University Medical Center St. Radboud, Department of Medical Oncology, Nijmegen, The Netherlands (E-mail: c.punt@onco.azn.nl)
We thank Drs Wheatley and Ives for their valuable comments. We entirely agree with their views on the necessity of performing well-designed meta-analyses in situations where individual trials are not sufficiently powered to detect a small but meaningful benefit of a specific intervention. In this respect, we are looking forward to the peer-reviewed publication of their meta-analysis on interferon- (IFN-
) as adjuvant treatment in melanoma.
However, two remarks should be made. First, the impact of IFN- on disease-free survival that the authors mention, varies substantially among the reported trials; therefore, this does not permit a straightforward interpretation of the overall result. Secondly, the results from the great majority of previously published adjuvant trials were obtained in patient populations that were suboptimally staged compared with the current standard (i.e. stratification for results on ulceration of primary and sentinel node biopsies). Consequently, the result of any meta-analysis in which these staging techniques were not included cannot be blindly implemented into current practice.
C. J. A. Punt & A. M. M. Eggermont
University Medical Center St Radboud, Department of Medical Oncology, Nijmegen, The Netherlands (E-mail: c.punt@onco.azn.nl)