Progression-free survival (PFS) is "the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse". In

oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's Etymology, etymological origin is the Greek word ὄγ ...

, PFS usually refers to situations in which a tumor is present, as demonstrated by laboratory testing, radiologic testing, or clinically. Similarly, "disease-free survival" is the length of time after patients have received treatment and have no detectable disease. Time to progression (TTP) does not count patients who die from other causes but is otherwise a close equivalent to PFS (unless there are many such events). The FDA gives separate definitions and prefers PFS.

Background

PFS is widely used as a surrogate endpoint in oncology. The definition of "progression" generally involves imaging techniques (plain radiograms,

CT scans A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

PET scan Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in Metabolism, metabolic processes, and in other physiological activities including bloo ...

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

s) or other aspects: biochemical progression may be defined on the basis of an increase in a tumor marker (such as CA125 for epithelial ovarian cancer or PSA for

prostate cancer Prostate cancer is the neoplasm, uncontrolled growth of cells in the prostate, a gland in the male reproductive system below the bladder. Abnormal growth of the prostate tissue is usually detected through Screening (medicine), screening tests, ...

). In clinical trials, what precisely constitutes an "event" in PFS (an event being either disease progression or death) may vary depending on the specific disease and/or the toxicological characteristics of the treatments in the trial; however, this is generally defined in the trial protocol prior to the trial enrolling patients. , change in the radiological aspects of a lesion is defined according to RECIST criteria. Progression may also be due to the appearance of a new lesion or to unequivocal progression in other lesions, such as an increase in size or the lesions spreading to nearby tissues. Progression-free survival is commonly used as an alternative to overall survival (OS). In some cancers, PFS and OS are strictly related, but in others they are not. In a time trade off study in renal cancer, physicians rated PFS the most important aspect of treatment, while for patients it fell below fatigue, hand foot syndrome, and other toxicities.

Special aspects

By definition, PFS refers to the date on which progression is detected. An advantage of measuring PFS over measuring OS is that PFS appears sooner than deaths, allowing faster trials. PFS also allows for greater insight into consequences of diseases and treatments that fall below the threshold of mortality, such as pain, organ dysfunction, interference in daily life, and other effects that progressive disease may have on the patient while they are still alive. The use of PFS for proof of effectiveness and regulatory approval is controversial. It is often used as a clinical endpoint in

randomized controlled trials A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...

for cancer therapies. It is a metric frequently used by the UK National Institute for Health and Clinical Excellence and the U.S.

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...

to evaluate the effectiveness of a cancer treatment. Studies find that new cancer drugs approved by the U.S.

improve progression-free survival by a median of 2 to 3 months depending on the sample and analyzed time period: 2.5 months, 2.70 months, 3.30 months. PFS improvements do not always result in corresponding improvements in overall survival, and the control of the disease may come at the biological expense of side effects from the treatment itself. This has been described as an example of the McNamara fallacy.

References

{{Reflist Medical terminology

Background

Special aspects

See also

References