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arXiv 2007.03792stat.MEstat.AP
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研究多种适应症的试验的统计学设计考虑

Statistical design considerations for trials that study multiple indications

Alexander M. Kaizer, Joseph S. Koopmeiners, Nan Chen, Brian P. Hobbs

摘要:

癌症生物学的突破已经定义了新的研究计划,强调开发针对肿瘤细胞中特定途径的疗法。临床试验设计的创新遵循了由纳入资格标准和多种治疗和/或组织学评价定义的主方案。因此,亚群异质性的表征已成为制定和选择研究设计的核心。然而,这种向主方案的过渡导致了在确定最佳试验设计和正确校准超参数方面的挑战。我们经常评估一系列无效和替代方案,但是对于如何综合可能不同的建议以确定最佳方案,几乎没有指导。这可能导致选择不完全适应亚群异质性的次优设计和统计方法。本文提出了新的优化标准,用于校准和评价主方案的候选统计设计,在入组患者亚群之间存在潜在的处理效应异质性。该框架被应用于证明传统的研究设计的统计特性时,治疗提供异质性的好处,以及确定最佳的设计,旨在监测潜在的异质性患者之间的不同的临床适应症,使用贝叶斯建模。

英文摘要:

Breakthroughs in cancer biology have defined new research programs emphasizing the development of therapies that target specific pathways in tumor cells. Innovations in clinical trial design have followed with master protocols defined by inclusive eligibility criteria and evaluations of multiple therapies and/or histologies. Consequently, characterization of subpopulation heterogeneity has become central to the formulation and selection of a study design. However, this transition to master protocols has led to challenges in identifying the optimal trial design and proper calibration of hyperparameters. We often evaluate a range of null and alternative scenarios, however there has been little guidance on how to synthesize the potentially disparate recommendations for what may be optimal. This may lead to the selection of suboptimal designs and statistical methods that do not fully accommodate the subpopulation heterogeneity. This article proposes novel optimization criteria for calibrating and evaluating candidate statistical designs of master protocols in the presence of the potential for treatment effect heterogeneity among enrolled patient subpopulations. The framework is applied to demonstrate the statistical properties of conventional study designs when treatments offer heterogeneous benefit as well as identify optimal designs devised to monitor the potential for heterogeneity among patients with differing clinical indications using Bayesian modeling.

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