Overcoming the Straw Man Effect in Oncology: Visualization and Ranking of Chemotherapy Regimens Using an Information...

Despite the plethora of randomized controlled trial (RCT) data, most cancer treatment recommendations are formulated by experts. Alternatively, network meta-analysis (NMA) is one method of analyzing multiple indirect treatment comparisons. However, NMA does not account for mixed end points or temporality. Previously, we described a prototype information theoretical approach for the construction of ranked chemotherapy treatment regimen networks. Here, we propose modifications to overcome an apparent straw man effect, where the most studied regimens were the most negatively valued.

RCTs from two scenarios-upfront treatment of chronic myelogenous leukemia and relapsed/refractory multiple myeloma-were assembled into ranked networks using an automated algorithm based on effect sizes, statistical significance, surrogacy of end points, and time since RCT publication. Vertex and edge color, transparency, and size were used to visually analyze the network. This analysis led to the additional incorporation of value propagation.

A total of 18 regimens with 42 connections (chronic myelogenous leukemia) and 28 regimens with 25 connections (relapsed/refractory multiple myeloma) were analyzed. An initial negative correlation between vertex value and size was ameliorated after value propagation, although not eliminated. Updated rankings were in close agreement with published guidelines and NMAs.

Straw man effects can distort the comparative efficacy of newer regimens at the expense of older regimens, which are often cheaper or less toxic. Using an automated method, we ameliorated this effect and produced rankings consistent with common practice and published guidelines in two distinct cancer settings. These findings are likely to be generalizable and suggest a new means of ranking efficacy in cancer trials.