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 exposures grouped in clusters. We implement these models in R using JAGS and we compare our approach to the one-stage dose-response meta-analysis model in a simulation study. We found that the Bayesian dose-response model with binomial likelihood has slightly lower bias than the Bayesian model with the normal likelihood and the frequentist one-stage model. However, all three models perform very well and give practically identical results. We also re-analyze the data from 60 randomized controlled trials (15,984 participants) examining the efficacy (response) of various doses of antidepressant drugs. All models suggest that the dose-response curve increases between zero dose and 40 mg of fluoxetine-equivalent dose, and thereafter is constant. We draw the same conclusion when we take into account the fact that five different antidepressants have been studied in the included trials. We show that implementation of the hierarchical model in Bayesian framework has similar performance to, but overcomes some of the limitations of the frequentist approaches and offers maximum flexibility to accommodate features of the data.
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…
We propose a flexible design for the identification of optimal dose combinations in dual-agent dose-finding clinical trials. The design is called AAA, standing for three adaptations: adaptive model selection, adaptive dose insertion, and adaptive cohort divi- sion. The adaptations highlight the need and opportunity for innovation for dual-agent dose finding, and are supported by the numerical results presented in the proposed simulation studies. To our knowledge, this is the first design that allows for all three adaptations at the same time. We find that AAA improves the statistical inference…
An accurately identified maximum tolerated dose (MTD) serves as the cornerstone of successful subsequent phases in oncology drug development. Bayesian logistic regression model (BLRM) is a popular and versatile model-based dose-finding design. However, BLRM with original overdose control strategy has been reported to be safe but "excessively conservative". In this manuscript, we investigate the reason for conservativeness and point out that a major reason could be the lack of appropriate underdose control. We propose designs that balance overdose and underdose control to improve the performanc…
There has been an increasing interest in using interval-based Bayesian designs for dose finding, one of which is the modified toxicity probability interval (mTPI) method. We show that the decision rules in mTPI correspond to an optimal rule under a formal Bayesian decision theoretic framework. However, the probability models in mTPI are overly sharpened by the Ockham's razor, which, while in general helps with parsimonious statistical inference, leads to suboptimal decisions in small-sample inference such as dose finding. We propose a new framework that blunts the Ockham's razor, and demonstra…
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…
U-DESPE: a Bayesian Utility-based methodology for dosing regimen optimization in early-phase oncology trials based on Dose-Exposure, Safety, Pharmacodynamics, Efficacy
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…
PK/PD-integrated Bayesian platform design for phase II dose regimen optimization
Inserm；Université Paris Cité（巴黎西岱大学）；Inria；HeKA；Centre d’Étude des Pathologies Respiratoires (CEPR)（呼吸疾病研究中心 (CEPR)）；UMR 1100；Université de Tours（图尔大学）；Service de Médecine Intensive Réanimation, CHRU de Tours（图尔大学医院重症医学科）；Université Sorbonne Paris Nord（巴黎北索邦大学）；IAME；Univ Rennes（雷恩大学）；EHESP；Irset；UMRS 1085
Phase I dose-finding trials in oncology seek to find the maximum tolerated dose (MTD) of a drug under a specific schedule. Evaluating drug-schedules aims at improving treatment safety while maintaining efficacy. However, while we can reasonably assume that toxicity increases with the dose for cytotoxic drugs, the relationship between toxicity and multiple schedules remains elusive. We proposed a Bayesian dose-regimen assessment method (DRtox) using pharmacokinetics/pharmacodynamics (PK/PD) information to estimate the maximum tolerated dose-regimen (MTD-regimen), at the end of the dose-escalati…
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…
The issue of determining not only an adequate dose but also a dosing frequency of a drug arises frequently in Phase II clinical trials. This results in the comparison of models which have some parameters in common. Planning such studies based on Bayesian optimal designs offers robustness to our conclusions since these designs, unlike locally optimal designs, are efficient even if the parameters are misspecified. In this paper we develop approximate design theory for Bayesian $D$-optimality for nonlinear regression models with common parameters and investigate the cases of common location or co…
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…
The use of drug combinations in clinical trials is increasingly common during the last years since a more favorable therapeutic response may be obtained by combining drugs. In phase I clinical trials, most of the existing methodology recommends a one unique dose combination as "optimal", which may result in a subsequent failed phase II clinical trial since other dose combinations may present higher treatment efficacy for the same level of toxicity. We are particularly interested in the setting where it is necessary to wait a few cycles of therapy to observe an efficacy outcome and the phase I …
Most conventional risk analysis methods rely on a single best estimate of exposure per person which does not allow for adjustment for exposure-related uncertainty. Here, we propose a Bayesian model averaging method to properly quantify the relationship between radiation dose and disease outcomes by accounting for shared and unshared uncertainty in estimated dose. Our Bayesian risk analysis method utilizes multiple realizations of sets (vectors) of doses generated by a two-dimensional Monte Carlo simulation method that properly separates shared and unshared errors in dose estimation. The exposu…
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…
This manuscript introduces an \proglang{R} package called \pkg{trialr} that implements a collection of clinical trial methods in \proglang{Stan} and \proglang{R}. In this article, we explore three methods in detail. The first is the continual reassessment method for conducting phase I dose-finding trials that seek a maximum tolerable dose. The second is EffTox, a dose-finding design that scrutinises doses by joint efficacy and toxicity outcomes. The third is the augmented binary method for modelling the probability of treatment success in phase II oncology trials with reference to repeated mea…
