Overall survival is the most reliable cancer endpoint, usually the preferred endpoint, and studies can be conducted to adequately assess it. An improvement in survival is a clinical benefit. The endpoint is precise and easy to measure, document by the date of death. Bias is not a factor in endpoint measurement. Demonstration of a statistical significant improvement in overall survival has supported new drug approvals.
Now, let's look at overall survival difference in D9901. This 4.5-month median survival difference is clinically meaningful, but it has the following limitations, as Dr. Bo-Guang Zhen will discuss in detail in his presentation. First, post hoc analysis. All survival analysis were done post hoc, because survival was not the pre-specified endpoint, the primary method for survival analysis, and its comparison was not pre-specified. Second, it's one study with a small sample size, so the difference could be due to chance alone. Therefore, uncertainties exist regarding the persuasiveness of the survival results in the support of sipuleucel-T BLA efficacy claim, and that's the reason why we're all here to discuss these issues today, and FDA would like to seek advice from the advisory committee.
Dr. Liu.