• Alexis B Webb, Christine D Berg, Philip E Castle, David Crosby, Ruth Etzioni, Larry G Kessler, Usha Menon, Mahesh Parmar, SteeleRobert J CRJCUniversity of Dundee, Department of Surgery, Ninewells Hospital, Dundee, UK., and Peter D Sasieni.
• Cancer Research UK, London, UK.
• Lancet Oncol. 2024 May 1; 25 (5): e183e192e183-e192.

AbstractThe requirement of large-scale expensive cancer screening trials spanning decades creates considerable barriers to the development, commercialisation, and implementation of novel screening tests. One way to address these problems is to use surrogate endpoints for the ultimate endpoint of interest, cancer mortality, at an earlier timepoint. This Review aims to highlight the issues underlying the choice and use of surrogate endpoints for cancer screening trials, to propose criteria for when and how we might use such endpoints, and to suggest possible candidates. We present the current landscape and challenges, and discuss lessons and shortcomings from the therapeutic trial setting. It is hugely challenging to validate a surrogate endpoint, even with carefully designed clinical studies. Nevertheless, we consider whether there are candidates that might satisfy the requirements defined by research and regulatory bodies.Copyright © 2024 Elsevier Ltd. All rights reserved.

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