Overall Survival vs Disease-Specific Survival

To the Editor Mailankody and Prasad, in their Viewpoint, discussed some of the age-related problems associated with the use of overall survival as an outcome in cancer drug trials. They suggested that overall survival in drug trials should be treated as a surrogate end point for overall survival in the real world. Some of the issues that the authors raise related to overall survival are due to the fact that the overall survival benefit decreases with age due to competing risks. It is not clear why the authors did not discuss disease-specific survival as a true outcome.

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