron

Full Member
2+ Year Member
Joined
Dec 10, 2019
Messages
32
Reaction score
93
How come Australians (Eg: Shankar Siva), Canadians (David Palma) and the English are doing some of the constructive/ expanding scope of trials and the we almost always to self destructive clinical trials? May be except for the Cardiac SBRT.

Members don't see this ad.
 
  • Like
Reactions: 2 users
I wouldn't necessarily ascribe it directly to individual people. David Palma also came up with one of the poorest trial ideas I've ever seen (MISSILE - neoadjuvant SBRT followed by planned surgery for operable NSCLC).
 
  • Like
Reactions: 4 users
How come Australians (Eg: Shankar Siva), Canadians (David Palma) and the English are doing some of the constructive/ expanding scope of trials and the we almost always to self destructive clinical trials? May be except for the Cardiac SBRT.

Many academics in rad onc run RT omission or hypofrac trials because it is the easiest and fastest way to get a promotion. When you think about it, RT-only related research can be quite boring. Look at all the clinical outcomes/retrospective chart reviews that "leaders" in our field have built their careers on. And when trials have been run (again, RT focused), it's been stuff such as 3D vs IMRT (can it get more boring than that?).

So what happens when you have more and more academics because of practice consolidation with academic departments buying up private practices? A lot of people who need to impress their chairs for promotion by publishing trials. And the easiest investigator initiated trials to run as a rad onc are omission or hypofrac trials. Lowest hanging fruit.

Just to be clear, I'm not calling hypofrac inherently bad but the ongoing breast trials are just getting ridiculous at this point. Are the side effects of modern breast RT that horrifying that we need to run 1000 pt trials with biomarker stratification when now in 5 fractions, we can decrease local recurrence risk with minimal toxicity? People should be running RT vs 5 years of endocrine therapy trials but that's too hard and how will those academic Twitter voices ever become "famous" if they don't have a new study to tweet out every 6 months? In addition, I hate the virtue signaling of some of the academic attendings on Twitter about hypofrac'ing - it's as if doing a lot of hypofrac'ing makes you somehow noble, disregarding the many other factors that go into quality patient care. Many academics at prominent institutions are not even hypofrac'ing prostates or breasts.

All the while MSK and MDACC charging 6x the rate of community MDs for a same RT courses while attendings tweet about how paying for parking is a key driver of financial toxicity. What a joke.

Edit: Added a paragraph and grammar.
 
Last edited:
  • Like
  • Love
  • Haha
Reactions: 16 users
Members don't see this ad :)
with better genetic risk profiling, so many opportunities to omit needless xrt. 8-9/10 lumpectomy pts don’t benefit from xrt and possibly equal proportion of Prostate pts. just don’t know which ones, so we radiate them all. Imagine when genetic profiles can be refined to predict the 80% of early state breast pts who don’t benefit from xrt! Erin Gillespie is very excited about this promising line of research #radoncrocks.
 
Last edited:
  • Like
Reactions: 1 user
with better genetic risk profiling, there will be so many opportunities to omit needless xrt. 8-9/10 lumpectomy pts don’t benefit from xrt and possibly equal proportion of Prostate pts. We just don’t know which ones, so we radiate them all. Imagine if genetic profiles could be refined to tell us which ones! Erin Gillespie is very excited about this promising line of research #radoncrocks.
Erin Gillespie, the mother of all gaslighters, being excited about any topic makes me want to completely ignore it.
 
  • Like
  • Haha
Reactions: 10 users
I wouldn't necessarily ascribe it directly to individual people. David Palma also came up with one of the poorest trial ideas I've ever seen (MISSILE - neoadjuvant SBRT followed by planned surgery for operable NSCLC).
I actually thought this was quite innovative and out of the box.
 
  • Like
Reactions: 1 user
potential use of neoadjuvant SBRT itself is an interesting thought, don’t you think? We don’t have a market share in the operable pts, and all the trials comparing SBRT vs. Sx have failed to accrue. So, I think it was a clever way of getting into that market space.. what if you had a pCR of 95% (i know it showed only 60%)? Nigro regimen for anal cancer started like that, right?
 
