In Reply Dr Burke asks why we focused on overall survival and not disease-specific survival in our Viewpoint,1 particularly among the elderly who face competing risks. We made the case that a marginal improvement in overall survival in an ideal population may be lost when that therapy is extrapolated to a real-world population. It is likely the case that a marginal benefit to disease-specific survival is also diluted or lost in the world because the mechanism of the loss is due to an increase in toxicity, frequent dose reductions, and discontinuations,2 leading to a tipping of the benefit/harm balance.
Mailankody S, Prasad V. Overall Survival vs Disease-Specific Survival—Reply. JAMA Oncol. 2018;4(4):586. doi:10.1001/jamaoncol.2017.3865
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