Phase I dose-finding studies aim at identifying the maximal tolerated dose (MTD). It is not uncommon that several dose-finding studies are conducted, although often with some variation in the administration mode or dose panel. For instance, sorafenib (BAY 43-900) was used as monotherapy in at least 29 phase I trials according to a recent search in clinicaltrials.gov. Since the toxicity may not be directly related to the specific indication, synthesizing the information from several studies might be worthwhile. However, this is rarely done in practice and only a fixed-effect meta-analysis framework was proposed to date. We developed a Bayesian random-effects meta-analysis methodology to pool several phase I trials and suggest the MTD. A curve free hierarchical model on the logistic scale with random effects, accounting for between-trial heterogeneity, is used to model the probability of toxicity across the investigated doses. An Ornstein-Uhlenbeck Gaussian process is adopted for the random effects structure. Prior distributions for the curve free model are based on a latent Gamma process. An extensive simulation study showed good performance of the proposed method also under model deviations. Sharing information between phase I studies can improve the precision of MTD selection, at least when the number of trials is reasonably large.
Dose-response models express the effect of different dose or exposure levels on a specific outcome. In meta-analysis, where aggregated-level data is available, dose-response evidence is synthesized using either one-stage or two-stage models in a frequentist setting. We propose a hierarchical dose-response model implemented in a Bayesian framework. We present the model with cubic dose-response shapes for a dichotomous outcome and take into account heterogeneity due to variability in the dose-response shape. We develop our Bayesian model assuming normal or binomial likelihood and accounting for …
We propose BaySize, a sample size calculator for phase I clinical trials using Bayesian models. BaySize applies the concept of effect size in dose finding, assuming the MTD is defined based on an equivalence interval. Leveraging a decision framework that involves composite hypotheses, BaySize utilizes two prior distributions, the fitting prior (for model fitting) and sampling prior (for data generation), to conduct sample size calculation under desirable statistical power. Look-up tables are generated to facilitate practical applications. To our knowledge, BaySize is the first sample size tool…
Controlled interventions provide the most direct source of information for learning causal effects. In particular, a dose-response curve can be learned by varying the treatment level and observing the corresponding outcomes. However, interventions can be expensive and time-consuming. Observational data, where the treatment is not controlled by a known mechanism, is sometimes available. Under some strong assumptions, observational data allows for the estimation of dose-response curves. Estimating such curves nonparametrically is hard: sample sizes for controlled interventions may be small, whil…
An important objective in environmental risk assessment is estimation of minimum exposure levels, called Benchmark Doses (BMDs) that induce a pre-specified Benchmark Response (BMR) in a target population. Established inferential approaches for BMD analysis typically involve one-sided, frequentist confidence limits, leading in practice to what are called Benchmark Dose Lower Limits (BMDLs). Appeal to Bayesian modeling and credible limits for building BMDLs is far less developed, however. Indeed, for the few existing forms of Bayesian BMDs, informative prior information is seldom incorporated. W…
In this paper we consider two-stage adaptive dose-response study designs, where the study design is changed at an interim analysis based on the information collected so far. In a simulation study, two approaches will be compared for these type of designs; (i) updating the study design by calculating the maximum likelihood estimate for the dose-response model parameters and then calculating the design for the second stage that is locally optimal for this estimate, and (ii) using the complete posterior distribution of the model parameter at interim to calculate a Bayesian optimal design (i.e. ta…
Unblinded sample size re-estimation (SSR) is often planned in a clinical trial when there is large uncertainty about the true treatment effect. For Proof-of Concept (PoC) in a Phase II dose finding study, contrast test can be adopted to leverage information from all treatment groups. In this article, we propose two-stage SSR designs using frequentist conditional power and Bayesian posterior predictive power for both single and multiple contrast tests. The Bayesian SSR can be implemented under a wide range of prior settings to incorporate different prior knowledge. Taking the adaptivity into ac…