  • Like
Reactions: 1 user
So what happens when you have more and more academics because of practice consolidation with academic departments buying up private practices? A lot of people who need to impress their chairs for promotion by publishing trials. And the easiest investigator initiated trials to run as a rad onc are omission or hypofrac trials. Lowest hanging fruit.
RadOnc is a fascinating anthropological study in this respect. We can't forget that a big draw for students applying into RadOnc is the alleged lifestyle benefits it offers. So for many years now we have attracted some of the best med students who, whether they want to openly admit it or not, don't want to work as hard as a surgeon.

As RadOnc practices got gobbled up by academic institutions, you have more and more people with academic titles who are interested in lifestyle. In order to make more money in academics, you need to get promoted. How do you get promoted? Publishing! Which leads me to a quote often attributed to Bill Gates (though I think it was actually a bricklayer who said it):

“I will always choose a lazy person to do a difficult job because a lazy person will find an easy way to do it.”

What's the easiest clinical trial to run in RadOnc, get published, and get promoted? As @speakeroftruth said, omission, hypofrac, or especially quality of life trials. Getting a quality of life protocol approved at my institution is a joke.

Thus, we race to the bottom: the catfish of medicine, looking for breadcrumbs so we can have 3 academic days a week instead of 2.
 
  • Like
  • Angry
Reactions: 10 users
Lack of creativity is a major problem and I would echo what is said above. Fortunately, there are more than a few of us trying to expand, not contract our role in oncology. We talk about Crane a lot as one example. I currently have 3 trials with novel drugs trying to further cement and expand our role in a couple disease sites. What makes this kind of research hard? MONEY. A 30 patient trial can easily be a million dollars and you have to convince someone to pay for it. Who wants to mess with writing grants when you can just put together a protocol where you just tweak fractionation a little and are off to the races? Unless more people are willing to violate Ohms law, the race to the bottom will proceed as planned.
 
  • Like
  • Love
Reactions: 7 users
Lack of creativity is a major problem and I would echo what is said above. Fortunately, there are more than a few of us trying to expand, not contract our role in oncology. We talk about Crane a lot as one example. I currently have 3 trials with novel drugs trying to further cement and expand our role in a couple disease sites. What makes this kind of research hard? MONEY. A 30 patient trial can easily be a million dollars and you have to convince someone to pay for it. Who wants to mess with writing grants when you can just put together a protocol where you just tweak fractionation a little and are off to the races? Unless more people are willing to violate Ohms law, the race to the bottom will proceed as planned.
@ramsesthenice stop being so likeable with your reasonable treatment of residents and expansion of RadOnc indications and efficacy
 
  • Like
Reactions: 5 users
I actually thought this was quite innovative and out of the box.

What did you feel was innovative about it
MISSILE was interesting but it had a fatal flaw. It was looking at (or looking for) cancer cells under a microscope 10 weeks after radiotherapy. Seeing a living cancer cell 10 weeks after radiotherapy gives unclear (and more onerously false) information about the ultimate LC probability. Seeing zero cancer cells would admittedly be informative, but the MISSILE saw ~40% patients having viable cancer cells after SBRT at that 10 week mark. A viable cancer cell can easily be non-clonogenic however and have mitotic catastrophe when it attempts cell division some far-flung time after irradiation. If I were designing a MISSLE like study, I would surgerize at 10 weeks, 30 weeks, and 60 weeks. (And I would of course not surgerize anyone obviously failing before the surgerization.) Now one obviously needs to get comfortable with the premise that light microscopy results after radiotherapy correlate 1:1 with clinical results after radiotherapy for this type of exploration to have clinical utility. On second thought, why don't I do something far simpler and just look at patient survival in a randomized trial of SBRT patients and surgerized patients :)
 
