High-dimensional biomarkers such as genomics are increasingly being measured in randomized clinical trials. Consequently, there is a growing interest in developing methods that improve the power to detect biomarker-treatment interactions. We adapt recently proposed two-stage interaction detecting procedures in the setting of randomized clinical trials. We also propose a new stage 1 multivariate screening strategy using ridge regression to account for correlations among biomarkers. For this multivariate screening, we prove the asymptotic between-stage independence, required for family-wise error rate control, under biomarker-treatment independence. Simulation results show that in various scenarios, the ridge regression screening procedure can provide substantially greater power than the traditional one-biomarker-at-a-time screening procedure in highly correlated data. We also exemplify our approach in two real clinical trial data applications.
The identification of predictive biomarkers from a large scale of covariates for subgroup analysis has attracted fundamental attention in medical research. In this article, we propose a generalized penalized regression method with a novel penalty function, for enforcing the hierarchy structure between the prognostic and predictive effects, such that a nonzero predictive effect must induce its ancestor prognostic effects being nonzero in the model. Our method is able to select useful predictive biomarkers by yielding a sparse, interpretable, and predictable model for subgroup analysis, and can …
Efforts to develop biomarker-targeted anti-cancer therapies have progressed rapidly in recent years. Six antibodies acting on programmed death ligand 1 or programmed death 1 pathways were approved in 75 cancer indications between 2015 and 2021. With efforts to expedite regulatory reviews of promising therapies, several targeted cancer therapies have been granted accelerated approval on the basis of single-arm phase II trials. And yet, in the absence of randomization, patient outcomes may not have been studied under standard of care chemotherapies for emerging biomarker subpopulations prior to …
Genentech Inc.（基因泰克公司）；University of Washington（华盛顿大学）；Flatiron Health, Inc.（Flatiron Health公司）；University of California, Berkeley（加州大学伯克利分校）
Finding translational biomarkers stands center stage of the future of personalized medicine in healthcare. We observed notable challenges in identifying robust biomarkers as some with great performance in one scenario often fail to perform well in new trials (e.g. different population, indications). With rapid development in the clinical trial world (e.g. assay, disease definition), new trials very likely differ from legacy ones in many perspectives and in development of biomarkers this heterogeneity should be considered. In response, we recommend considering building in the heterogeneity when…
As a future trend of healthcare, personalized medicine tailors medical treatments to individual patients. It requires to identify a subset of patients with the best response to treatment. The subset can be defined by a biomarker (e.g. expression of a gene) and its cutoff value. Topics on subset identification have received massive attention. There are over 2 million hits by keyword searches on Google Scholar. However, how to properly incorporate the identified subsets/biomarkers to design clinical trials is not trivial and rarely discussed in the literature, which leads to a gap between resear…
Biomarker measurements can be relatively easy and quick to obtain and they are useful to investigate whether a compound works as intended on a mechanistic, pharmacological level. In some situations, it is realistic to assume that patients, whose post-baseline biomarker levels indicate that they do not sufficiently respond to the drug, are also unlikely to respond on clinically relevant long term outcomes (such as time-to-event). However the determination of the treatment effect in the subgroup of patients that sufficiently respond to the drug according to their biomarker levels is not straight…
An endeavor central to precision medicine is predictive biomarker discovery; they define patient subpopulations which stand to benefit most, or least, from a given treatment. The identification of these biomarkers is often the byproduct of the related but fundamentally different task of treatment rule estimation. Using treatment rule estimation methods to identify predictive biomarkers in clinical trials where the number of covariates exceeds the number of participants often results in high false discovery rates. The higher than expected number of false positives translates to wasted resources…
In clinical trials, identification of prognostic and predictive biomarkers is essential to precision medicine. Prognostic biomarkers can be useful for the prevention of the occurrence of the disease, and predictive biomarkers can be used to identify patients with potential benefit from the treatment. Previous researches were mainly focused on clinical characteristics, and the use of genomic data in such an area is hardly studied. A new method is required to simultaneously select prognostic and predictive biomarkers in high dimensional genomic data where biomarkers are highly correlated. We pro…
Detection of interactions between treatment effects and patient descriptors in clinical trials is critical for optimizing the drug development process. The increasing volume of data accumulated in clinical trials provides a unique opportunity to discover new biomarkers and further the goal of personalized medicine, but it also requires innovative robust biomarker detection methods capable of detecting non-linear, and sometimes weak, signals. We propose a set of novel univariate statistical tests, based on the theory of random walks, which are able to capture non-linear and non-monotonic covari…