An important task in drug development is to identify patients, which respond better or worse to an experimental treatment. Identifying predictive covariates, which influence the treatment effect and can be used to define subgroups of patients, is a key aspect of this task. Analyses of treatment effect heterogeneity are however known to be challenging, since the number of possible covariates or subgroups is often large, while samples sizes in earlier phases of drug development are often small. In addition, distinguishing predictive covariates from prognostic covariates, which influence the resp…
An important objective in biomedical risk assessment is estimation of minimum exposure levels that induce a pre-specified adverse response in a target population. The exposure/dose points in such settings are known as Benchmark Doses (BMDs). Recently, parametric Bayesian estimation for finding BMDs has become popular. A large variety of candidate dose-response models is available for applying these methods, however, leading to questions of model adequacy and uncertainty. Here we enhance the Bayesian estimation technique for BMD analysis by applying Bayesian model averaging to produce point est…
Leveraging preclinical animal data for a phase I first-in-man trial is appealing yet challenging. A prior based on animal data may place large probability mass on values of the dose-toxicity model parameter(s), which appear infeasible in light of data accrued from the ongoing phase I clinical trial. In this paper, we seek to use animal data to improve decision making in a model-based dose-escalation procedure for phase I oncology trials. Specifically, animal data are incorporated via a robust mixture prior for the parameters of the dose-toxicity relationship. This prior changes dynamically as …
Memorial Sloan Kettering Cancer Center（纪念斯隆-凯特琳癌症中心）；Columbia University（哥伦比亚大学）
Exploratory cancer drug studies test multiple tumor cell lines against multiple candidate drugs. The goal in each paired (cell line, drug) experiment is to map out the dose-response curve of the cell line as the dose level of the drug increases. We propose Bayesian Tensor Filtering (BTF), a hierarchical Bayesian model for dose-response modeling in multi-sample, multi-treatment cancer drug studies. BTF uses low-dimensional embeddings to share statistical strength between similar drugs and similar cell lines. Structured shrinkage priors in BTF encourage smoothness in the dose-response curves whi…
Remote, bivariate expert elicitation to determine the prior probability distribution for sample size calculation in a Bayesian non-inferiority multicenter randomized controlled trial (Croup Dosing Trial)
We propose an adaptive design for early phase drug combination cancer trials with the goal of estimating the maximum tolerated dose (MTD). A nonparametric Bayesian model, using beta priors truncated to the set of partially ordered dose combinations, is used to describe the probability of dose limiting toxicity (DLT). Dose allocation between successive cohorts of patients is estimated using a modified Continual Reassessment scheme. The updated probabilities of DLT are calculated with a Gibbs sampler that employs a weighting mechanism to calibrate the influence of data versus the prior. At the e…
Optimal Biological Dose Combination Finding: A Design Roadmap and Robust Cross-Indication Bayesian Borrowing
Population Health Sciences Institute, Newcastle University（纽卡斯尔大学人口健康科学研究所）；Quantitative Science and Evidence Generation, Astellas Pharma Global Development Inc.（安斯泰来全球开发公司定量科学与证据生成部）
Aims: Combinations of treatments can offer additional benefit over the treatments individually. However, trials of these combinations are lower priority than the development of novel therapies, which can restrict funding, timelines and patient availability. This paper develops a novel trial design to facilitate the evaluation of novel combination therapies that combines elements of phase II and phase III trials. Methods: This trial uses response adaptive randomisation to increase the information collected about successful novel drug combinations and Bayesian dose-response modelling to undertak…
If explicit, formal consideration of clinical pharmacology at all informs the design and conduct of modern oncology dose-finding trials, the designs themselves hardly attest to this. Yet in conducting a trial, investigators affirm that they hold reasonable expectations of participant safety - expectations that necessarily depend on beliefs about how certain pharmacologic parameters are distributed in the study population. Thus, these beliefs are implicit in a trial's presumed conformance to a community standard of safety, and may therefore to some extent be reverse-engineered from trial design…
The commonplace description of phase 1 clinical trials in oncology as "primarily concerned with safety" is belied by their near universal adoption of dose-escalation practices which are inherently unsafe. In contrast with dose titration, cohort-wise dose escalation regards patients as exchangeable, an indefensible assumption in the face of widely appreciated inter-individual heterogeneity in pharmacokinetics and pharmacodynamics (PKPD). I have previously advanced this argument in terms of a precautionary coherence principle that brings the well-known coherence notion of Cheung (2005) into cont…