  • Like
Reactions: 5 users
Members don't see this ad :)
MISSILE was interesting but it had a fatal flaw. It was looking at (or looking for) cancer cells under a microscope 10 weeks after radiotherapy. Seeing a living cancer cell 10 weeks after radiotherapy gives unclear (and more onerously false) information about the ultimate LC probability. Seeing zero cancer cells would admittedly be informative, but the MISSILE saw ~40% patients having viable cancer cells after SBRT at that 10 week mark. A viable cancer cell can easily be non-clonogenic however and have mitotic catastrophe when it attempts cell division some far-flung time after irradiation. If I were designing a MISSLE like study, I would surgerize at 10 weeks, 30 weeks, and 60 weeks. (And I would of course not surgerize anyone obviously failing before the surgerization.) Now one obviously needs to get comfortable with the premise that light microscopy results after radiotherapy correlate 1:1 with clinical results after radiotherapy for this type of exploration to have clinical utility. On second thought, why don't I do something far simpler and just look at patient survival in a randomized trial of SBRT patients and surgerized patients :)
Bingo. The time scale of the surgery was so pitifully off the mark. Give the immune system time to remove the cancer cells instead of surgerizing too early and making everyone feel that the SBRT local control is actually 60% and everything else is a fluke. Pathetic.
 
  • Like
Reactions: 2 users
Bingo. The time scale of the surgery was so pitifully off the mark. Give the immune system time to remove the cancer cells instead of surgerizing too early and making everyone feel that the SBRT local control is actually 60% and everything else is a fluke. Pathetic.
To be fair to Palma, he said somewhere (probably Twitter IIRC) that he wanted a longer interval but this was the compromise he was able to get with the surgeons. They were pushing for shorter than he wanted.
 
  • Like
Reactions: 2 users
Golly gee, it sure would've been nice if SCAROP had used molecular signatures in their projections of radiotherapy services, 80% of breast cancer, 90% of prostate cancer won't require radiotherapy in 2025, it sure would've been sensible to cut residency spots by 85%. Those whiz kid boomers are so goofy sometimes!
 
  • Haha
Reactions: 1 users

Look at the endpoints for these trials. 5 year (one is 10 year) IBTR or LRR. In low molecular score or luminal A patients?

I will predict now that every one of these trials will demonstrate very low local recurrence for whatever cohorts they are studying. You can take an entirely unselected group of ER+ patients and give them endocrine therapy alone for 5 years and you will find very few local recurrences at that time point. (~6% for older women on Tamoxifen alone). How many recurrences are they expecting out of 200 patients? 15? Fewer than 15? How do you even make inferences based on this type of study?

We know that recurrences for ER+ breast cancer happen throughout ones lifetime, I believe almost monotonically. (I welcome someone to show me data that proves this is wrong).

Salvaging a recurrence is no fun and re-initiation of endocrine therapy is definitely no fun.

How much dose are we giving the heart nowadays? Should always be close to clinically meaningless for early stage patients.

Have we ever demonstrated an overall survival decrement to radiation for early breast cancer in massive population based studies where women routinely received >5X the cardiac dose that they should be receiving in a contemporary clinic?

NNT for statin for cardiac event (not death) avoidance over 100. Nobody tells you how many people have a hard time tolerating statins.

Seems like its getting a little absurd to me.

Now imagine how you would feel if you were also the doc who gave the endocrine therapy? Maybe we need to start doing this? Community medoncs inundated with heme consults anyway. Mid-levels managing their breast follow-ups many places. How bout the value added if radonc clinics took over non chemo management of non-metastatic breast cancer? Maybe an academic can look at this?
 
  • Like
Reactions: 9 users
Golly gee, it sure would've been nice if SCAROP had used molecular signatures in their projections of radiotherapy services, 80% of breast cancer, 90% of prostate cancer won't require radiotherapy in 2025, it sure would've been sensible to cut residency spots by 85%. Those whiz kid boomers are so goofy sometimes!
Accurate Molecular signatures is a great way to get rid of much of radonc.
 