Network meta-analysis (NMA) allows the combination of direct and indirect evidence from a set of randomized clinical trials. Performing NMA using individual patient data (IPD) is considered as a "gold standard" approach as it provides several advantages over NMA based on aggregate data. For example, it allows to perform advanced modelling of covariates or covariate-treatment interactions. An important issue in IPD NMA is the selection of influential parameters among terms that account for inconsistency, covariates, covariate-by-treatment interactions or non-proportionality of treatments effect…
While the HVTN 505 trial showed no overall efficacy of the tested vaccine to prevent HIV infection over placebo, previous studies, biological theories, and the finding that immune response markers strongly correlated with infection in vaccine recipients generated the hypothesis that a qualitative interaction occurred. This hypothesis can be assessed with statistical methods for studying treatment effect modification by an intermediate response variable (i.e., principal stratification effect modification (PSEM) methods). However, available PSEM methods make untestable structural risk assumption…
Often in Phase 3 clinical trials measuring a long-term time-to-event endpoint, such as overall survival or progression-free survival, investigators also collect repeated measures on biomarkers which may be predictive of the primary endpoint. Although these data may not be leveraged directly to support early stopping decisions, can we make greater use of these data to increase efficiency and improve interim decision making? We present a joint model for longitudinal and time-to-event data and a method which establishes the distribution of successive estimates of parameters in the joint model acr…
We propose a novel adaptive design for clinical trials with time-to-event outcomes and covariates (which may consist of or include biomarkers). Our method is based on the expected entropy of the posterior distribution of a proportional hazards model. The expected entropy is evaluated as a function of a patient's covariates, and the information gained due to a patient is defined as the decrease in the corresponding entropy. Candidate patients are only recruited onto the trial if they are likely to provide sufficient information. Patients with covariates that are deemed uninformative are filtere…
Longitudinal and high-dimensional measurements have become increasingly common in biomedical research. However, methods to predict survival outcomes using covariates that are both longitudinal and high-dimensional are currently missing. In this article, we propose penalized regression calibration (PRC), a method that can be employed to predict survival in such situations. PRC comprises three modeling steps: First, the trajectories described by the longitudinal predictors are flexibly modeled through the specification of multivariate mixed effects models. Second, subject-specific summaries of t…
Analysing subgroups defined by biomarkers is of increasing importance in clinical research. In some situations the biomarker is subject to misclassification error, meaning the true subgroups are identified with imperfect sensitivity and specificity. For time-to-event data, it is improper to assume the Cox proportional hazards model for the effects with respect to the true subgroups, since the survival distributions with respect to the diagnosed subgroups will not adhere to the proportional hazards assumption. This precludes the possibility of using simple adjustment procedures. Instead, we pre…
Background: The concept of combinatorial biomarkers was conceived around 2010: it was noticed that simple biomarkers are often inadequate for recognizing and characterizing complex diseases. Methods: Here we present an algorithmic search method for complex biomarkers which may predict or indicate Alzheimer's disease (AD) and other kinds of dementia. We applied data mining techniques that are capable to uncover implication-like logical schemes with detailed quality scoring. Our program SCARF is capable of finding multi-factor relevant association rules automatically. The new SCARF program was a…
Selective recruitment designs preferentially recruit individuals that are estimated to be statistically informative onto a clinical trial. Individuals that are expected to contribute less information have a lower probability of recruitment. Furthermore, in an information-adaptive design recruits are allocated to treatment arms in a manner that maximises information gain. The informativeness of an individual depends on their covariate (or biomarker) values and how information is defined is a critical element of information-adaptive designs. In this paper we define and evaluate four different me…
In two harmonized efficacy studies to prevent HIV infection through multiple infusions of the monoclonal antibody VRC01, a key objective is to evaluate whether the serum concentration of VRC01, which changes cyclically over time along with the infusion schedule, is associated with the rate of HIV infection. Simulation studies are needed in the development of such survival models. In this paper, we consider simulating event time data with a continuous time-varying covariate whose values vary with time through multiple drug administration cycles, and whose effect on survival changes differently …
When Method Choice Changes Statistical Inference: A Comparison of a Baseline Two-Stage Approach and Bayesian Joint Modeling for Longitudinal and Survival Data in an HIV Clinical Trial
