Emulating Comparative Oncology Trials With Real-World Evidence Studies (ENCORE): Process Development and...

Real-world evidence (RWE) is increasingly used to complement findings from randomized controlled trials (RCTs), contextualizing the effectiveness and safety of medical interventions as delivered in routine clinical practice. Advances in the curation and accessibility of electronic health record (EHR) data present the opportunity to utilize real-world data (RWD) to investigate therapeutic areas including oncology, where administrative healthcare claims databases alone are often not fit-for-purpose. The RCT DUPLICATE initiative has previously evaluated when RWE can most appropriately draw causal conclusions by emulating trials for nononcology indications. Here, we present the design and trial selection for the emulation of comparative oncology trials with real-world evidence (ENCORE) project, which extends this work to oncology. ENCORE is designed to emulate 12 RCTs in four oncology-specialized EHR databases across four different cancer indications, specifically non-small-cell lung cancer, breast cancer, colorectal cancer, and multiple myeloma. It will place special emphasis on systematic evaluation of fitness of data in relation to the study design and statistical analysis for a particular research question and preregistration of study protocols prior to initiation and analysis. Prespecified criteria will assess agreement of treatment effect estimates between RCTs and their respective emulations. Through extensive sensitivity analyses benchmarked against RCT results, the ENCORE project aims to inform understanding of how measurement, design, and analytic decisions influence the interpretation of results from emulated oncology trials using RWD.