  • Sad
Reactions: 1 users
To be fair to Palma, he said somewhere (probably Twitter IIRC) that he wanted a longer interval but this was the compromise he was able to get with the surgeons. They were pushing for shorter than he wanted.
This is what you get when bargaining with surgeons. I'd rather not run the trial at all if I had to bargain with surgeons. Palma proceeded with running the trial and now everyone will associate him (not the surgeons) with that trial's horrendous design.
 
  • Like
Reactions: 2 users
This is what you get when bargaining with surgeons. I'd rather not run the trial at all if I had to bargain with surgeons. Palma proceeded with running the trial and now everyone will associate him (not the surgeons) with that trial's horrendous design.
Early pathologic endpoints can be tricky. Look at rectal cancer. With TNT the pCR at 8 weeks is 25-30% but cCR approaches 50-60%. If all non pCRs are destined to fail you would expect local control with W/W to be around 50% but it is closer to 75-80%. Seems like those isolated cells may not be relevant...
 
  • Like
Reactions: 6 users
Early pathologic endpoints can be tricky. Look at rectal cancer. With TNT the pCR at 8 weeks is 25-30% but cCR approaches 50-60%. If all non pCRs are destined to fail you would expect local control with W/W to be around 50% but it is closer to 75-80%. Seems like those isolated cells may not be relevant...
100% agree... This is exactly why we shouldn't have trials with endpoints like MISSILE did. As I mentioned in another post, Merck thought they were being smart doing just that with their golden child Keytruda for neoadjuvant therapy of TNBC. Their attempt for FDA approval in that setting has been stonewalled (for now, at least) because of the questionable value of that endpoint.
 
Bingo. The time scale of the surgery was so pitifully off the mark. Give the immune system time to remove the cancer cells instead of surgerizing too early and making everyone feel that the SBRT local control is actually 60% and everything else is a fluke. Pathetic.
This was a phase 2 trial which generates further questions. I thought it did that. Local control was 100%. Pcr 60% is pretty good imo. Surgery alone path cr is 0%. Also a study looked at neoadjuvant chemo which showed a path cr of 8%. Path cr was predictive for survival.
 
Last edited:
Early pathologic endpoints can be tricky. Look at rectal cancer. With TNT the pCR at 8 weeks is 25-30% but cCR approaches 50-60%. If all non pCRs are destined to fail you would expect local control with W/W to be around 50% but it is closer to 75-80%. Seems like those isolated cells may not be relevant...
There was a good editorial on the missile study and this was an important point that was brought up.
 
There was a good editorial on the missile study and this was an important point that was brought up.

Agreed It was good. Unfortunately, seems that mainly radonc has read that editorial

Many surgeons used MISSILE to focus only on pCR and consistently say we only “cure” 60% of patients
 
This was a phase 2 trial which generates further questions. I thought it did that. Local control was 100%. Pcr 60% is pretty good imo. Surgery alone path cr is 0%. Also a study looked at neoadjuvant chemo which showed a path cr of 8%. Path cr was predictive for survival.
Yes it does generate further questions...like the surgeons questioning whether SBRT actually works, since their underdeveloped brains are trained like Pavlovian dogs to think that cutting is the only "true" way to kill cancer. Is this really a good look for radonc to other onc specialties? That trial did us a huge disservice to other specialties. We spend a lot of time on this forum talking about trials that "hurt" the use of RT for certain indications. SBRT for early-stage operable NSCLC is shining, and even many surgeons are scared to the point that they refuse to enroll on many of these trials. Then Palma's MISSILE comes out and that missile backfires onto our own specialty and gives the surgeons fodder to use against us. But I'm sure Palma can use it on his CV and for academic promotion at the expense of the perception of our field. Way to go.
 
