Selpercatinib or Chemotherapy in RET Fusion-Positive NSCLC

To the Editor: In their article on the phase 3 LIBRETTO-431 trial, Zhou and colleagues (Nov. 16 issue)(1) describe the results of treatment with selpercatinib, which led to significantly longer progression-free survival than platinum-based chemotherapy with or without pembrolizumab among patients with advanced RET fusion-positive non-small-cell lung cancer (NSCLC). However, we encourage a critical review of the ethical considerations that were made in the design of this trial. The Declaration of Helsinki states that "when there is conclusive proof of definitive outcomes, physicians must assess whether to continue, modify, or immediately stop the study."(2) Before initiating a randomized clinical trial, . . .