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Of 104 solid-tumour cancer drug decisions by Canada's pan-Canadian Oncology Drug Review from 2011 to 2020, three in four were positive, almost all with conditions, and only half of the recommended drugs had shown that they extend life, by a median of 3.7 months.
A cohort study of every solid-tumour cancer drug submission with a final recommendation from the inception of the pan-Canadian Oncology Drug Review (pCODR) in July 2011 to February 2020, using public pCODR documents and the trial reports behind them, with ESMO Magnitude of Clinical Benefit Scale scores available at the time of assessment.
Of 104 recommendations, 78 (75.0 per cent) were positive and 72 of those (92.3 per cent) conditional. Positively recommended drugs were more likely to rest on phase 3 randomised trials (92.3 against 53.8 per cent) and to show substantial ESMO-MCBS benefit (61.5 against 19.2 per cent). The commonest primary endpoints of successful submissions were progression-free survival (53.9 per cent) and overall survival (32.1 per cent); 39 of the 78 positively recommended submissions had shown an overall survival benefit, with a median gain of 3.7 months (interquartile range 2.7 to 6.5).
Canada's cancer drug review filters out some weak evidence, but a positive recommendation does not mean a drug has been shown to extend life; patients and clinicians should look at the trial result behind each funded drug.
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