  • Like
Reactions: 1 user
Yes it does generate further questions...like the surgeons questioning whether SBRT actually works, since their underdeveloped brains are trained like Pavlovian dogs to think that cutting is the only "true" way to kill cancer. Is this really a good look for radonc to other onc specialties? That trial did us a huge disservice to other specialties. We spend a lot of time on this forum talking about trials that "hurt" the use of RT for certain indications. SBRT for early-stage operable NSCLC is shining, and even many surgeons are scared to the point that they refuse to enroll on many of these trials. Then Palma's MISSILE comes out and that missile backfires onto our own specialty and gives the surgeons fodder to use against us. But I'm sure Palma can use it on his CV and for academic promotion at the expense of the perception of our field. Way to go.

agree with initial part of your statements and criticism of trial.

I’m curious where the expected pCR they came up with came from

I don’t agree with personal criticism of Palma. Guy is doing a lot of great things and doubt he need much more on CV

nonetheless, agree MISSLE has unintentionally caused harm to perception of SBRT as cure, at least amongst surgeons

Really need VALOR to pan out
 
  • Like
Reactions: 2 users
agree with initial part of your statements and criticism of trial.

I’m curious where the expected pCR they came up with came from

I don’t agree with personal criticism of Palma. Guy is doing a lot of great things and doubt he need much more on CV

nonetheless, agree MISSLE has unintentionally caused harm to perception of SBRT as cure, at least amongst surgeons

Really need VALOR to pan out
Who the heck knows. Yet another reason why the trial was utterly poorly designed. The expected pCR was 90% because they thought that clinical LC = pCR rate. Whoops!

I used to think highly about Palma for the same reasons you are thinking, but his rep took a hit because of this trial. If he really cared about the field he would just not publish this study. It's OK to not publish a trial that one completes, especially if the trial is so poorly designed, bargaining with the surgeons takes place, the expected primary endpoint rate was not thought out well enough, and the results turn out like this. But of course it is a good CV padder and for the academic ladder. Let's just hope this sort of thing is an aberration for him and not the future norm. Let's also hope he doesn't continue to pad his CV by publishing secondary analyses or updates of this trial, because that would be even worse for his rep. I'm willing to give him the benefit of the doubt for now but that does not obviate the awful way this trial was done from start to finish.
 
It's OK to not publish a trial that one completes, especially if the trial is so poorly designed, bargaining with the surgeons takes place, the expected primary endpoint rate was not thought out well enough, and the results turn out like this.

The NIH would disagree with you on this. Publication of results is not suppose to be dictated by the outcome. IE, it is considered unethical to withhold publication if you don't like the results. These situations suck because there are good explanations why the results are difficult to interpret but the reality is if the pCR were 95% we wouldn't hesitate to publish the results. If you would publish one result, you have to be prepared to publish the opposite results as well. Which is why appropriate trial design upfront is so critical.
 
  • Like
Reactions: 10 users
The NIH would disagree with you on this. Publication of results is not suppose to be dictated by the outcome. IE, it is considered unethical to withhold publication if you don't like the results. These situations suck because there are good explanations why the results are difficult to interpret but the reality is if the pCR were 95% we wouldn't hesitate to publish the results. If you would publish one result, you have to be prepared to publish the opposite results as well. Which is why appropriate trial design upfront is so critical.
Totally agree, no beef with this statement. If "purism" is to be practiced that's fine. But in practicality and reality there are tons of trials all the time that are never published, especially single-arm nonrandomized studies like MISSILE. I don't think either "the purist" or "the pragmatic" approach is necessarily good or bad - I don't think cookie-cutter generalizations such as "all completed trials should be published" are necessarily true (like nearly all cookie-cutter generalizations), so if there is any trial that's not worth publishing, it's a trial like this, which is a remarkably poorly designed self-immolating dumpster fire.
 
