MARS: a sense of perspective and an inconvenient truth

Our plain-English summary of MARS: a sense of perspective and an inconvenient truth, by V.W. Rusch, H.L. Kindler (Journal of Thoracic Oncology, 2013).

The study

• Authors: V.W. Rusch, H.L. Kindler
• Journal: Journal of Thoracic Oncology
• Published: 2013;8(5):e49-50
• Type of article: Letter, Comment
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this letter, Rusch and Kindler replied to a letter from Drs. Treasure, Utley and O'Byrne. Those authors had written to correct what they considered misperceptions about the Mesothelioma and Radical Surgery (MARS) trial, which compared extrapleural pneumonectomy (EPP) with no EPP in patients with malignant pleural mesothelioma (MPM). Rusch and Kindler stated that significant concerns about the trial's methodology had already been reported by an international group of mesothelioma investigators and did not need to be repeated. They described a major concern: a trial originally designed to accrue 50 patients with MPM, to test whether randomizing between EPP and no surgery was feasible, had been reported as a definitive phase III trial showing no survival benefit for EPP. They called this a fundamental violation of the principles of clinical trial analysis and reporting. They stated that the article in the November issue of the Journal of Thoracic Oncology and its accompanying editorial had focused on the International Association for the Study of Lung Cancer Staging Committee's effort to develop an international database. That database was intended to lead to evidence-based revisions of the UICC and AJCC staging system for MPM. They concluded that discussions of the role of EPP in managing MPM, or of the MARS trial, were tangential to the primary focus of that effort.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This item is a short reply letter to the editor, not a research study, and it reports no new data. The authors responded to a letter by Tom Treasure, Martin Utley and Ken O'Byrne, who had written to correct what those writers considered misperceptions about the Mesothelioma and Radical Surgery (MARS) trial. The authors said significant concerns about the trial's methodology had already been reported by an international group of mesothelioma investigators. They described a major concern as follows: the trial was originally designed to accrue 50 patients with malignant pleural mesothelioma to test the feasibility of randomizing between extrapleural pneumonectomy (EPP) and no surgery, but it was reported as a definitive phase III trial showing no survival benefit for EPP. The authors called this a fundamental violation of the principles of clinical trial analysis and reporting. They added that the journal article and editorial under discussion had focused on building an international database to revise the staging system for malignant pleural mesothelioma. The authors concluded that discussion of EPP or the MARS trial was tangential to that effort. The letter does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor (a reply to another letter); no original data
• Who was studied: No population was studied. The letter discusses the MARS trial, which the authors describe as originally designed to accrue 50 patients with malignant pleural mesothelioma.
• Exposure: No asbestos exposure is discussed. The treatment at issue was extrapleural pneumonectomy (EPP) versus no surgery.
• Main results:
  • The letter reports no findings of its own. The authors argued that concerns about the MARS trial's methodology had already been published by an international group of mesothelioma investigators.
  • The authors argued that a trial designed to test the feasibility of randomizing 50 patients was reported as a definitive phase III trial, and they called this a fundamental violation of clinical trial principles.
  • The authors stated that the article and editorial under discussion focused on building an international database to support evidence-based revisions of the UICC and AJCC staging system for malignant pleural mesothelioma.
• The authors' conclusion: The authors concluded that discussion of the role of EPP or of the MARS trial was tangential to the main focus of the staging effort.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Clinical Trial, Lung Cancer, Staging, UICC, AJCC.

Related studies

• MARS: a sense of perspective and an inconvenient truth — T. Treasure, M. Utley, et al. (2013)
• The MARS feasibility trial: conclusions not supported by data — W. Weder, R.A. Stahel, et al. (2011)
• The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma — V.W. Rusch, K. Chansky, et al. (2016)
• Canada, chrysotile, and the search for truth — T. Ogden (2008)
• Common sense in the environment — (1991)
• Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study — T. Treasure, L. Lang-Lazdunski, et al. (2011)

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