Here we propose a novel searching scheme for a tuning parameter in high-dimensional penalized regression methods to address variable selection and modeling when sample sizes are limited compared to the data dimensions. Our method is motivated by high-throughput biological data such as genome-wide association studies (GWAS) and epigenome-wide association studies (EWAS). We propose a new estimate of the regularization parameter $λ$ in penalized regression methods based on an estimated lower bound of the proportion of false null hypotheses with confidence $(1 - α)$. The bound is estimated by appl…
Functional forms in joint models for longitudinal and time-to-event data: A practical guide with application and interpretation
Erasmus University Medical Center（伊拉斯姆斯大学医学中心）；European Organisation for Research and Treatment of Cancer（欧洲癌症研究与治疗组织）；University Medical Center Utrecht（乌得勒支大学医学中心）
Stochastic volatility often implies increasing risks that are difficult to capture given the dynamic nature of real-world applications. We propose using arc length, a mathematical concept, to quantify cumulative variations (the total variability over time) to more fully characterize stochastic volatility. The hazard rate, as defined by the Cox proportional hazards model in survival analysis, is assumed to be impacted by the instantaneous value of a longitudinal variable. However, when cumulative variations pose a significant impact on the hazard, this assumption is questionable. Our proposed B…
The analysis of randomized trials with time-to-event endpoints is nearly always plagued by the problem of censoring. As the censoring mechanism is usually unknown, analyses typically employ the assumption of non-informative censoring. While this assumption usually becomes more plausible as more baseline covariates are being adjusted for, such adjustment also raises concerns. Pre-specification of which covariates will be adjusted for (and how) is difficult, thus prompting the use of data-driven variable selection procedures, which may impede valid inferences to be drawn. The adjustment for cova…
Penalized Deep Partially Linear Cox Models with Application to CT Scans of Lung Cancer Patients
William & Mary（威廉与玛丽学院）；University of Michigan（密歇根大学）；Massachusetts General Hospital（麻省总医院）；Duke University（杜克大学）；Harvard T.H. Chan School of Public Health（哈佛大学陈曾熙公共卫生学院）
Efficient estimation of cumulative incidence curves via data fusion with surrogates: application to integrated analysis of vaccine trial and immunobridging data
Biomarker subpopulations have become increasingly important for drug development in targeted therapies. The use of biomarkers has the potential to facilitate more effective outcomes by guiding patient selection appropriately, thus enhancing the benefit-risk profile and improving trial power. Studying a broad population simultaneously with a more targeted one allows the trial to determine the population for which a treatment is effective and allows a goal of making approved regulatory labeling as inclusive as is appropriate. We examine new methods accounting for the complete correlation structu…
An intermediate response measure that accurately predicts efficacy in a new setting can reduce trial cost and time to product licensure. In this paper, we define a trial level general surrogate as a trial level intermediate response that accurately predicts trial level clinical responses. Methods for evaluating trial level general surrogates have been developed previously. Many methods in the literature use trial level intermediate responses for prediction. However, all existing methods focus on surrogate evaluation and prediction in new settings, rather than comparison of candidate trial leve…
When it comes to clinical survival trials, regulatory restrictions usually require the application of methods that solely utilize baseline covariates and the intention-to-treat principle. Thereby a lot of potentially useful information is lost, as collection of time-to-event data often goes hand in hand with collection of information on biomarkers and other internal time-dependent covariates. However, there are tools to incorporate information from repeated measurements in a useful manner that can help to shed more light on the underlying treatment mechanisms. We consider dynamic path analysis…
In vaccine studies, investigators are often interested in studying effect modifiers of clinical treatment efficacy by biomarker-based principal strata, which is useful for selecting biomarker study endpoints for evaluating treatments in new trials, exploring biological mechanisms of clinical treatment efficacy, and studying mediators of clinical treatment efficacy. However, in trials where participants may enter the study with prior exposure therefore with variable baseline biomarker values, clinical treatment efficacy may depend jointly on a biomarker measured at baseline and measured at a fi…
Two-part joint models for a longitudinal semicontinuous biomarker and a terminal event have been recently introduced based on frequentist estimation. The biomarker distribution is decomposed into a probability of positive value and the expected value among positive values. Shared random effects can represent the association structure between the biomarker and the terminal event. The computational burden increases compared to standard joint models with a single regression model for the biomarker. In this context, the frequentist estimation implemented in the R package frailtypack can be challen…
A Globally Calibrated Bayesian Optimal Phase II Design for Adaptive Enrichment Trials
Kyowa Kirin Co., Ltd.（协和麒麟株式会社）；Faculty of Science and Engineering, Chuo University（中央大学理工学部）；Graduate School of Medicine, The University of Osaka（大阪大学大学院医学系研究科）