Totally agree, no beef with this statement. If "purism" is to be practiced that's fine. But in practicality and reality there are tons of trials all the time that are never published, especially single-arm nonrandomized studies like MISSILE. I don't think either "the purist" or "the pragmatic" approach is necessarily good or bad - I don't think cookie-cutter generalizations such as "all completed trials should be published" are necessarily true (like nearly all cookie-cutter generalizations), so if there is any trial that's not worth publishing, it's a trial like this, which is a remarkably poorly designed self-immolating dumpster fire.
In this case I think publication is helpful. There are plenty of prospective series showing excellent local control with SBRT alone. These results are helpful in that they inform how not to make pathologic assessments in early stage NSCLC. Educated readers will quickly assume these tumor cells are probably of limited significance. I realize that some surgeons will seize on it to suggest SBRT is an insufficient therapy but they would have to ignore so much data to get there, they almost certainly already felt that way before this publication.
 
In this case I think publication is helpful. There are plenty of prospective series showing excellent local control with SBRT alone. These results are helpful in that they inform how not to make pathologic assessments in early stage NSCLC. Educated readers will quickly assume these tumor cells are probably of limited significance. I realize that some surgeons will seize on it to suggest SBRT is an insufficient therapy but they would have to ignore so much data to get there, they almost certainly already felt that way before this publication.
I would not hesitate to say that surgeons would use anything and everything to belittle SBRT and aggrandize their own modality. Hell with logic, reasoning, prior data, etc. In other words ... I think you are giving surgeons too much credit :rofl:

I for one learned nothing from MISSILE. I never made those types of "pathologic assessments" and I am not sure who else would. Tons of data about ITCs in breast cancer, the NEJM paper that scarbrtj has cited showing breast cancer cells in the marrow of early-stage breast patients, your own example of rectal cancer cited in the thread above, and I am sure there are more in other disease sites too. Did we really think NSCLC was going to be any different? Do we really need a worthless junk trial to corroborate the obvious?
 
How much are we supporting our "constructive" clinical trials though? Our main oligomet trial LU-002 has lagged accrual for 4 years now and hasnt even met half of its planned 400 pts. Not to mention all the failed SBRT vs surgery trials. At least we can blame those on the surgeon buy in. People have jumped straight to treating oligomets off study, which is understandable, but at the same time delays broader adoption of SBRT for oligomets (and makes insurance approval more painful)
 
  • Like
Reactions: 1 user
Who the heck knows. Yet another reason why the trial was utterly poorly designed. The expected pCR was 90% because they thought that clinical LC = pCR rate. Whoops!

I used to think highly about Palma for the same reasons you are thinking, but his rep took a hit because of this trial. If he really cared about the field he would just not publish this study. It's OK to not publish a trial that one completes, especially if the trial is so poorly designed, bargaining with the surgeons takes place, the expected primary endpoint rate was not thought out well enough, and the results turn out like this. But of course it is a good CV padder and for the academic ladder. Let's just hope this sort of thing is an aberration for him and not the future norm. Let's also hope he doesn't continue to pad his CV by publishing secondary analyses or updates of this trial, because that would be even worse for his rep. I'm willing to give him the benefit of the doubt for now but that does not obviate the awful way this trial was done from start to finish.
I don’t think you can just decide NOT to publish a study because the results were opposite of your hypothesis.
 
  • Like
Reactions: 3 users
How much are we supporting our "constructive" clinical trials though? Our main oligomet trial LU-002 has lagged accrual for 4 years now and hasnt even met half of its planned 400 pts. Not to mention all the failed SBRT vs surgery trials. At least we can blame those on the surgeon buy in. People have jumped straight to treating oligomets off study, which is understandable, but at the same time delays broader adoption of SBRT for oligomets (and makes insurance approval more painful)

This is an immensely complicated problem with a lot of possible solutions. In my opinion, one issue I see is too many redundant trials. Just look at how many oligomets and abscopal studies are currently accruing. I don't want to downplay how hard it is to get multisite trials off the ground. The regulatory burden is amplified and IRBs like to get in pissing matches etc. There is also the reality that being PI for a small trial will do more for your promotion than being a middling co-investigator on a larger trial. But without question pooled efforts would get us answers a lot faster than multiple underpowered redundant trials.
 
