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利用患者报告结局的等渗I期癌症临床试验设计

Isotonic Phase I cancer clinical trial design utilizing patient-reported outcomes.

作者信息

Wages Nolan A, Lin Ruitao

机构信息

Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, U.S.A.

Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, U.S.A.

出版信息

Stat Biopharm Res. 2025;17(1):36-45. doi: 10.1080/19466315.2023.2288013. Epub 2024 Jan 5.


DOI:10.1080/19466315.2023.2288013
PMID:40842959
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12365655/
Abstract

This article considers the concept of designing Phase I clinical trials using both clinician- and patient-reported outcomes to adaptively allocate study participants to tolerable doses and determine the maximum tolerated dose (MTD) at the study conclusion. We describe a new isotonic patient-reported outcome (PRO-ISO) Phase I design with the flexibility of allocating patients to lower, more tolerable regimens if a large number of PRO-DLT events are seen at higher doses. We conduct simulation studies of the operating characteristics of the design and compared them to the patient-reported outcomes continual reassessment method (PRO-CRM). We illustrate that the PRO-ISO makes appropriate dose assignments during the study to give investigators and reviewers an idea of how the method behaves. In simulation studies, the PRO-ISO demonstrates comparable performance to the PRO-CRM in terms of recommending target doses and allocating patients to these doses. It also performs well relative to a nonparametric optimal benchmark applied to the PRO setting. Finally, we extend our methodology to account for the problem of late-onset toxicities.

摘要

本文探讨了利用临床医生报告结局和患者报告结局来设计I期临床试验的概念,以便自适应地将研究参与者分配至可耐受剂量,并在研究结束时确定最大耐受剂量(MTD)。我们描述了一种新的等渗患者报告结局(PRO-ISO)I期设计,该设计具有灵活性,如果在较高剂量下出现大量PRO-DLT事件,可将患者分配至更低、更可耐受的治疗方案。我们对该设计的操作特征进行了模拟研究,并将其与患者报告结局连续重新评估法(PRO-CRM)进行比较。我们举例说明,PRO-ISO在研究期间进行了适当的剂量分配,使研究者和评审者了解该方法的表现。在模拟研究中,PRO-ISO在推荐目标剂量以及将患者分配至这些剂量方面,表现出与PRO-CRM相当的性能。相对于应用于PRO设置的非参数最优基准,它也表现良好。最后,我们扩展了我们的方法,以解决迟发性毒性问题。

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本文引用的文献

[1]
Application of the patient-reported outcomes continual reassessment method to a phase I study of radiotherapy in endometrial cancer.

Int J Biostat. 2023-5-1

[2]
Controlled backfill in oncology dose-finding trials.

Contemp Clin Trials. 2021-12

[3]
Randomised Phase 1 clinical trials in oncology.

Br J Cancer. 2021-9

[4]
Patient-Reported Outcomes for Tolerability Assessment in Phase I Cancer Clinical Trials.

J Natl Cancer Inst. 2021-8-2

[5]
Adapting isotonic dose-finding to a dynamic set of drug combinations with application to a phase I leukemia trial.

Clin Trials. 2021-6

[6]
Adaptive dose-finding based on safety and feasibility in early-phase clinical trials of adoptive cell immunotherapy.

Clin Trials. 2019-12-19

[7]
Incorporating patient-reported outcomes in dose-finding clinical trials.

Stat Med. 2020-2-10

[8]
Time-to-event model-assisted designs for dose-finding trials with delayed toxicity.

Biostatistics. 2020-10-1

[9]
The Impact of Early-Phase Trial Design in the Drug Development Process.

Clin Cancer Res. 2018-10-16

[10]
Revisiting isotonic phase I design in the era of model-assisted dose-finding.

Clin Trials. 2018-8-13

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