Wages Nolan A, Lin Ruitao
Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, U.S.A.
Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, U.S.A.
Stat Biopharm Res. 2025;17(1):36-45. doi: 10.1080/19466315.2023.2288013. Epub 2024 Jan 5.
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.
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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