  • Like
Reactions: 1 users
Funding is a huge problem. Nobody wants to pay for radiation trials. So many of the trials that come out are just institutionally funded.

So you can convince your home institution to do them, maybe, and possibly with some pittance of funding from Varian, Elekta, or Viewray. No way that's going to permit you to do it in a multi-institutional setting.

There's cooperative group too, but that's got its own issues. At the end of that, they're still NCI funded and NCI still "disapproves" (rejects) plenty of those concepts. Ask me how I know :laugh:
 
  • Like
  • Haha
Reactions: 2 users
I don’t think you can just decide NOT to publish a study because the results were opposite of your hypothesis.
That's not what I am saying. If the results will actively hurt your field/disease site/indication and its perception especially with referring physicians, and it's a single-arm single-center investigator-initiated nonrandomized phase II study that was never designed properly in the first place, then maybe one should be a little more thoughtful about that whole process.

For instance, given the preponderance of randomized data using SBRT for oligomets, how would you feel if an underpowered single-arm trial from a single no-name center was published, which showed a numeric OS improvement over historical controls, but was negative because their statistical hypothesis assumed a massive 20% improvement in 2-year OS? Is that trial of 30 patients that was poorly designed from the get-go really worth disseminating? Would people really take it seriously in light of the existing data? Wouldn't people who are anti-oligomet-SBRT use it as fodder?

Like I said above, this stuff happens all the time. I get if you want to be a purist, but as you know in the real world out there, purism and pragmatism are like yin and yang - can't have one without the other. Sometimes in life, the best answer is no answer at all, and less is more.
 
  • Like
Reactions: 1 user
There's cooperative group too, but that's got its own issues. At the end of that, they're still NCI funded and NCI still "disapproves" (rejects) plenty of those concepts. Ask me how I know :laugh:
Im going to go out on a limb and say it is not because you asked Mrs. Cleo?
 
Im going to go out on a limb and say it is not because you asked Mrs. Cleo?

CALL ME NOW TO HAVE YOUR PROPOSAL NOT DISCUSSED BY THE STUDY SECTION


miss-cleo - Copy.jpg
 
  • Like
  • Haha
Reactions: 4 users
I'm having a grant reviewed in early March. If I get not discussed, I am coming after you!!! :laugh:

Maybe Miss Cleo can revive my cooperative group protocol from the dead.
 
  • Haha
Reactions: 1 user
I'm having a grant reviewed in early March. If I get not discussed, I am coming after you!!! :laugh:

Maybe Miss Cleo can revive my cooperative group protocol from the dead.

Sadly, it would appear that Youree Harris, better known as Miss Cleo, died of metastatic colon cancer in 2016 :(

Even more sad, it appears that she was sued > 50 times for engaging in "deceptive advertising." Im scared to think how many people didn't know exactly what they were getting from her.
 
  • Sad
Reactions: 1 user
Sadly, it would appear that Youree Harris, better known as Miss Cleo, died of metastatic colon cancer in 2016 :(

Even more sad, it appears that she was sued > 50 times for engaging in "deceptive advertising." Im scared to think how many people didn't know exactly what they were getting from her.
Damn buzz killer!
 
For instance, given the preponderance of randomized data using SBRT for oligomets, how would you feel if an underpowered single-arm trial from a single no-name center was published, which showed a numeric OS improvement over historical controls, but was negative because their statistical hypothesis assumed a massive 20% improvement in 2-year OS? Is that trial of 30 patients that was poorly designed from the get-go really worth disseminating? Would people really take it seriously in light of the existing data? Wouldn't people who are anti-oligomet-SBRT use it as fodder?
That trial should never have been approved by the IRB / the competent authorities.
They are supposed to look at things like that.
 
  • Haha
Reactions: 1 user
That trial should never have been approved by the IRB / the competent authorities.
They are supposed to look at things like that.
No guarantee that they do that sort of thing well (or even close) :rofl:
 
  • Angry
Reactions: 1 user
Top