Drug combination trials are increasingly common nowadays in clinical research. However, very few methods have been developed to consider toxicity attributions in the dose escalation process. We are motivated by a trial in which the clinician is able to identify certain toxicities that can be attributed to one of the agents. We present a Bayesian adaptive design in which toxicity attributions are modeled via Copula regression and the maximum tolerated dose (MTD) curve is estimated as a function of model parameters. The dose escalation algorithm uses cohorts of two patients, following the contin…
Electron ptychography has seen a recent surge of interest for phase sensitive imaging at atomic or near-atomic resolution. However, applications are so far mainly limited to radiation-hard samples because the required doses are too high for imaging biological samples at high resolution. We propose the use of non-convex, Bayesian optimization to overcome this problem and reduce the dose required for successful reconstruction by two orders of magnitude compared to previous experiments. We suggest to use this method for imaging single biological macromolecules at cryogenic temperatures and demons…
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）
In Oncology, trials evaluating drug combinations are becoming more common. While combination therapies bring the potential for greater efficacy, they also create unique challenges for ensuring drug safety. In Phase-I dose escalation trials of drug combinations, model-based approaches enable efficient use of information gathered, but the models need to account for trial complexities: appropriate modeling of interactions becomes increasingly important with growing numbers of drugs being tested simultaneously in a given trial. In principle, we can use data from multiple arms testing varying combi…
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…
A major practical impediment when implementing adaptive dose-finding designs is that the toxicity outcome used by the decision rules may not be observed shortly after the initiation of the treatment. To address this issue, we propose the data augmentation continual reassessment method (DA-CRM) for dose finding. By naturally treating the unobserved toxicities as missing data, we show that such missing data are nonignorable in the sense that the missingness depends on the unobserved outcomes. The Bayesian data augmentation approach is used to sample both the missing data and model parameters fro…
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 frame…
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…
To better understand effects of exposure to food allergens, food challenge studies are designed to slowly increase the dose of an allergen delivered to allergic individuals until an objective reaction occurs. These dose-to-failure studies are used to determine acceptable intake levels and are analyzed using parametric failure time models. Though these models can provide estimates of the survival curve, their parametric form may misrepresent the survival function for doses of interest, and different models that describe the data similarly may produce different dose-to-failure estimates. Motivat…
PKComb-BOIN12: A Pharmacokinetically Guided Bayesian Design for Dose Optimisation in Oncology Drug-Combination Trials
Global Statistical Sciences, Eli Lilly and Company（礼来公司全球统计科学部）；Department of Biostatistics, The University of Texas MD Anderson Cancer Center（德克萨斯大学安德森癌症中心生物统计学系）；Population Health Sciences Institute, Newcastle University（纽卡斯尔大学人口健康科学研究所）
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 …
The geographic variation of terrestrial radiation can be exploited in epidemiological studies of the health effects of protracted low-dose exposure. Various methods have been applied to derive maps of this variation. We aimed to construct a map of terrestrial radiation for Switzerland. We used airborne $γ$-spectrometry measurements to model the ambient dose rates from terrestrial radiation through a Bayesian mixed-effects model and conducted inference using Integrated Nested Laplace Approximation (INLA). We predicted higher levels of ambient dose rates in the alpine regions and Ticino compared…
Shape constrained regression analysis has applications in dose-response modeling, environmental risk assessment, disease screening and many other areas. Incorporating the shape constraints can improve estimation efficiency and avoid implausible results. We propose two novel methods focusing on Bayesian monotone curve and surface estimation using Gaussian process projections. The first projects samples from an unconstrained prior, while the second projects samples from the Gaussian process posterior. Theory is developed on continuity of the projection, posterior consistency and rates of contrac…
We propose a new integrated phase I/II trial design to identify the most efficacious dose combination that also satisfies certain safety requirements for drug-combination trials. We first take a Bayesian copula-type model for dose finding in phase I. After identifying a set of admissible doses, we immediately move the entire set forward to phase II. We propose a novel adaptive randomization scheme to favor assigning patients to more efficacious dose-combination arms. Our adaptive randomization scheme takes into account both the point estimate and variability of efficacy. By using a moving refe…
Today there are approximately 85,000 chemicals regulated under the Toxic Substances Control Act, with around 2,000 new chemicals introduced each year. It is impossible to screen all of these chemicals for potential toxic effects either via full organism in vivo studies or in vitro high-throughput screening (HTS) programs. Toxicologists face the challenge of choosing which chemicals to screen, and predicting the toxicity of as-yet-unscreened chemicals. Our goal is to describe how variation in chemical structure relates to variation in toxicological response to enable in silico toxicity characte…
Estimates of national immunization coverage are crucial for guiding policy and decision-making in national immunization programs and setting the global immunization agenda. WHO and UNICEF estimates of national immunization coverage (WUENIC) are produced annually for various vaccine-dose combinations and all WHO Member States using information from multiple data sources and a deterministic computational logic approach. This approach, however, is incapable of characterizing the uncertainties inherent in coverage measurement and estimation. It also provides no statistically principled way of expl…
